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Endocrine- Diabetes > Microvascular Complications > Flashcards

Microvascular Complications Flashcards

1
Q

What are the major macrovascular complications of diabetes?

A

Coronary heart disease and stroke

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2
Q

What are the major microvascular complications of diabetes?

A

Neuropathy, nephropathy, retinopathy

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3
Q

The main mortality in diabetes is due to what?

A

Increased CV risk

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4
Q

What are the end stages of each of the main microvascular complications of diabetes?

A

Blindness, dialysis, amputation

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5
Q

The pathophysiology of microvascular complications begins as a result of what?

A

Hyperglycaemia and hyperlipidaemia

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6
Q

As a result of hyperglycaemia and hypertriglyceridaemia, there is hypoxia, oxidative stress, inflammation and mitochondrial dysfunction of where in the body?

A

The vessels

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7
Q

What causes damage to the nerves?

A

Reduced blood flow

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8
Q

How does microvascular disease tend to present?

A

Often asymptomatic and so can be quite severe on presentation

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9
Q

What are some risk factors for neuropathy?

A

Increased length of diabetes, poor control, high cholesterol/lipids, smoking and alcohol, inherited traits, mechanical injury

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10
Q

Patients with which type of diabetes are at increased risk of neuropathy?

A

Type 1

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11
Q

What is meant by inherited traits being a risk factor for neuropathy?

A

Certain families with diabetes may be susceptible to a particular microvascular complication

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12
Q

Peripheral neuropathy usually affects which nervous system? What can happen if it gets very severe?

A

Predominantly sensory, though in very severe cases the motor aspect can also be involved

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13
Q

What are some symptoms of peripheral neuropathy?

A

Numbness, tingling/burning, sharp pains/cramps, loss of balance and coordination

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14
Q

What complications can peripheral neuropathy lead to?

A

Painless trauma, foot ulcers and Charcot foot

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15
Q

What is usually the cause of foot ulcers in peripheral neuropathy?

A

Ill-fitting shoes or something in the shoe which cannot be felt

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16
Q

Do diabetic foot ulcers heal well? Why/why not?

A

They do not heal well because of the vascular compromise. There will be delayed healing which can result in chronic ulcers.

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17
Q

Why does Charcot foot occur?

A

As a result of loss of proprioception

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18
Q

What happens in Charcot foot?

A

There are multiple traumas which the patient is unaware of which damages the deep structures of the foot and leads to increased bone resorption (osteoclastic activity)

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19
Q

If peripheral neuropathy is painful, what analgesics can be used?

A

Atypicals such as amitriptyline or gabapentin

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20
Q

If atypical analgesics are not recommended for a patient with localised pain from diabetic neuropathy, what can be used?

A

Capsaicin cream

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21
Q

What is the onset of focal neuropathy?

A

Sudden onset

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22
Q

What nerves does focal neuropathy affect?

A

Specific nerves, most often in the head, torso or leg

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23
Q

If nerves of the eye are involved in focal neuropathy, what can this lead to?

A

Inability to focus eyes, diplopia, aching behind eyes

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24
Q

Within which group of neuropathies is entrapment neuropathy included?

A

Focal neuropathy

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25
Q

What is entrapment neuropathy?

A

Weakness in one nerve or a group of nerves which cause muscle weakness or pain e.g. Carpal tunnel

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26
Q

What does proximal neuropathy include?

A

Lumbosacral plexus neuropathy, femoral neuropathy, diabetic amyotrophy (wasting)

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27
Q

How does proximal neuropathy often present?

A

Pain in the thighs, hips, buttocks or legs, usually on one side of the body

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28
Q

Who is proximal neuropathy most common in?

A

Elderly patients with T2DM and marked weight loss

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29
Q

The nerves involved in autonomic neuropathy control what?

A

Regulation of the heartbeat and BP, as well as control of lots of internal organs

30
Q

How can autonomic neuropathy often be picked up?

A

Tachycardia

31
Q

How can autonomic neuropathy present in terms of the GI system?

A

Gastric slowing/frequency, constipation/diarrhoea

32
Q

How can gastroparesis as a result of autonomic neuropathy present?

A

Persistent nausea and vomiting, bloating and loss of appetitie

33
Q

If a patient has hypoglycaemia around 30 mins after eating, what can this suggest?

A

Gastroparesis (slow stomach emptying)

34
Q

What are some treatment options for gastroparesis?

