Type 1 Diabetes Flashcards
what is normoalbuminuria
what is microalbuminuria
30-300 mg in 24hrs
what is albuminuria
> 300mg/24hrs
how would you manage diabetic nephropathy
aim for good glycemic control
screen for microalbuminuria
treat with ACE (T1) or ARB(T2) to reduce the intraglomerular pressure as they reduce tone in the efferent arterioles
what causes diabetic neuropathy
the most likely cause is nerve ischaemia
glucose can also slow conduction as well as glycosylation of nerve proteins
both demyelination and axonal loss occur
what causes diabetic neuropathy
the most likely cause is nerve ischaemia
glucose can also slow conduction as well as glycosylation of nerve proteins
what is microalbuminuria
30-300 mg in 24hrs
what is albuminuria
> 300mg/24hrs
how would you manage diabetic nephropathy
aim for good glycemic control
screen for microalbuminuria
treat with ACE (T1) or ARB(T2) to reduce the intraglomerular pressure as they reduce tone in the efferent arterioles
what does 90, 60, 30, 15 and 0 mea in the context of kidneys
the GFR in chronic kidney disease CKD1 = >90ml CKD2 = 60-90 ml CKD 3= 30-60 ml CKD4 = 15-30 ml CKD5 = 0-15ml
what causes diabetic neuropathy
the most likely cause is nerve ischaemia
glucose can also slow conduction as well as glycosylation of nerve proteins
which frequency tuning fork should be used to check perception of vibration
128Hz
how would you manage postural hypotension as a result of diabetes
avoid diuretics
fludrocortison
support stocking
what is the big risk of diabetic foot ulcers
osteomyelitis
a sign of this is being able to probe down to bone
if there is any evidence amputation should be sought
which neuropathies lead to charcot neuropathy
a mixture of sensory peripheral neuropathy and autonomic neuropathy
enhanced blood flow occurs and three is excessive osteoclastic activity leading to deformity
which conditions may be the result of autonomic neuropathy
erectile dysfunction postural hypotension gastroparesis diarrhoea/constipation bladder dysfunction blunted counter-response to hypoglycaemia
how does diabetes cause erectile dysfunction
endothelial dysfunction - cannot produce NO
autonomic neuropathy - no NANC fibre to stimulate the release of NO
PDE5 inhibitors are available but only works in partial dysfunction
what would you treat gastroparesis with
prokinetics (erythromycin)
antiemetics
gastric pacemaker
how would you manage postural hypotension as a result of diabetes
avoid diuretics
fludrocortison
support stocking
what are the histiological hallmarks of diabetic nephropathy
basement membrane thickening and increased mesangium
what is a Kimmelsteil-Wilson kidney
an end stage diabetic kidney with nodular glomerular sclerosis
what is the hall mark of diabetic retinopathy
microaneurysms
what is the risk of new vessel formation in diabetic retinopathy
new vessels are accompanied by supporting connective tissue
this leads to pre retinal fibrosis
this can cause tractional retinal detachment
what are macular drusen and what are they associated with
accumulation of phospholipid between Bruch’s membrane and the retinal pigment layer
AMD
appear after the age of 40
