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MD2 Endocrine > Diabetic Complications > Flashcards

Diabetic Complications Flashcards

1
Q

What are the chronic complication of diabetes attributable to macrovascular disease?

A

CVD
PVD
Cerebrovascular disease

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2
Q

What are the chronic complication of diabetes attributable to microvascular disease?

A

Retinopathy
Nephropathy
Neuropathy: peripheral sensory, autonomic, other

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3
Q

What type of complications are HbA1C levels particularly predictive of?

A

Microvascular complications

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4
Q

What are the 3 classifications of diabetic eye disease?

A

Non-proliferative
Pre-proliferative
Proliferative

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5
Q

What is the clinical definition of microalbuminuria?

A

Albumin excretion rate 30-300mg/24 hrs

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6
Q

What is the most common screening test for microalbuminuria?

A

Albumin creatinine ratio

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7
Q

What is a normal albumin creatinine ratio?

A

Less than 2.5 mg/mmol (males)

Less than 3.5 mg/mmol (females)

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8
Q

How is microalbuminuria diagnosed?

A

2/3 positive screening tests (albumin creatinine ratio)

Less commonly with 24-hr urine collection

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9
Q

Describe the progression of microproteinuria to nephropathy in T1DM and T2DM where there is no specific intervention

A

T1DM: albuminuria increases at 10-20%/year to overt nephropathy within 10-15 years
T2DM: 20-40% progress to overt nephropathy

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10
Q

What is the danger with proliferative diabetic retinopathy?

A

Vitreous haemorrhage from neovascularisation

Can be prevented by laser treatment

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11
Q

What are the 2 life and sight-threatening emergencies in diabetic retinopathy?

A

Proliferative: vitreous haemorrhage

Maculopathy

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12
Q

How else can diabetic retinopathy present?

A

Cataracts

Glaucoma

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13
Q

What is the definition of macroproteinuria?

A

Albumin excretion rate >300mg/24 hrs

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14
Q

What is the untreated natural H of diabetic nephropathy with macroproteinuria?

A

T1DM: GFR decreases to rate of 2-20mL/min/year
T2DM: 20% ESKD at 20 years

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15
Q

What types of neuropathy are seen in diabetes?

A 
Distal symmetric polyneuropathy: "glove and stocking" affects up to 50%, often painful and distressing, 70% of amputations in DM relate to sensory neuropathy
Autonomic neuropathy (very common if sensitive tests are used)
Other types (much rarer): individual peripheral and cranial nerve involvement (esp median, 3rd nerve), polyradiculopathies (thoracic and lumbar nerve roots), mononeuritis multiplex (asymmetrical involving multiple peripheral nerves)
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16
Q

What dyslipidaemia is seen in T2DM?

A

High TG
Low HDL
Small dense LDL

17
Q

What is a common presenting Sx of MI in T2DM?

A

Often silent: dyspnoea on exertion is common (have high degree of clinical suspicion)

18
Q

What kind of cerebrovascular disease is seen in T2DM?

A

TIA
Stroke
High rate of multi-infarct dementia

19
Q

What ischaemic prone areas are particularly susceptible to PVD?

A

Great toe
Medial surface 1st metatarsal head
Lateral surface 5th metatarsal
NB Secondary infection is common

20
Q

What are the principles of prevention and treatment of eye disease in DM?

A

Early detection through regular examination (retinopathy is asymptomatic until visual loss occurs)
Laser treatment significantly reduces risk of severe visual loss from PDR and can improve macular oedema
Meticulous BSL control
Stop smoking
Some evidence for renin-angiotensin system blockade

21
Q

What are the principles of treatment for diabetic nephropathy?

A

Meticulous BP control: ideal 120-130/70-75 (both systolic and diastolic HTN accelerate progression, treat with ACEI and ARBs, appropriate anti-hypertensive therapy in T1DM can decrease need for dialysis and transplantation from 73% to 31% over 16 years)
Meticulous glucose control: ideally HbA1c less than 7.0%
Early detection and treatment of UTIs
Avoidance of nephrotoxic agents (esp IV contrast)

22
Q

What are the principles of diabetic neuropathy?

A

Meticulous glucose control: can result in some restoration of nerve function but long-standing changes are usually permanent
TCAs (amitriptyline, despiramine, imipramine)
SNRI anti-depressants (venlafaxine, duloxitine)
Anti-epileptics (carbamazepine, gabapentin, pregabalin)
Opioid analgesics (tramadol)
Capsaicin cream (depletes substance P from nerve endings)

23
Q

How can foot ulcers in high risk feet be prevented?

A 
Good education on foot care
Daily inspection
Regular podiatry review
Early treatment of skin injury
Appropriate footwear
Callus detection and treatment
Urea cream for dry feet
Early referral for ulcers
24
Q

What medical treatments provide the best reduction in CHD in diabetic patients?

A 
Statins: 30-40% (reduction in event rate related to achieved LDL cholesterol)
Fibrates: 10-20%
ACEI: 20-25%
Aspirin: 20%
Glucose control: 15%
25
Q

What are the current lipid targets for high risk patients from National Heart Foundation of Australia?

A

LDL less than 2.5mmol/L to 2.0mmol/L
HDL >1.0mmol/L
TGs less than 1.5mmol/L

MD2 Endocrine (11 decks)

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