3: Microvascular complications of diabetes Flashcards Preview

Endocrine Week 2 2017/18 > 3: Microvascular complications of diabetes > Flashcards

Flashcards in 3: Microvascular complications of diabetes Deck (39)
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1

What are the three main microvascular complications of diabetes?

Neuropathy

Nephropathy

Retinopathy

2

What are the end-stage outcomes of

retinopathy

nephropathy

neuropathy?

Retinopathy - blindness

Nephropathy - dialysis

Neuropathy - amputation

3

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

more complications

4

Good glycaemic control should be achieved ___ to avoid microvascular complications.

early

5

What causes microvascular complications in hyperglycaemia?

Hypoxia

Oxidative stress

Build-up of end products

leading to inflammation

something about mitochondrial dysfunction

6

What is peripheral neuropathy?

Loss of feeling

Pain

in the hands and feet.

7

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.

8

Peripheral neuropathy tends to have a "_____" distribution.

glove and stocking

9

What kind of pain do patients with peripheral neuropathy have?

Burning / tingly pain

10

Patients with peripheral neuropathy often develop numbness.

What can this lead to?

Accumulation of injuries (burns, ill-fitting shoes)

11

What eponymous name is given to the "bag of bones" appearance of a foot in peripheral neuropathy?

Charcot foot

12

Can drugs treat the loss of sensation in peripheral neuropathy?

No

Pain only

13

What are the treatment options for painful peripheral neuropathy?

Amitriptyline

Duloxetine

Gabapentin

Pregabalin

i.e atypical analgesics

Topical capsaicin cream

14

How can Charcot foot be avoided?

Appropriate footwear

Regular checking of feet

15

What are some presentations of autonomic neuropathy?

Tachycardia

Postural hypotension

Gastroparesis

Dysphagia

16

Why does gastroparesis pose a concern in diabetics?

Affects blood glucose levels due to abnormal digestion, vomiting, diarrhoea etc.

17

What drug is commonly used to treat gastroparesis in diabetics with autonomic neuropathy?

Metoclopramide

18

Improving ___ control often improves the symptoms of diabetes complications.

glycaemic

19

How is gastroparesis treated?

Dietary - smaller, more frequent meals, low fat and fibre

Promotility drugs (revise these)

Botox

Gastric pacemaker

20

What are two cardiovascular presentations of autonomic neuropathy?

Hypertension / postural hypotension

Tachycardia

21

How is peripheral neuropathy screened for?

Hand / foot exam once a year

22

What other investigations can be done for neuropathy?

Nerve conduction studies, EMG

Heart rate

Ultrasound of bladder for prolonged emptying

Gastric emptying study

23

What is a kidney complication of diabetes?

Nephropathy

24

Many patients on ___ also have diabetes.

dialysis

25

What are the consequences of diabetic nephropathy?

Hypertension > accelerated CVD

Renal dysfunction

26

How is diabetic nephropathy screened for?

Albumin / creatinine ratio (ACR)

27

What is the name for an increase in albumin found in the urine, and is an indicator of renal damage?

Microalbuminuria

28

Renal disease secondary to diabetes accelerates ___ disease.

cardiovascular

29

What is the blood pressure target for diabetic patients?

< 130 / 80 mmHg

30

What is the HbA1c target for patients with diabetes?

< 53 mmol/mol

ideally < 48