(PM3B) Diabetes Complications Flashcards by Nikki Gurung

How is mortality increased with diabetes complications?

Increase in prevalence of cardiovascular disease and renal failure

How well did you know this?

Not at all

Perfectly

How is morbidity increased with diabetes complications?

Diabetic foot
Retinopathy
Peripheral neuropathy
Peripheral vascular disease

How well did you know this?

Not at all

Perfectly

What are the short-term complications of diabetes?

(1) Hypoglycaemia
(2) Diabetic ketoacidosis - DKA
(3) Hyperosmolar Hyperglycaemic State - HHS

How well did you know this?

Not at all

Perfectly

What are the long-term complications of diabetes?

(1) Retinopathy
(2) Cardiovascular disease
(3) Neuropathy
(4) Peripheral vascular disease
(5) Nephropathy

How well did you know this?

Not at all

Perfectly

When does hypoglycaemia occur?

When blood glucose falls below 4mmol/L

How well did you know this?

Not at all

Perfectly

What can hypoglycaemia lead to if not treated? c u c

Convulsions
Unconsciousness
Coma

How well did you know this?

Not at all

Perfectly

What are the potential causes of hypoglycaemia?

(1) Too much injected insulin
(2) Altered insulin ABSORPTION
(3) Altered insulin CLEARANCE
(4) Decreased insulin requirement
(5) Failure to recognise symptoms

How well did you know this?

Not at all

Perfectly

How is hypoglycaemia treated?

If conscious: 10-20g of glucose

If unconscious: IM/ SC glucagon OR IV glucose (dextrose)

How well did you know this?

Not at all

Perfectly

(1) What is nocturnal hypoglycaemia?

(2) How can it be recognised?

(1) Blood glucose <4mmol/L at night

(2) Waking up tired/ with a headache/ wet from sweating

How well did you know this?

Not at all

Perfectly

What advice can be given to diabetic patients experiencing hypoglycaemia? p bg at g dct

(1) Look for patterns - adjust insulin accordingly
(2) More regular blood glucose monitoring
(3) Avoid triggers - e.g. alcohol
(4) Carry glucose tablets/ sweets
(5) Diabetes Care Team

How well did you know this?

Not at all

Perfectly

How does alcohol decrease blood sugar?

Inhibits glycogen breakdown + release in the liver

How well did you know this?

Not at all

Perfectly

(1) What is diabetic ketoacidosis (DKA)?

(2) When is it most common?

(1) Use of fats + proteins as an energy alternative to glucose. Causes a build up of ketones, leading to acidosis.

(2) Type 1 diabetics

How well did you know this?

Not at all

Perfectly

What most commonly causes DKA?

Infections - 40%
Diabetes diagnosis - 10-20%

How well did you know this?

Not at all

Perfectly

What is the effect of infection on insulin requirements for a diabetic patient?

Can increase insulin requirements

How well did you know this?

Not at all

Perfectly

What are the most severe symptoms of DKA?

Diabetes symptoms with greater severity
- Thirst
- Polyuria
- Tiredness
- Blurry vision

How well did you know this?

Not at all

Perfectly

What are the less frequent symptoms of DKA? n c ap lb u ph d

Nausea
Cramp
Abdominal pain
Laboured breathing
Unconsciousness
Postural hypotension
Dehydration

How well did you know this?

Not at all

Perfectly

What is the treatment for DKA?

(1) IV rehydration - 0.9% saline
(2) Insulin infusion - to correct hyperglycaemia
(3) Correction of electrolyte balance

How well did you know this?

Not at all

Perfectly

In DKA, which electrolyte is most likely to be affected?

How is it affected?

Potassium

Decreases - hypokalaemia

What is HHS? me. hbg, d

Hyperosmolar Hyperglycaemic State

Occurs in T2DM
Medical emergency
Very high blood glucose levels
Severe dehydration

What causes HHS?d ai

Diuretics
Acute illness

(1) When is ketone build-up observed in the urine?

(2) In which similar condition is it NOT present? Why?

DKA
HHS - because some insulin is produced in T2DM

What are the symptoms of HHS?

