microvascular complications of diabetes

Question 1

3 main microvascular complications

Answer 1

neuropathy, nephropathy and retinopathy

Question 2

diabetic neuropathy can lead to

Answer 2

amputation

Question 3

diabetic nephropathy can lead to

Answer 3

dialysis

Question 4

diabetic retinopathy can lead to

Answer 4

blindness

Question 5

types of diabetic neuropathy

Answer 5

1. peripheral
2. proximal
3. focal
4. autonomic

Question 6

peripheral neuropathy definition

Answer 6

pain/ loss of sensation to the peripheries (i.e. the hands and feet)

Question 7

autonomic neuropathy definition

Answer 7

group of symptoms caused by damage to the nerve of the autonomic nervous system

Question 8

proximal neuropathy definition

Answer 8

pain in the thighs, hips or buttocks leading to weakness in the legs and muscular atrophy (amyotrophy)

Question 9

focal neuropathy definition

Answer 9

sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g carpal tunnel syndrome, ulnar mononeuropathy, foot drop, bells palsy, cranial nerve palsy

Question 10

risk factors for neuropathy

Answer 10

increased duration of having diabetes, poor glycemic control, high cholesterol/ lipids, smoking, alcohol, mechanical injury

Question 11

symptoms of peripheral neuropathy

Answer 11

• numbness/ reduced sensitivity
• tingling/ burning sensation
• sharp pain and cramps which are worse at night
• pain sensitivity to touch
• loss of balance and co-ordination

Question 12

peripheral neuropathy is said to have a what distribution

Answer 12

glove stocking

Question 13

complications of peripheral neuropathy

Answer 13

1. painless trauma
2. charcotts foot
3. diabetic foot ulcers

Question 14

charcots foot

Answer 14

loss of pain sensation leads to increased mechanical trauma (because there are unimpeded by pain), this results in repeated joint injury causing the eventual fracture of the bones causing deformity

Question 15

preventing charcotts foot

Answer 15

with orthotic shoes

Question 16

management of chariots foot

Answer 16

can be surgical or non-surgical, non-surgical management involves the use of bisphosphonates which reduce resorption of bone by osteoclasts

Question 17

diabetic foot ulcer

Answer 17

typically painless, punched out ulcer in an area of thick calluses which may be present with a superadded infection

Question 18

management of diabetic foot ulcers

Answer 18

surgical debridement, off-loading using a plaster cast, treat any infection present with antibiotics , wound dressings

Question 19

preventing diabetic foot ulcers

Answer 19

refer to podiatry early, examine feet regularly to distinguish between neuropathy and ischaemia but remember the two can co-exsit

Question 20

in diabetic foot ulcers what should you assess the degree off

Answer 20

1. neuropathy
2. ischaemia
3. bone deformity
4. infection

Question 21

management of peripheral neuropathy

Answer 21

loss of sensation cannot be reversed but pain can be managed

tricyclic anti-depressant (amitrytiline) OR duloxetine OR garbapentin or prcegablin
2nd line= opiate compounds

Question 22

if patient cannot tolerate oral treatments for peripheral neuropathy

Answer 22

topical capsaicin cream

Question 23

focal neuropathy

Answer 23

appears very suddenly and affects a single nerve most commonly in the head, torso or leg

Question 24

presentation of focal neuropathy

Answer 24

• inability to focus eye
• double vision
• aching behind eye
• bells palsy
• pain in thigh/ chest/ lower back/ pelvis
• pain on outside of foot

Question 25

management of focal neuropathy

Answer 25

there is no specific treatment and usually resolves over time however, if particularly severe immunosuppression can help (corticosteroids, IV immunoglobulin, ciclophospahmide)

Question 26

proximal neuropathy is also known as

Answer 26

lumbosacral plexus neuropathy, femoral neuropathy or diabetic amyotrophy

Question 27

proximal neuropathy causes

Answer 27

painful wasting of the quadriceps and other pelvifemoral muscles

Question 28

what is proximal neuropathy often associated with

Answer 28

weight loss

Question 29

proximal neuropathy is most common in

Answer 29

elderly people who have type 2 diabetes

Question 30

autonomic neuropathy is not

Answer 30

a specific disease it is a group of symptoms caused by damage to the nerves of the autonomic nervous system

Question 31

presentation of autonomic neuropathy

Answer 31

• postural hypotension
• gastroparesis
• urinary retention
• erectile dysfunction
• diarrhoea
• gustatory sweating
• loss of respiratory sinus arrhythmia

Question 32

postural hypotension

Answer 32

is a drop in blood pressure when standing from sitting or lying down which can result in dizziness and fainting

Question 33

management of postural hypotension

Answer 33

fludrocortisone

Question 34

gastroparesis

Answer 34

delayed stomach emptying which can cause nausea, vomiting, floating and early satiety

Question 35

diagnosis of gastroparesis

Answer 35

gastric scintigraphy with a technetium labelled meal

Question 36

management of gastroparesis

Answer 36

anti-emetics (metoclopramide, domperidone), erythromycin, gastric pacing

Question 37

gustatory sweating

Answer 37

autonomic neuropathy can affect the nerves that control sweating so the body can no longer regulate its temperature which causes profuse sweating during eating

Question 38

management of gustatory sweating

Answer 38

topical glycopyrolate, clonidine, botulism toxin injections