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The Endocrine System > Microvascular Complications of Diabetes > Flashcards

Microvascular Complications of Diabetes Flashcards

1
Q

What are the 3 main microvascular complications of diabetes?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
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2
Q

Why do microvascular complications occur in diabetes?

A

Hyperglycaemia and hyperlipiaemia contribute to hypoxia, oxidative stress, inflammation, mitochondrial dysfunction and damaged nerves

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3
Q

What are the 4 types of neuropathy experienced in diabetes?

A
  1. Peripheral
  2. Autonomic
  3. Proximal
  4. Focal neuropathy
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4
Q

Neuropathy is more associated with which type of diabetes?

A

Type 1

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5
Q

Which things increase an individuals risk of developing neuropathy?

A
  1. Poor glycaemic control
  2. Increased length of time with diabetes
  3. Alcohol
  4. High cholesterol
  5. Smoking
  6. Inherited
  7. Mechanical injury
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6
Q

What is the most common neuropathy?

A

Peripheral

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7
Q

What is peripheral neuropathy and how does it present?

A

Distal or sensorimotor neuropathy

  1. Numbness/insensitivity
  2. Tingling/burning
  3. Sharp pains/cramps
  4. Sensitivite touch is maintained
  5. Loss of balance and coordination
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8
Q

What are some complications of peripheral neuropathy?

A
  1. Charcot foot
  2. Painless trauma
  3. Foot ulcer
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9
Q

What is a Charcot foot?

A

Progressive degeneration of a weight bearing joint, marked by bony destruction, bone resorption, and eventual deformity

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10
Q

Why is it so key that intensive treatment is started from the outset of diabetes?

A

Good glycaemic control from the start decreases long term risks

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11
Q

Why are injuries obtained from peripheral neuropathy particularly dangerous?

A
  1. They can worsen more than normal due to lack of pain
  2. Infection may occur and healing is poor
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12
Q

Which treatment may slow progression of Charcot foot?

A

Bisphosphonates

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13
Q

How may peripheral neuropathy be treated if it is painful?

A
  1. Amitriptyline
  2. Duloxetine
  3. Gabapentin
  4. Pregabalin
  5. Capsaicin cream
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14
Q

What is focal neuropathy?

A

Acute neuropathy affecting specific nerves, or groups of nerves most often in the head, torson or leg

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15
Q

How may focal neuropathy present?

A
  1. Inability to focus eye
  2. Double vision
  3. Aching behind eye
  4. Bell’s palsy
  5. Pain in thigh/chest/lower back/pelvis
  6. Pain on outside of foot
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16
Q

What is entrapment neuropathy and give an example?

A

Weakness in one nerve or group of nerves causing muscle weakness or pain

Carpal tunnel

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17
Q

What is proximal neuropathy and how does it present?

A
  1. Lumbosacral plexus neuropathy
  2. Femoral neuropathy
  3. Diabetic amyotrophy

Presents with:

  • Pain in thighs, hips, buttocks or legs
  • Usually occurs on one side
  • More common in elderly T2DM
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18
Q

What is proximal neuropathy associated with?

A

Weight loss

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19
Q

What is autonomic neuropathy?

A

Neuropathy affecting the nerves of the autonomic nervous system

20
Q

How may autonomic neuropathy present?

A
  1. Changes in HR/BP
  2. GI motility changes e.g. gastroparesis
  3. Sexual function change
  4. Urination
  5. Vision
21
Q

How may gastroparesis present?

A
  1. Becoming full easily
  2. GORD
  3. Vomiting
  4. Diarrhoea
22
Q

How is gastroparesis best treated?

A
  1. Improve glycaemic control
  2. Lower fat intake
  3. Smaller meals
  4. Promotility drugs
  5. Botox into sphincter
  6. Gastric pacemaker
23
Q

Why may someone with diabetes experience “gustatory sweating”?

A

Autonomic neuropathy affecting sweat glands

24
Q

How can autonomic neuropathy of sweat glands be treated?

A
  1. Topical glycopyrrolate
  2. Clonidine
  3. Botuliunum toxin (botox)
25
Q

When autonomic neuropathy affects the heart how is blood pressure generally affected?

A

Postural hypotension

26
Q

How does autonomic neuropathy affect the eyes?

A

Makes pupils less responsive to light

27
Q

In terms of neuropathy, what may USS be used for in terms of diagnosis?

A

Bladder or urinary tract to show normal emptying and function

28
Q

What is the use of nerve conduction studies or electomyography?

A

Determines type and extent of nerve damage in neuropathy

(how well muscles respond)

29
Q

What does the FRAME project stand for?

A

Foot Risk Awareness and Management Education

30
Q

What is diabetic nephropathy?

A

Progressive disease

Damage to capillaries surrounding glomeruli

Leads to scarring and renal failure

31
Q

What are the key consequences of diabetic nephropathy?

A
  1. Hypertension
  2. Renal function decline
  3. Increased protein in urine
  4. Accelerated disease
32
Q

When is nephropathy screened for?

A

At diagnosis and annually

33
Q

How is nephropathy screened for?

A

Dipstick

34
Q

What are the key risk factors for nephropathy progression?

A
  1. Hypertension
  2. Cholesterol
  3. Smoking
  4. Poor glycaemic control
  5. Albuminuria
35
Q

What is the hypertension aim for all diabetic patients?

A

Should be below 130/80mmHg

(SIGN says 130/70mmHg is the goal)

36
Q

What is the hypertension medication of choice?

A

ACEI

(ARB 2nd line)

37
Q

What is the HbA1c of someone with good glycaemic control in diabetes?

A

<53mmol/mol

38
Q

What are the main eye pathologies of diabetics?

A
  1. Retinopathy
  2. Cataracts
  3. Glaucoma
  4. Acute hyperglycaemia can cause visual blurring
39
Q

What are the two key areas of the retina which become damaged in retinopathy?

A

Macula and fovea

40
Q

Damage at the macula and fovea cause what type of visual disturbance?

A

Central vision

41
Q

What is proliferative retinopathy?

A

The most severe type of retinopathy

Involves development of many new small and esily friable vessels which may bleed

42
Q

How often are the retina of diabeteics screened?

A

Annually

43
Q

How may a patient describe the experience of a severe proliferative retinopathy?

A

Curtain coming down over eye

(due to new vessel rupture)

44
Q

What are some secondary complications of diabetic retinopathy?

A
  1. Glaucoma
  2. Retinal detachment
45
Q

What are the treatments for retinopathy?

A
  1. Laser
  2. Virectomy
  3. Anti-VEGF injections
46
Q

Which complication may occur in up to 50% of diabetic men?

A

Erectile dysfunction

47
Q

Which medications may induced erectile dysfunction?

A
  1. Beta blockers
  2. Thiazide diuretics
  3. Antidepressants
  4. Sedatives
  5. Analgesics

The Endocrine System (35 decks)

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