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LCRS Endo > Macrovascular complications and Diabetic Neuropathy of the Foot > Flashcards

Macrovascular complications and Diabetic Neuropathy of the Foot Flashcards

1
Q

what are the diseases associated in macrovascular disease?

A
  • early widespread atherosclerosis
  • IHD
  • cerebrovascular disease
  • peripheral vascular disease
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2
Q

stages of atheroma formation

A
  • initial lesion with macrophages creating foam cells
  • fatty streak with intracellular lipids
  • intermediate with extracellular lipids
  • atheroma where a core of lipids has formed (clinically significant from this point on)
  • fibroatheroma, the atheroma is fibrotic with calcific layers
  • complication stage with surface defect and thrombosis
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3
Q

what is associated with significantly reduced life expectancy?

A

hyperglycaemia (the earlier the presentation, the shorter the life ex)

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4
Q

how do women and men with diabetes compare in atheroma formation?

A

women lose the protection of being a woman when they have diabetes when developing atheroma

they suffer more than men so the relative risk is much worse for them than men

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5
Q

difference in effects of microvascular and macrovascular disease

A

micro causes morbidity

macro causes morbidity and mortality

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6
Q

what is the biggest cause of mortality in diabetics?

A

IHD

more than in the general population

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7
Q

why does malignancy reduce as a cause of death in diabetics?

A

many diabetes die before cancer can manifest

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8
Q

what is the MI risk in diabetics compared to non-diabetics?

A

diabetes who have never had an MI have a greater chance of an MI than non-diabetics who have had an MI before

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9
Q

what do diabetics who look well tend to have?

A

IHD

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10
Q

what is the Framingham risk score?

A

Framingham risk score

– gender-specific algorithm to estimate 10-year cardiovascular event risk.

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11
Q

which ethnicity have a worse mortality for CHD?

A

South Asians

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12
Q

cerebrovasc disease in diabetics?

A

present earlier
more widespread
uncommon in people younger than 60

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13
Q

what does peripheral vasc disease in diabetics lead to?

A

leads to diabetic foot problems

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14
Q

what does renal artery stenosis contribute to?

A

contributes to hypertension

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15
Q

is treatment of hyperglycaemia effective in reducing CVD risk?

A

hyperglycaemia treatment alone is not enough and has a minor effect on reducing risk of CVD

intensive glucose control improves CHD but does not change mortality much

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16
Q

risk factors of macrovascular disease (non-modifiable)

A 
age
sex
birth weight
FH
genes
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17
Q

risk factors of macrovascular disease (modifiable)

A

dyslipidaemia
hypertension
smoking
diabetes

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18
Q

what two factors need management to prevent complications in T2DM

A

BP and cholesterol

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19
Q

what drug can help significantly reduce macrovascular disease risk?

A

statins

20
Q

examples of treatment for reducing blood glucose

A

metformin
sulphonylureas
insulin

21
Q

what is the blood pressure management target?

A

<130/80 when there is damage to kidneys, eyes or cerebrovasculature

otherwise <140/80

needs constant monitoring

22
Q

how is lipids management monitored?

A

CV risk analysed annually

23
Q

risk factors of IHD

A
  • fasting glucose > 6mmol/L
  • waist circumference (men >102, women >88)
  • insulin resistance
  • hypertension
  • low HDL
24
Q

what increase is proportional to the risk of retinopathy?

A

increasing HbA1c

25
Q

what is canakinumab?

A

reduces inflammation
decreased lipids
for damaged arteries
targets IL-1beta

26
Q

what complications of diabetes predispose you to diabetic foot disease?

A

neuropathy (sensory, motor and autonomic)

peripheral vascular disease

27
Q

prevalence

  • of DFN in diabetics
  • current/past foot ulcerations
A

2-3%

5-7%

28
Q

risk of amputation in foot ulcerations

A

60x higher in diabetics

10% of NHS bed occupancy due to diabetes related foot problems (50% with foot disease)

29
Q

how can sensory function be tested?

A

monofilament

10g pressure applied when monofilament bends

30
Q

what are the 8 ways that can lead to foot ulceration?

A

1) Sensory neuropathy – cannot feel monofilament – ulcers due to abnormal pressures.
2) Motor neuropathy – imbalance of extensors/flexors so foot is abnormal shape – ulcers due to abnormal pressures.
3) Limited join mobility – causes joint immobility and cannot put hands flat against each other.
4) Autonomic neuropathy – no sweating so skin dries out and you get ulcers.
5) Peripheral vascular disease – blood flow is compromised to the lower limbs.
6) Trauma – repeated or minor episodes.
7) Reduced resistance to infection.
8) Other – diabetic complications (e.g. retinopathy).

31
Q

how is a neuropathic foot described after examination?

A 
numb
warm 
dry 
palpable foot pulses
ulcers at points of pressure
32
Q

how is an ischaemic foot described after examination?

A

cold
pulseless
ulcers at foot margins

33
Q

what are the features of a neuropathic foot?

A 
numb
warm
dry 
pulseless
ulcers at points of pressures and foot margins
34
Q

what factors must be assessed in foot examination?

A
  • appearance (callus, deformity)
  • touch/feel (hot, dry)
  • foot pulses (dorsalis pedis, posterior tibial)
  • neuropathy (vibration, fine touch)
  • vibration, temperature, ankle jerk, fine touch
35
Q

where on the foot can pressure often increase?

A

great toe metatarsal head (50% of foot lacerations occur here)

36
Q

what must be managed in diabetics?

A 
o	Hyperglycaemia.
o	Hypertension.
o	Dyslipidaemia.
o	Stop smoking.
o	Education.
37
Q

what are the preventive measures against diabetic neuropathy of the foot?

A

o Controlling diabetes: Inspecting feet daily.
o Have feet measured for shoes :Buying shoes with laces and square toe box.
o Attend chiropodist: Cut nails straight across.
o Take care when feet get hot: Never walk barefoot.

38
Q

how is foot ulceration managed?

A

 Relief of pressure – bed rest and redistribution of pressure.
 Antibiotics – possibly long-term.
 Debridement.
 Re-vascularisation – angioplasty or arterial bypass surgery.
 Amputation.

39
Q

what causes dryness in feet?

A

autonomic control of sweat glands lost

40
Q

what causes hand disorders in T2DM?

A

inability to flatten the palm due to glycosylated tendons limiting joint motility

41
Q

why do ischaemic feet feel cold?

A

poor blood supply

42
Q

what is Charcot Foot?

A

abnormal disorientation of bones in feet which is painful to a non-diabetic but not painful to a diabetic due to sensory neuropathy

there is a destruction of joints

43
Q

what causes the deformity of Charcot ?

A

due to loss of joint-position sense

this abnormal shape predisposes the foot to ulceration which then further predisposes the foot to osteomyelitis

44
Q

what is osteomyelitis?

A

bone infection

45
Q

osteomyelitis vs charcot

A

osteomyelitis: infection
- hot red foot with ulceration
- forefoot and hind foot issues

Charcot:bone issue

  • hot red foot without ulceration
  • mid foot issues

LCRS Endo (18 decks)

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