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Yr3 Met 3B > 4. Diabetic Complications > Flashcards

4. Diabetic Complications Flashcards

(51 cards)

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1
Q

What is the most common complication of Diabetes?

A

Retinopathy: 21%

Erectile Dysfunction: 20%

Abnormal ECG: 18%

Rare: Feet, Stroke ischaemia

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2
Q

Why do Diabetic complications occur?

A

Long term exposure to Hyperglycemia:

  1. Vessel closure: Decreasing oxygen/nutrient supply
  2. Vessel permeability: Dilation of damaged vessels
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3
Q

What Risk Factors increase risk of complications in Diabetics?

A
  1. Smoking
  2. Hypertension
  3. Dyslipidemia
  4. Hyperglycemia
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4
Q

What are the Main Groups of Diabetic Complications?

A

Microvascular

Macrovascular

Other

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5
Q

What is classed under the Microvascular group of Diabetic complications?

A

Retinopathy
Nephropathy
Neuropathy (Peripheral Sensorimotor/Autonomic)

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6
Q

What is classed under the Macrovascular group of Diabetic complications?

A

Coronary Heart Disease
Cerebrovascular Disease
Peripheral Vascular Disease

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7
Q

What is classed under the Other group of Diabetic complications?

A

Skin
Rheumatological
Liver

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8
Q

What is Diabetic Retinopathy?

A

Complication of diabetes caused by Hyperglycemia damaging the back of the eye (retina)

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9
Q

What is the most common cause of blindness in working age people?

A

Diabetic Retinopathy

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10
Q

How can Diabetic Retinopathy be prevented?

A
  1. Good BP control
  2. Good Glycaemic control
  3. Regular eye screening
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11
Q

What is Non-Proliferative Retinopathy?

A

Retinopathy NOT involving the Macula

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12
Q

What three main features are there for Non-Proliferative Retinopathy?

A
  1. Microaneurysms
  2. Dot Haemorrhages
  3. Hard Exudates (Lipid deposits)
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13
Q

What Three subgroups of Non-proliferative Retinopathy are there?

A

Mild
Moderate
Severe

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14
Q

What can be seen in Severe Non-Proliferative Retinopathy?

A

Cotton Wool Spots (Soft Exudates)

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15
Q

What do Cotton Wool Spots indicate?

A

Areas of Retinal Ischaemia

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16
Q

What is Proliferative Retinopathy?

A

Ischaemic Retina leading to Growth Factor production and Neovascularisation

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17
Q

What do NVD and NVE mean in the context of Proliferative Retinopathy?

A

NVD: New Vessels on Disk
NVE: New Vessels Elsewhere

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18
Q

What is Diabetic Maculopathy?

A

Presence of any retinopathy within 1 DISC DIAMETER around macula

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19
Q

What different types of Maculopathy are there?

A

Focal/Exudative - Hard exudates around Macula leading to Macular Oedma/Vision Loss

Diffuse

Ischaemic - Retinal Vessel Closure

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20
Q

How can we prevent Diabetic Retinopathy?

A
  1. Diabetic patients should undergo yearly Digital Retinal Screening
  2. Aim for HbA1C <53 (control glycemia)
  3. Aim for good BP/cholesterol
  4. Laser Photocoagulation
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21
Q

When would one use Laser Photocoagulation?

Study These Flashcards
A

Sight preservation for Proliferative Retinopathy or Maculopathy

22
Q

What types of Diabetic Neuropathy exist?

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A
  1. Peripheral Sensory Neuropathy
  2. Autonomic Neuropathy
  3. Proximal Motor Neuropathy (Amyotrophy)
  4. Mononeuropathy (Cranial Nerve palsies, Carpal Tunnel)
23
Q

How do we test for Peripheral Sensory Neuropathy?

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A

Screening for high risk of ulceration

  1. Low Vibration sense
  2. Low Fine Touch sense (Semmes Weinstein Monofilament)
  3. Low Ankle reflexes
  4. Muscle Wasting
24
Q

What symptoms can we see for Peripheral Sensory Neuropathy?

