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Year 2 Endocrine > Microvascular Complications of diabetes > Flashcards

Microvascular Complications of diabetes Flashcards

1
Q

What types of microvascular complications are common?

A

Neuropathy
Nephropathy
Retinopathy

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2
Q

What other complications are common as a result of diabetes?

A

Cognitive dysfunction
Erectile dysfunction
Psychiatric

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3
Q

What is believed to cause the pathophysiology behind microvascular disease?

A

Hyperglycaemia

Hyperlipidaemia

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4
Q

What is the presenting complaint in peripheral neuropathy?

A

Burning tingling sensation
Loss of feeling
Loss of coordination
Gloves and Stockings - distribution

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5
Q

What are the three screening tests done at each annual review?

A

Digital retinal screenig
Foot risk assessment
Urine albumin:creatinine ratio

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6
Q

What are the risk factors for developing neuropathy?

A

Duration of diabetes, smoking, alcohol, high LDL,

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7
Q

What are the common injures associated with peripheral neuropathy?

A

Painless trauma
Diabetic foot ulcer
Charcot foot

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8
Q

What increases the likely hood of complications?

A

Macrovascular peripheral vascular disease

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9
Q

What is Charcot foot?

A

Destructive inflammatory process which leads to the breakdown of bones within the foot.

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10
Q

How does Charcot foot present?

A

Hot swollen foot

To differentiate from deep cellulitis - MRI

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11
Q

What is the treatment for Charcot foot?

A

Avoid all weight bearing

Total contact cast

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12
Q

What is a low risk on diabetic foot screening?

A

Normal sensation and pulses

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13
Q

What is a moderate risk in diabetic foot screening

A

Absent sensation or pulse

Unable to care for own feet

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14
Q

What is a high risk in diabetic foot screening?

A

Absent sensation and pulse

Scars from ulcer

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15
Q

In painful neuropathy what is the treatment?

A

Amitriptyline
gabapentin
Pregablin

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16
Q

If pain in neuropathy is localised and patient wishes to avoid the side effects of other drugs what can be used?

A

Topical Capsaicin cream

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17
Q

What is diabetic amyotrophy?

A

Self resolving painful muscle loss

Usually proximal limbs hips thighs gluteals

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18
Q

Autonomic neuropathy

A 
Affects Heart rate
Blood pressure
Sexual function
Sweating
Digestion
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19
Q

What affect on the GI system does autonomic neuropathy have?

A

Gastric Slowing (gastroparesis)
Persistant nausea and vomiting
oesophageal nerve damage dysphagia

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20
Q

What is the impact on Blood glucose levels in autonomic neuropathy affecting the GI tract

A

Constantly fluctuating due to abnormal digestion

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21
Q

What drugs are used to promote GI motility in autonomic neuropathy?

A

Metoclopramide

Erythromycin

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22
Q

What drugs are used to alleviate nausea in autonomic neuropathy?

A

Odansetron 5-HT3 antagonist

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23
Q

What toxin is used in GI autonomic neuropathy?

A

Botulinum toxin

Injected into the pyloric sphincter to relax it

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24
Q

What is a highly successful treatment used to control GI autonomic neuropathy?

A

GI pacemaker

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25
What can be used to control pain in GI autonomic neuropathy?
NSAIDs Gabapentin Tramadol
26
What can be other autonomic neuropathy complications?
Postural hypertension - usually ride hypertensive | Sweat - Gustatory sweating after eating
27
Nephropathy
Damage to capillary beds found within the glomeruli leading to poor filtration, inflammation and subsequent scarring.
28
What is characteristic if diabetic nephropathy?
Developmental Hypertension Relentless decline in renal function Accelerated vascular disease
29
What is the average loss of function in diabetic nephrology?
10% per year
30
If the urine dipstick come back +ve what should be done?
Send a sample of for quantitive results
31
What is the normal range for ACR?
<3.5 female | <2.5 male
32
Microalbuminuria is classed as what?
ACR of 3.5 - <30 females | 2.5 - <50 males
33
In microalbuminuria will the dipstick test work?
No dipstick will come back as negative
34
Proteinuria
ACR of >30 women | >50 men
35
What will a dipstick show in proteinuria?
Positive
36
In screening what happens?
Abnormal test results confirmed by first pass (first urine of the day) urine sample
37
What causes fluctuations in microalbuminuria levels?
Time of the day Exercise Protein load Gender
38
How many samples should be tested for microalbuminuria?
3x
39
What is the first line treatment for diabetic nephropathy?
ACE or ARB inhibitors | Discuss Angiotensen II antagonist therapy
40
Example of ARB
Losartan
41
Example of ACE inhibitor
Lisinopril
42
What do ACE inhibitors do within the kidney?
They dilate the efferent tubule reducing filtration pressure
43
In type II diabetes what should everyone with renal issues be prescribed?
SGLT2i | reduces risk of both CVD and renal related mortality
44
At what EGFR should metformin be stopped?
30 this is usually in severe Nephropathy | metformin is excreted via the kidneys so can build up triggering lactic acidosis
45
Can DDP-4 inhibitors be used in nephropathy?
Dose should be reduced but continue
46
In acute hyperglycaemia what is a common symptom?
Blurred vision
47
What can be the ocular conditions associated with diabetes?
Glaucoma Cataracts Diabetic macular oedema
48
What is a maculopathy?
Abnormalities focused within the macula
49
What is the macula?
Dense collection of rods and cones, appears a dark patch | Responsible for most of the vision
50
What is the centre of the macula called?
Fovea
51
What is a sign of a bleed within the eye?
Sudden loss vision without trauma | floaters
52
What is the main reason behind bleeds in regards to retinopathy?
Ischaemic drive within eye causes new vessel growth which have weaker walls
53
What is main treatment in retinopathy?
Pan retinal photocoagulation
54
What is the effect of laser therapy on the eye?
By killing cells it reduces the ischaemic drive which reduces the stimulation that results in new vessel development.
55
Where are the lasers focused?
Around the periphery | Vision is hardly affected might have some blurriness in periphery
56
What is the treatment for a bleed within the eye?
Vitrectomy - removal of blood
57
Diabetic macular oedema
Fluid build up resulting in out-bulging of the retina causing blind spots and possibly blindness.
58
What is treatment for diabetic macular oedema?
Intravitreal Anti - VEGF
59
What is VEGF
Vascular epidermal growth factor
60
What is the effect of anti VEGF on retinopathy?
Inhibits stimulus that drives new vessel growth and reduces oedema

Year 2 Endocrine (21 decks)

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