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Part 3 – PM3B > (PM3B) Diabetes Complications > Flashcards

(PM3B) Diabetes Complications Flashcards

1
Q

How is mortality increased with diabetes complications?

A

Increase in prevalence of cardiovascular disease and renal failure

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2
Q

How is morbidity increased with diabetes complications?

A
  • Diabetic foot
  • Retinopathy
  • Peripheral neuropathy
  • Peripheral vascular disease
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3
Q

What are the short-term complications of diabetes?

A

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

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4
Q

What are the long-term complications of diabetes?

A

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

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5
Q

When does hypoglycaemia occur?

A

When blood glucose falls below 4mmol/L

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6
Q

What can hypoglycaemia lead to if not treated?

A
  • Convulsions
  • Unconsciousness
  • Coma
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7
Q

What are the potential causes of hypoglycaemia?

A

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

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8
Q

How is hypoglycaemia treated?

A

If conscious: 10-20g of glucose

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

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9
Q

(1) When is dextrose administered to a diabetic patient?

(2) How is it administered?

A

(1) An unconscious patient having a hypoglycaemic episode

Intravenous (IV) injection

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10
Q

How and when is glucagon administered to a patient?

A
  • IM/ SC injection
  • Unconscious
  • Hypoglycaemic
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11
Q

(1) What is nocturnal hypoglycaemia?

(2) How can it be recognised?

A

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

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

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12
Q

What advice can be given to diabetic patients experiencing hypoglycaemia?

A

(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

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13
Q

How does alcohol decrease blood sugar?

A

Inhibits glycogen breakdown + release in the liver

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14
Q

(1) What is diabetic ketoacidosis (DKA)?

(2) When is it most common?

A

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

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15
Q

What is the treatment for diabetic ketoacidosis (DKA)?

A
  • Emergency rehydration
  • Emergency insulin

(Often requires hospital admission)

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16
Q

What most commonly causes DKA?

A

Infections - 40%

Diabetes diagnosis - 10-20%

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17
Q

What is DKA?

A

Diabetic Ketoacidosis

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18
Q

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

A

Can increase insulin requirements

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19
Q

What are the most severe symptoms of DKA?

A

Diabetes symptoms with greater severity

  • Thirst
  • Polyuria
  • Tiredness
  • Blurry vision
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20
Q

What are the less frequent symptoms of DKA?

A
  • Nausea
  • Cramp
  • Abdominal pain
  • Laboured breathing
  • Unconsciousness
  • Postural hypotension
  • Dehydration
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21
Q

What is the treatment for DKA?

A

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

22
Q

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

How is it affected?

A

Potassium

Decreases - hypokalaemia

23
Q

What does HHS stand for?

A

Hyperosmolar Hyperglycaemic State

24
Q

What is HHS?

A

Hyperosmolar Hyperglycaemic State

  • Occurs in T2DM
  • Medical emergency
  • Very high blood glucose levels
  • Severe dehydration
25
Q

What causes HHS?

A
  • Diuretics

- Acute illness

26
Q

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

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

A
  • DKA

- HHS - because some insulin is produced in T2DM

27
Q

What are the symptoms of HHS?

A 
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
28
Q

What are the diagnostic symptoms of HHS?

A

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

29
Q

What is more common, DKA or HHS?

A

DKA is more common

30
Q

What is the treatment for HHS?

A
  • IV fluids
  • IV low-dose insulin
  • Anticoagulant - HHS is associated with vascular thrombosis
  • Prevention of foot ulceration
31
Q

Which comorbidities does HHS increase risk of?

A

(1) Vascular (arterial/ venous) thrombosis

(2) Foot ulceration - increases susceptibility to pressure sores

32
Q

When does the incidence of microvascular complications overtake the incidence of microvascular complications?

A

As the average blood glucose increases

Incidence of macrovascular complications increases linearly

Incidence of microvascular complications increases exponentially

33
Q

What does ‘metabolic syndrome’ refer to?

A

Type 2 diabetes mellitus due to a cardiovascular disease risk factor

34
Q

How can the complication of cardiovascular disease be minimised in diabetic patients?

A
  • Reduce weight
  • Exercise
  • Statins (>40yrs old)
  • Maintain BP in normal range (<130/85mmHg)
  • Smoking cessation
35
Q

How is diabetic neuropathy caused?

A

Diabetes + poor glycaemic control affects the blood vessels supplying the nerves

Leads to nerve damage - neuropathy

36
Q

What are the types of neuropathy associated with diabetes?

A

(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

37
Q

How is diabetic foot ulceration caused?

A

Poorly managed diabetes leads to poor circulation and nerve damage

38
Q

How can the skin of a diabetic patient often present?

A
  • Dry
  • Cracked
  • Lacking elasticity
  • More prone to injury
  • Infected
39
Q

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

A

(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

40
Q

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

A

(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

41
Q

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

A

(1) Sensory - analgesia
(2) Motor - Physiotherapist - Prevent muscle degradation

(3) Autonomic
- Sildenafil - specifically indicated for erectile dysfunction
- Antiemetics - specifically indicated for nausea + vomiting (gastroparesis)

42
Q

Are antiemetics useful in Type 2 diabetic patients?

A

Can be beneficial for treating nausea + vomiting or gastroparesis (delayed gastric emptying)

Limited evidence to suggest effectiveness of antiemetics in T2DM

43
Q

What is retinopathy?

A

Damage to the retina

44
Q

How is retinopathy caused?

A

Weak blood vessels bleed onto the retina

Blind spots form due to leakage

45
Q

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

A

(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

46
Q

What is the treatment for diabetic retinopathy?

A

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

47
Q

What is VEGF?

A

Vascular endothelial growth factor

48
Q

How common is nephropathy in diabetic patients?

A

25-50% of all diabetics

49
Q

How is nephropathy caused in diabetic patients?

A
  • Hyperglycaemia damages small blood vessels supplying the kidney
  • Poor blood supply affects kidney function
  • Leads to nephropathy
50
Q

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

A
  • Annual kidney function test (protein presence indicates damage)
  • Maintenance of normal blood glucose
  • Maintenance of normal BP (<130/85mmHg)
  • Smoking cessation
51
Q

What is the treatment for diabetic nephropathy?

A

(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

52
Q

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

A

ACE inhibitors and Angiotensin II Receptor blockers

Part 3 – PM3B (32 decks)

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