A

Improved glycemic control, small and frequent meals, promotability drugs, pain relief

35
Q

Autonomic neuropathy can involve the nerves which control sweating. What can this lead to?

A

Profuse sweating at night or while eating

36
Q

How can excessive sweating as a result of diabetic neuropathy be treated?

A

Glycopyrolate

37
Q

What effect can autonomic neuropathy have on the eyes? When can this cause problems?

A

Less responsive to changes in light. Can cause problems when a light is turned on in a dark room or when driving at night

38
Q

What investigation can determine the type and extent of nerve damage and how well muscles respond to nerve stimuli?

A

Nerve conduction studies or electromyography

39
Q

What investigation can be used to asses whether the bladder and urinary tract are working properly in terms of neuropathy?

A

Ultrasound

40
Q

What tests can be done for gastroparesis?

A

Gastric emptying studies

41
Q

How often should diabetic patients be screened for neuropathy?

A

Yearly

42
Q

What should be done when assessing a diabetic patient for neuropathy?

A

Assess feet and circulation to assess the risk of ulceration

43
Q

Describe diabetic nephropathy?

A

Progressive kidney disease caused by damage to the capillaries in the glomeruli

44
Q

What characterises diabetic nephropathy?

A

Nephrotic syndrome and scarring of the glomeruli

45
Q

In diabetic nephropathy there can be classic nodules which are seen in no other condition. What are these known as?

A

Kimmelstein-Wilson nodules

46
Q

Why is screening necessary for nephropathy?

A

It does not present with symptoms until it is well established

47
Q

What are some consequences of diabetic nephropathy?

A

Hypertension, decline in renal función, accelerated vascular disease

48
Q

What is used to screen for nephropathy?

A

Urinary albumin to creatinine ratio

49
Q

When should screening for diabetic nephropathy occur?

A

At the time of diagnosis and annually from age 12 onwards

50
Q

If microalbuminuria occurs in diabetes, what should you do?

A

Check if there is any other cause for renal disease and also check for retinopathy and hypertension

51
Q

What can slow the progression of nephropathy?

A

Improved glycemic control

52
Q

What are some risk factors for the progression of nephropathy?

A

Hypertension, high cholesterol, smoking, poor glycemic control, microalbuminuria

53
Q

What is the drug of choice to control hypertension in diabetes?

A

ACE inhibitor (ARB if intolerant)

54
Q

Where should blood pressure be maintained in all patients with diabetes?

A

< 130/80

55
Q

Any patient with microalbuminuria or proteinuria should be started on what therapy?

A

ACE inhibitor/ARB

56
Q

What is the target HbA1c for good control?

A

53mmol/mol

57
Q

What may need to happen to the dose of insulin if a patient has renal impairment?

A

Decreased (since it will be excreted slower by the kidneys)

58
Q

What are some eye pathologies which can occur in diabetes?

A

Diabetic retinopathy, cataracts, glaucoma

59
Q

Acute hyperglycaemia can have what effect on the eyes?

A

Reversible blurring of vision

60
Q

Dot/blot/flame on fundoscopy refers to what?

A

Haemorrhage

61
Q

Cotton wool spots on fundoscopy refer to what?

A

Ischaemic areas

62
Q

Hard exudates on funduscopy refer to what?

A

Lipid breakdown products

63
Q

What may be seen in mild, non proliferative retinopathy?

A

Haemorrhages and microaneurysms

64
Q

What may be seen in moderate, non proliferative retinopathy?

A

Microaneurysms, hard exudates, haemorrhages

65
Q

What may be seen in severe, non proliferative retinopathy?

A

Microvascular abnormalities, venous bleeding, haemorrhages

66
Q

What will be seen in proliferative retinopathy?

A

New vessel formation

67
Q

In terms of the eyes, what conditions are screened for annually?

A

Retinopathy and maculopathy

68
Q

What are some complications of bleeding in the eye?

A

Sudden changes in vision, floaters, secondary glaucoma, retinal detachment

69
Q

How can retinopathy be treated?

A

Lasers or surgery (vitrectomy)

70
Q

How common in erectile dysfunction in diabetics?

A

50% of men

71
Q

What are some medications which can cause erectile dysfunction?

A

Anti-hypertensives, beta blockers, CNS drugs

Endocrine- Diabetes (11 decks)

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