What are the three main microvascular complications of diabetes?
What are the end-stage outcomes of
Retinopathy - blindness
Nephropathy - dialysis
Neuropathy - amputation
The (better / poorer) your glycaemic control, i.e the higher your level of ___, the greater your risk of microvascular complications.
poor glycaemic control
higher HbA1c levels
Good glycaemic control should be achieved ___ to avoid microvascular complications.
What causes microvascular complications in hyperglycaemia?
Build-up of end products
leading to inflammation
something about mitochondrial dysfunction
What is peripheral neuropathy?
Loss of feeling
in the hands and feet.
What is autonomic neuropathy?
Damage to autonomic nerves producing:
changes in bowel habit, bladder function, sexual function, sweating, HR, BP...
basically everything controlled by autonomic nerves.
Peripheral neuropathy tends to have a "_____" distribution.
glove and stocking
What kind of pain do patients with peripheral neuropathy have?
Burning / tingly pain
Patients with peripheral neuropathy often develop numbness.
What can this lead to?
Accumulation of injuries (burns, ill-fitting shoes)
What eponymous name is given to the "bag of bones" appearance of a foot in peripheral neuropathy?
Can drugs treat the loss of sensation in peripheral neuropathy?
What are the treatment options for painful peripheral neuropathy?
i.e atypical analgesics
Topical capsaicin cream
How can Charcot foot be avoided?
Regular checking of feet
What are some presentations of autonomic neuropathy?
Why does gastroparesis pose a concern in diabetics?
Affects blood glucose levels due to abnormal digestion, vomiting, diarrhoea etc.
What drug is commonly used to treat gastroparesis in diabetics with autonomic neuropathy?
Improving ___ control often improves the symptoms of diabetes complications.
How is gastroparesis treated?
Dietary - smaller, more frequent meals, low fat and fibre
Promotility drugs (revise these)
What are two cardiovascular presentations of autonomic neuropathy?
Hypertension / postural hypotension
How is peripheral neuropathy screened for?
Hand / foot exam once a year
What other investigations can be done for neuropathy?
Nerve conduction studies, EMG
Ultrasound of bladder for prolonged emptying
Gastric emptying study
What is a kidney complication of diabetes?
Many patients on ___ also have diabetes.
What are the consequences of diabetic nephropathy?
Hypertension > accelerated CVD
How is diabetic nephropathy screened for?
Albumin / creatinine ratio (ACR)
What is the name for an increase in albumin found in the urine, and is an indicator of renal damage?
Renal disease secondary to diabetes accelerates ___ disease.
What is the blood pressure target for diabetic patients?
< 130 / 80 mmHg
What is the HbA1c target for patients with diabetes?
< 53 mmol/mol
ideally < 48