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Endocrinology > Microvascular Complications of Diabetes > Flashcards

Microvascular Complications of Diabetes Flashcards

1
Q

what are the macrovascular complications of diabetes

A

IHD, stroke

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2
Q

what are all the chronic complications of diabetes

A

IHD, stroke

neuropathy, nephropathy, retinopathy

cognitive dysfunction/ dementia

erectile dysfunction

psychiatric

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3
Q

what is the pathophysiology of microvascular complications

A 
hyperglycaemia and hyperlipidaemia 
=
-AGE-RAGE pathway 
-hypoxia 
-oxidative stress
-inflammation 
-mitochondrial dysfunction
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4
Q

what are the four types of neuropathy

A

peripheral, autonomic, proximal, focal neuropathy

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5
Q

what is peripheral neuropathy

A

pain/loss of feeling in feet/ hands

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6
Q

what is autonomic neuropathy

A

changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure

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7
Q

what is proximal neuropathy

A

pain in the thighs, hips, buttocks leading to weakness in the legs (amyotrophy)

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8
Q

what is focal neuropathy

A

sudden weakness in one nerve or a group of nerves causing muscle weakness or pain (carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy)

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9
Q

what are the risk factors for neuropathy

A 
increased length of diabetes 
poor glycaemic control 
T1DM>T2DM
high cholesterol/ lipids 
smoking 
alcohol 
genetics
mechanical injuty
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10
Q

what are the symptoms of peripheral neuropathy

A

distal symmetric or sensorimotor neuropathy:

  • numbness/ insensitivity
  • tingling/ burning
  • sharp pains or cramps
  • sensitivity to touch
  • loss of balance and coordination
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11
Q

what are the complications of peripheral neuropathy

A

painless trauma
foot ulcer
charcots foot

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12
Q

what is charcots foot

A

when the bones weaken due to significant nerve damage

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13
Q

what are the treatment options for painful neuropathy

A

amitriptyline (off label), duloxetine, gabapentin, pregabalin (combinations of these not recommended)

if localised then can used topical capsaicin cream

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14
Q

what are the symptoms of focal neuropathy

A

appears suddenly, affects specific nerves (often head, torso, leg)

  • inability to focus eye
  • double vision
  • aching behind eye
  • bells palsy
  • pain in thigh/ chest/ lower back/ pelvis
  • pain on outside of foot
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15
Q

what is entrapment neuropathy

A

type of focal neuropathy- weakness in one nerve or a group of nerves causing muscle weakness or pain (carpal tunnel)

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16
Q

what types of neuropathy can cause peripheral neuropathy

A

lumbosacral plexus neuropathy
femoral neuropathy
diabetic amyotrophy (limb weakness)

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17
Q

what are the symptoms of proximal neuropathy

A

starts with pain in the thighs, hips, buttocks or legs, usually more on one side of the body
proximal muscle weakness
often associated with marked weight loss

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18
Q

who is proximal neuropathy most common in

A

elderly with type 2

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19
Q

how can the digestive system be affected by autonomic neuropathy

A

gastric slowing/ frequency
constipation/ diarrhoea
gastroparesis (slow stomach emptying), persistent nausea and vomiting, bloating, loss of appetite
oesophagus nerve damage- swallowing difficulties

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20
Q

how can autonomic neuropathy affect blood sugar levels

A

can cause them to fluctuate widely due to abnormal food digestion

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21
Q

what is the treatment for diabetic gastroparesis

A

improved glycaemic control
dietary- smaller more frequent food portions, low fat, low in fibre (prevent bezoars)
liquid meals (if severe)
promotility drugs- metoclopramide, domperidone, erythromycin
anti nausea medications- prochlorperazine and serotonin antagonists (ondansetron)
abdominal pain - NSAIDs, low dose tricyclic anitdepressants, gabapentin, tramadol, fentanyl
botox
gastric pacemaker

