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2 Endocrine > Microvascular Complications of Diabetes > Flashcards

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
Q

how can you screen for neuropathy?

A

nerve conduction study
electromyography
USS/gastric emptying study for GI complications

26
Q

what does a nerve conduction study do?

A

checks the type and extent of nerve damage

27
Q

what does an electromyography do?

A

checks how well muscles respond to electrical signals by nearby nerves

28
Q

diabetic nephropathy is made up of which 3 pathologies?

A

nephrotic sundrome
diffuse scarring of glomeruli
angiopathy of capillaries

29
Q

consequences of diabetic nephropathy on the patient?

A

hypertension
decline in renal function
accelerated vascular disease

30
Q

what test would indicate nephropathy?

A

urinary albumin creatinine ratio

31
Q

what urine ACR would indicate microalbuminuria in females and males?

A
  1. 5-25 in women

3. 5-35 in men

32
Q

what urine ACR would indicate macroalbuminuria in females and males?

A

male >25

female >35

33
Q

what screenings should be done for a patient with microalbuminuria?

A

hypertension
IHD
retinopathy
PVD

34
Q

risk factors for nephropathy progression?

A 
hypertension
cholesterol
smoking
glycaemic control
albuminuria
35
Q

what blood pressure should be maintained in all diabetics?

A

130/80mmHg

36
Q

what drug should patients with microalbuminuria or proteinuria be started on?

A

ACEi or ARB

37
Q

what HBA1c would indicate good glycaemic control that would prevent nephropathy?

A

<53mmol/mol

38
Q

most common cause of kidney failure?

A

diabetes

39
Q

what eye pathologies other than diabetic retinopathy do diabetics get?

A

cataract
glaucoma
acute hyperglycaemia

40
Q

where is the retina located?

A

back of the eye

41
Q

what do cotton wool spots on the eye indicate?

A

ischaemia

42
Q

what are hard exudates on the eye made of?

A

lipid breakdown products

43
Q

what does IRMA stand for in terms of the eye?

A

intra retinal microvascular abnormalities

44
Q

when would you refer a retinopathy compared to just monitoring it?

A

if there is IRMA AND haemorrhages in both hemi fields of the eye

45
Q

what is maculopathy?

A

lesions near the centre of the fovea of the eye

46
Q

when would you refer a maculopathy?

A

if the lesions are smaller than 1 disc diameter of the centre of the fovea

47
Q

what presentation would suggest mild background retinopathy?

A

haemorrhages and microaneurysms only

48
Q

what symptom is seen in pre proliferative but not in mild retinopathy?

A

hard exudates

49
Q

what type of retinopathy is IRMA and venous beading seen in?

A

severe non-proliferative

50
Q

how can bleeding in the eye present?

A

floaters

sudden change in vision

51
Q

how is retinopathy treated?

A

laser

vitrectomy

52
Q

cause of erectile dysfunction in diabetic men?

A

vascular problems

autonomic neuropathy

53
Q

drug causes of erecile dysfunction?

A

thiazides
beta blockers
CNS drugs
analgesics

2 Endocrine (35 decks)

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