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PHARM 343 > Microvascular Diabetes > Flashcards

Microvascular Diabetes Flashcards

1
Q

Prevalence of Dysglycemia in Canada
- Additionally, what percentage of those that have diabetes are unaware they do

A

50%: Normoglycemia
40%: Pre-Diabetes
10%: Diabetes
- 3% of population is unaware of that they have diabetes

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2
Q

Dysglycemia and affects on Microvascular/Macrovascular complications

A

Having Prediabetes or Diabetes increases risk of Microvascular/Macrovascular complications
- Need to start as soon as possible

Is important to start early, aggressive management of diabetes and related complications if necessary

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3
Q

Why is early, aggressive management of diabetes and related complications important

A

Diabetes has a head start even before diagnosis

Longer you have diabetes the more likely you will develop microvascular complications

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4
Q

Diabetes Related Complications
- Microvascular

A

Nephropathy
Retinopathy
Neuropathy
Foot Ulcerations / Infections / Amputations

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5
Q

Diabetes is the leading cause of _______

A

Nephropathy
- 1/2 of people with diabetes develop renal damage

Adult Blindness

Lower limb amputations

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6
Q

CKD and CV events

A

People with CKD should be considered at high risk of CV events

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7
Q

Nephropathy
- Treatment

A

Intense glycemic control
Optimized blood pressure control
Medications that disrupt renin angiotensin aldosterone system

Make sure to prevent hyperkalemia monitor potassium when using:
- ACEi
- ARBS
- Renin Inhibitors

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8
Q

Nephropathy
- Practical Implications

A

As renal function decreases may have to adjust some medication’s doses for diabetes patients

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9
Q

Nephropathy
- Monitor what?

A

Screen random urine albumin-to-creatinine ratio and estimated glomerular filtration rate
- ACR (Should be low = meaning no albumin)
- eGFR (Should be high = proper filtration)

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10
Q

Nephropathy
- Monitor timeframe

A

Type 1: Annually, start 5 years after diagnosis
Type 2: Annually, start at diagnosis

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11
Q

Nephropathy
- Stages of Renal Functions

A

Normal
Microalbuminuria
Overt Nephropathy
Renal Failure (ESRD)

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12
Q

Nephropathy
- Stages of Renal Functions (Normal)

A

< 30 mg albumin / 24 hours
ACR < 2.0 mg/mmol

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13
Q

Nephropathy
- Stages of Renal Functions (Microalbuminuria)

A

30-300 mg albumin / 24 hours
ACR 2.0-20.0 mg/mmol

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14
Q

Nephropathy
- Stages of Renal Functions (Overt Nephropathy)

A

> 300 mg albumin / 24 hours
ACR > 20.0 mg/mmol

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15
Q

Dangers of Retinopathy

A

Can lead to increased fall risks, hip fractures, mortality

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16
Q

Macular Edema

A

Diffuse or focal vascular leakage at the macula

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17
Q

Nonproliferative Diabetic Retinopathy

A

Microaneurysms, intraretinal hemorrhage, vascular malformation and tortuosity

18
Q

Capillary Nonperfussion

A

Vascular closure
- Blood is not received in some parts of the eye

19
Q

Retinopathy
- Implications

A

Ensure numbers on devices are large and can be seen even for patients with vision difficulties

20
Q

Retinopathy
- Screening

A

Performed by vision care professional
- Optometrist
- Ophthalmologist

Type 1: annually, start 5 years after diagnosis
Type 2: Every 1-2 years, start at diagnosis
- Frequency depends on age and severity

21
Q

Neuropathy Classes

A
  1. Sensorimotor Nevers
  2. Autonomic Neuropathy
22
Q

Sensorimotor nevers

A
  • Neuropathic pain
  • Changes to lower limb mobility
  • Loss of sensation
23
Q

Autonomic Neuropathy
- Cardiovascular

A

Resting tachycardia
Decreased heart rate variability
Exercise intolerance
Abnormal blood pressure regulation

Clinical Implications:
- Increased sensitivity to CV adverse effects of medications

24
Q

Autonomic Neuropathy
- Gastrointestinal

A

Gastroparesis
Constipation, Diarrhea (Especially at night)
Incontinence

Clinical Implications:
- Alters absorption of medications
- Drugs that increase GI motility have limited effectiveness

25
Q

Autonomic Neuropathy
- Gastrointestinal affects what drugs

A

Metoclopramide
Domperidone
Erythromycin

26
Q

Autonomic Neuropathy
- Urogenitcal

A

Bladder dysfunction
- Overflow incontinence
- Erectile dysfunction

27
Q

Neuropathies
- Screening

A

Type 1: Annually, start 5 years at diagnosis
Type 2: Annually, start at diagnosis

28
Q

Neuropathies
- Treatment

A

Intense and tight glycemic control can reduce risk of onset and slow progression

May need pharmacological therapy to manage pain

29
Q

Neuropathies
- Neuroreceptor Reuptake Inhibitors

A

TCAs
SNRIs

Inhibition of serotonin and norepinephrine reuptake leading to enhanced inhibition

30
Q

Neuropathies
- Anticonvulsants

A

Gabapentin
Pregabalin

Mechanism: Blocks Ca2+ influx preventing release of excitatory neurotransmitters

31
Q

Physical Assessment for Sensory Neuropathy

A
  • Check vascular return
  • Cotton swab (Allodynia)
  • Tuning fork (Sense vibrations)
  • Check feet pulse
  • Thermal Challenges / Little pressure (Hyperalgesia)
  • Monofilament
32
Q

Allodynia

A

Abnormal response to a non-noxious stimulus

33
Q

Hyperalgesia

A

Intense pain to a little noxious stimulus

34
Q

Neuropathies
- Goals

A

Reduce pain intensity
- 30-50% reduction

Improve health-related quality of life

35
Q

Foot Ulcers
- Progression

A
  1. Breakdown of skin
  2. Ulceration
  3. Infection
  4. Gangrene and Osteomyelitis
  5. Amputation
36
Q

Foot Ulcers
- Screening

A
  • Daily inspection of feet
  • Annual inspection of feet by healthcare professional
37
Q

Foot Ulcers
- Treatment

A

Corns, Calluses, Ingrown, Toenails, Warts, Splinters, Wounds
- Refer to foot care specialist
- Aggressive management of infecitons

38
Q

Other Considerations
- Vaccinations

A
  • Annual influenza vaccine
  • Pneumococcal vaccine
39
Q

Other Considerations
- Mental Health (Diabetes Specific Conditions)

A
  • Fear of hypoglycemia
  • Psychologically induced insulin resistance
  • Diabetes distress
40
Q

Other Considerations
- Mental Health (Those with diabetes are at higher risk of the following psychiatric disorders)

A
  • Depression
  • Schizophrenia
  • Anxiety
  • Sleep Disorders
41
Q

Other Considerations
- Mental Health (Screening)

A

Regular screening for diabetes distress or symptoms of common psychiatric disorders

PHARM 343 (35 decks)

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