22
Q

what are the symptoms of autonomic neuropathy affecting the heart and blood vessels

A

blood pressure may drop sharply after sitting or standing causing a person to feel light headed/ faint

heart rate may stay high instead of rising and falling in response to normal body functions and physical activity

(body unable to adjust blood pressure and heart rate)

23
Q

how can autonomic neuropathy affect the eyes

A

makes them less responsive to changes in light

difficulty to see in dark

24
Q

what are the diagnostic tools for neuropathy

A 
nerve conduction studies/ electromyography 
heart rate variability 
ultrasound (bladder function)
gastic emptying studies 
foot screening
25
Q

what is diabetic neuropathy

A

progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli
characterised by nephrotic syndrome and diffuse scarring of the glomeruli

26
Q

what are the microvascular changes in diabetic nephropathy

A

angiopathy of capillaries- nodular glomeruloscerlosis

27
Q

what are the consequences of diabetic nephropathy

A

hypertension, decline in renal function, accelerated vascular disease

28
Q

what is nephrotic syndrome

A

collection of symptoms due to kidney damage- proteinuria, hypoalbuminaemia, peripheral oedema

29
Q

how do you screen for nephropathy

A

urinary albumin creatinine ratio (ACR)

30
Q

what are the risk factors for nephropathy progression

A 
hypertension 
cholesterol 
smoking
glycaemic control 
albuminuria
31
Q

what is the treatment for diabetic nephropathy

A

blood pressure maintained

glycaemic control

32
Q

what eye patholoies do people with diabetes get

A

diabetic retinopathy
cataract
glaucoma
acute hyperglycaemia

33
Q

what is cataract

A

clouding of the lens

34
Q

what is glaucoma

A

increase in fluid pressure in the eye leading to optic nerve damage

35
Q

what is acute hyperglycaemia

A

visual blurring (reversible)

36
Q

what is retinopathy treatment

A

laser, vitrectomy, anti VEGF injections

37
Q

what is the cause of diabetic erectile dysfunction

A

vascular and neuropathy

38
Q

what should be inculded in annular diabetes screening

A

eyes, feet and kidneys

39
Q

what are the symptoms of autonomic neuropathy when it affects nerves supplying sweat glands

A

body cannot regulate temp, profuse sweating at night/ while eating

40
Q

what is the treatment for sweat gland autonomic neuropathy

A

topical glycopyrrolate, clonidine, botox

41
Q

in the eye what is a dot/blot/flame

A

haemorrage

42
Q

in the eye what is a cotton wool spot

A

ischaemic areas

43
Q

in the eye what are hard exudates

A

lipid break down products

44
Q

in the eye what is is IRMA

A

intra-retinal microvascular abnormalities (abnormalities of blood vessels/ precursor to neovascularisation) (blood vessels not leaking)

45
Q

how is renital function graded

A

retiopathy and maculopathy graded separatley

46
Q

what are the grades of retinopathy

A

mild background (haemorrages and microaneurysms only)

pre proliferative retinopathy (microaneurysms, hard exudates, haemorrages)

severe non proliferative retinopathy (IRMA, venous bleeding, haemorrhages)

severe proliferative retinopathy (new vessel formation)

pre retinal fibrosis +/- traction retinal detachment

47
Q

what are the symptoms of retinal bleeding

A

floaters, sudden change in vision

48
Q

what causes diabetic erectile dysfunction

A

vascular and neuropathic

49
Q

what medications can case erectile dysfucntion

A

anti hypertensives, CNS drugs (anti depressants, tricyclics, SSRIs, tranquilizers, sedatives, analgesics)

50
Q

what else can cause erectile dysfucntion

A

chronic renal failure, hepatic failure, MS, depression, vascular disease, low LDL, high cholesterol, hormonal deficiency, spinal cord injury, surgery, radiation, substance abuse, alcohol, smoking, bicycle riding

Endocrinology (46 decks)

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