ø Polyuria
ø Thirst
ø Nausea + vomiting
ø Dry skin
ø General weakness
ø Leg cramps
ø Visual impairment
ø Confusion
ø Drowsiness + unconsciousness
ø Can lead to coma

What are the diagnostic symptoms of HHS?

(1) Very high blood glucose (>30mmol/L)
(2) Low ketone levels in urine (<3mmol/L)
(3) No acidosis
(4) Hyperosmolality

What is more common, DKA or HHS?

DKA is more common

What is the treatment for HHS? 4. i i a p

- IV fluids - IV low-dose insulin - Anticoagulant - HHS is associated with vascular thrombosis - Prevention of foot ulceration

Which comorbidities does HHS increase risk of?

(1) Vascular (arterial/ venous) thrombosis (2) Foot ulceration - increases susceptibility to pressure sores

How can the complication of cardiovascular disease be minimised in diabetic patients? w e s sc bp

- Reduce weight - Exercise - Statins (>40yrs old) - Maintain BP in normal range (<130/85mmHg) - Smoking cessation

How is diabetic neuropathy caused? bv nd

Diabetes + poor glycaemic control affects the blood vessels supplying the nerves Leads to nerve damage - neuropathy

What are the types of neuropathy associated with diabetes?

(1) SENSORY - numbness in extremities (2) AUTONOMIC - Incontinence, erectile dysfunction, resting tachycardia, gastroparesis (delayed gastric emptying) (3) MOTOR - Muscle weakness, muscle degradation, muscle twitching, cramp

How is diabetic foot ulceration caused? pc nd

Poorly managed diabetes leads to poor circulation and nerve damage

How can the skin of a diabetic patient often present? d c le i

- Dry - Cracked - Lacking elasticity - More prone to injury - Infected

Why are people with diabetic foot at increased risk of amputation? 3

(1) Ulceration of foot can lead to infection (2) Often not felt due to nerve damage (neuropathy) (3) Slow to heal due to poor circulation

What preventative management options are there for a diabetic patient attempting to avoid foot ulceration?

(1) Wash with soap (2) Dry thoroughly (3) Keep nails trimmed - podiatrist/ chiropodist (4) Keep skin healthy - podiatrist/ chiropodist (5) Wear fitting shoes (6) Annual clinical foot examination

What are the treatment options for each type of neuropathy, relating to diabetes?

(1) Sensory - analgesia (2) Motor - Physiotherapist - Prevent muscle degradation (3) Autonomic - Sildenafil - specifically indicated for erectile dysfunction - Antiemetics - specifically indicated for nausea + vomiting (gastroparesis)

What is retinopathy?

Damage to the retina

How is retinopathy caused?

Weak blood vessels bleed onto the retina Blind spots form due to leakage

What preventative management options are there for diabetic patients protecting against retinopathy?

(1) Annual eye screening (2) Maintenance of normal blood glucose (3) Maintenance of normal BP (<130/85mmHg) (4) Maintenance of normal LDL + HDL levels (5) Seek medical help if vision changes

What is the treatment for diabetic retinopathy?

(1) Laser surgery - improves circulation (2) Anti-VEGF intra-ocular injection - prevents inappropriate blood vessel growth (3) Intra-ocular corticosteroid implant - inhibit inflammation

How common is nephropathy in diabetic patients?

25-50% of all diabetics

How is nephropathy caused in diabetic patients?

- Hyperglycaemia damages small blood vessels supplying the kidney - Poor blood supply affects kidney function - Leads to nephropathy

How can the complication of nephropathy be reduced in diabetic patients?

- Annual kidney function test (protein presence indicates damage) - Maintenance of normal blood glucose - Maintenance of normal BP (<130/85mmHg) - Smoking cessation

What is the treatment for diabetic nephropathy?

(1) Management of BP and blood glucose (2) 1st Line: ACEi and ARBs (3) Diet modification - low salt, limited proteins (4) Dialysis (5) Kidney transplant - if kidney function is poor

What is the first line treatment for nephropathy in diabetic patients?

ACE inhibitors and Angiotensin II Receptor blockers