Study These Flashcards
A
  1. Numbness
  2. Pins and Needles
  3. Burning
  4. Shocking
25
What risks are there for patients with Peripheral Sensory Neuropathy?
Ulceration | Amputation
26
What is the most common cause of Non-traumatic amputation?
Diabetic Neuropathy
27
What issues can Diabetic Autonomic Neuropathy cause?
1. Genitourinary 2. GI 3. Cardiovascular
28
What Genitourinary issues can Diabetic Autonomic Neuropathy cause?
1. Erectile Dysfunction | 2. Atonic bladder (Issues with voiding/urinary incontinence)
29
What GI issues can Diabetic Autonomic Neuropathy cause?
1. Gastroparesis (Vomiting/Early satiety) 2. Chronic constipation 3. Gustatory sweating (when eating)
30
What CVS issues can Diabetic Autonomic Neuropathy cause?
Postural Hypotension
31
What is the most common cause of End Stage Renal Failure in the UK?
Diabetic Nephropathy
32
What percentage of Type 2 Diabetics have nephropathy?
25-30%
33
Which ethnic groups have a higher risk of Diabetic Nephropathy?
South Asians Afro-Caribbeans
34
List at least 5 Risk Factors for development/progression of Nephropathy
1. Duration of Diabetes 2. Hypertension 3. Poor glycemic control 4. Smoking 5. Male 6. Ethnicity 7. Family History
35
What are the clinical features of Diabetic Nephropathy?
1. Hypertension 2. Albuminuria (Preceded by Microalbuminuria) 3. Declining Renal Function Triad of Symptoms
36
Upon a renal biopsy, what can be found in Diabetic Nephropathy?
Kimmelstein-Wilson pathological lesion
37
How do we screen for Microalbuminuria?
1. Measure the Urine Albumin:Creatinine Ratio (ACR) 2. Normal: <2.5 mg/mmol in men, <3.5 mg/mmol in women 3. Repeat Twice if elevated 4. Positive if 2/3 is positive
38
How do we treat Nephropathy?
1. Maintain BP of 130/80 - Give ACEI - Consider ARB if ACEI sucks 2. Optimise Blood Glucose (<53) 3. Manage CV Risk Factors aggressively 4. Stop Metformin when eGFR <30 ml/min 5. Refer to specialist when eGFR <45 ml/min and falling 6. Renal Replacement Therapy
39
When should you stop Metformin on a Diabetic Nephropathy patient?
When their eGFR drops below 30 ml/min
40
When should you refer a Diabetic Nephropathy patient to a specialist?
When their eGFT drops below 45 ml/min and is FALLING
41
What types of Renal Replacement therapy is available for Diabetic Nephropathy patients?
Peritoneal Dialysis Haemodialysis Transplant Simultaneous Pancreas/Kidney Transplant in T1DM
42
What treatment can be provided for those with Diabetic Nephropathy?
1. Smoking Cessations 2. Maintain BP - ACEI - CCB - Thiazide - Alpha or Beta blocker 3. Cholesterol to 4 mmol/L - Statin (If 40+ and diabetic, or 40- and 1 RF) 4. HbA1c < 53
43
Give 5 ways we can treat or manage AMI?
1. Aspirin 2. Primary Angioplasty/Thrombolysis 3. Glucose-Insulin infusion 4. Secondary Prevention - ACEI, BB, Statin, Aspirin, Improve Glycemia 5. Cardiac rehab
44
How do we manage Cerebrovascular Events?
If it's within 3 hours, consider Thrombolysis - Treat all vascular risk factors aggressively using a) ACEI b) Statin c) Aspirin d) Glucose/Insulin infusion
45
What skin manifestations can persist via diabetes?
1. Oral/Genital Candidiasis 2. Skin abscesses 3. Diabetic dermopathy 4. Necrobiosis Lipoidica Diabeticorum (T1DM) 5. Bullosis Diabeticorum 6. Granuloma Annulare 7. ACANTHOSIS NIGRICANS (Insulin resistance) 8. Fungal Nail infections
46
What is Acanthosis Nigricans a sign of?
Insulin resistance
47
**What 6 Rheumatological manifestations are there of Diabetes?
1. Charcot Neuroarthropathy (Neuropathic joint leading to severe deformity/ulcer risk) 2. Diabetic Cheiroarthropathy (Due to limited joint mobility) 3. Adhesive Capsulitis (Frozen shoulder) 4. DISH 5. Flexor Tendinopathy 6. Diabetic osteoarthropathy
48
What liver issues are associated with Diabetes?
1. NAFLD (Very common) 2. Progression to NASH/Fibrosis/Cirrhosis 3. High ALT and AST > 2 x the upper limit of normal
49
What does NASH stand for in relation to liver diseases?
Non-alcoholic steato hepatitis
50
How can we investigate ALT and AST?
1. Hepatitis serology 2. US scan 3. Ferritin to exclude haemochromatosis
51
What drug can be used to reduce progression of Diabetic patients' liver to cirrhosis?
Pioglitazone

Yr3 Met 3B (13 decks)

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