Microvascular Complications of Diabetes Flashcards

1
Q

name chronic MACROvascular complications of diabetes?

A

IHD

stroke

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2
Q

name chronic MICROvascular complications?

A

neuropathy
nephropathy
retinopathy

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3
Q

is there a link between dementia and diabetes?

A

yes

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4
Q

what causes the oxidative stress in hyperglycaemia and hyperlipidaemia?

A

advanced glycaemic end products (AGEs) binding to receptors

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5
Q

what happens when an AGE binds to a RAGE?

A

get hypoxia which causes oxidative stress

then get inflammation causing mitochondrial dysfunction = microvascular complications

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6
Q

what type of neuropathy would cause changes in bowel/bladder function?

A

autonomic

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7
Q

what is amyotrophy and what type of neuropathy is it found in?

A

pain in the thighs, hips and buttocks = proximal

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8
Q

what neuropathy would a sudden presentation of carpal tunnel indicate?

A

focal

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9
Q
which of these is not a risk factor for neuropathy:
alcohol 
smoking
type 2 > type 1
increased length of diabetes
A

type 2>type 1

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10
Q

clinical presentation of peripheral neuropathy?

A

numbness
tingling/burning
sensitive to touch
loss of balance and coordination

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11
Q

treatment options for painful neuropathy?

A

amitryptiline and other complex analgesics

if localised, topical capsaicin cream

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12
Q

what nerves are most commonly affected by focal neuropathy?

A

head
torso
leg

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13
Q

where is pain commonly felt in focal neuropathy?

A
thigh
chest
lower back
pelvis
outside of foot
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14
Q

how does the eye present in focal neuropathy?

A

unable to focus
double vision
aching behind eye

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15
Q

what 4 symptomatic groups comprise proximal neuropathy

A

neuropathy of the lumbosacral plexus, the femur and diabetic amyotrophy, weight loss

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16
Q

what type of diabetes is proximal neuropathy more common in?

A

2

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17
Q

what are the roles of the nerves involved in autonomic neuropathy?

A
controlling:
heart rate
blood pressure
gastric motility
respiratory dunction
sexual function
vision
urination
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18
Q

clinical presentation of autonomic neuropathy on GI system?

A

constipation and diarrhoea due to gastric infrequency
dysphagia from oesophageal nerve damage
gastroparesis = vomiting, bloating

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19
Q

what can gastroparesis do to blood glucose levels?

A

fluctuates them due to abnormal food digestion

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20
Q

how can you minimise symptoms of autonomic neuropathy on the GI system pharmacologically?

A
smaller, more frequent meals
promotility drugs eg metoclopramide
anti nausea drugs
amitryptiline etc and NSAIDs for abdo pain
botox
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21
Q

what is it called when you sweat heavily at night or while eating?

A

gustatory sweating

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22
Q

what condition can present with gustatory sweating and why?

A

autonomic neuropathy of nerves affecting sweat glands so body can’t control temperature

23
Q

treatment for gustatory sweating?

A

glycopyrrolate
clonidine
botox

24
Q

when would you suspect heart and blood vessel involvement in autonomic neuropathy?

A

postural hypotension

tachycardia constantly

25
how can you screen for neuropathy?
nerve conduction study electromyography USS/gastric emptying study for GI complications
26
what does a nerve conduction study do?
checks the type and extent of nerve damage
27
what does an electromyography do?
checks how well muscles respond to electrical signals by nearby nerves
28
diabetic nephropathy is made up of which 3 pathologies?
nephrotic sundrome diffuse scarring of glomeruli angiopathy of capillaries
29
consequences of diabetic nephropathy on the patient?
hypertension decline in renal function accelerated vascular disease
30
what test would indicate nephropathy?
urinary albumin creatinine ratio
31
what urine ACR would indicate microalbuminuria in females and males?
2. 5-25 in women | 3. 5-35 in men
32
what urine ACR would indicate macroalbuminuria in females and males?
male >25 | female >35
33
what screenings should be done for a patient with microalbuminuria?
hypertension IHD retinopathy PVD
34
risk factors for nephropathy progression?
``` hypertension cholesterol smoking glycaemic control albuminuria ```
35
what blood pressure should be maintained in all diabetics?
130/80mmHg
36
what drug should patients with microalbuminuria or proteinuria be started on?
ACEi or ARB
37
what HBA1c would indicate good glycaemic control that would prevent nephropathy?
<53mmol/mol
38
most common cause of kidney failure?
diabetes
39
what eye pathologies other than diabetic retinopathy do diabetics get?
cataract glaucoma acute hyperglycaemia
40
where is the retina located?
back of the eye
41
what do cotton wool spots on the eye indicate?
ischaemia
42
what are hard exudates on the eye made of?
lipid breakdown products
43
what does IRMA stand for in terms of the eye?
intra retinal microvascular abnormalities
44
when would you refer a retinopathy compared to just monitoring it?
if there is IRMA AND haemorrhages in both hemi fields of the eye
45
what is maculopathy?
lesions near the centre of the fovea of the eye
46
when would you refer a maculopathy?
if the lesions are smaller than 1 disc diameter of the centre of the fovea
47
what presentation would suggest mild background retinopathy?
haemorrhages and microaneurysms only
48
what symptom is seen in pre proliferative but not in mild retinopathy?
hard exudates
49
what type of retinopathy is IRMA and venous beading seen in?
severe non-proliferative
50
how can bleeding in the eye present?
floaters | sudden change in vision
51
how is retinopathy treated?
laser | vitrectomy
52
cause of erectile dysfunction in diabetic men?
vascular problems | autonomic neuropathy
53
drug causes of erecile dysfunction?
thiazides beta blockers CNS drugs analgesics