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Endocrine system > Long-term complications - micro and macro > Flashcards

Long-term complications - micro and macro Flashcards

1
Q

What are some risk factors for complications associated with diabetes?

A
  • Duration of diabetes
  • Metabolic control
  • Smoking
  • Hypertension
  • Hyperlipidaemia
  • Genetics
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2
Q

What are some risk factors for cardiovascular disease?

A
  • Glucose control
  • Blood pressure
  • Smoking
  • Lipids
  • Proteinuria
  • Family history
  • Gender
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3
Q

What is the target HbA1c level in diabetics?

A

Target HbA1c - 53 mmols/mol (7%)

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4
Q

What is the target blood pressure in diabetics?

A

Control BP to ≤ 130/80

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5
Q

How can cardiovascular complication risk be decreased?

A
  • Smoking cessation - support, nicotine replacement or drug therapy (Zyban, Champix)
  • Statin therapy e.g. simvastatin for patients over 40 and in younger patients with significant complications
  • Lifestyle choices – maintaining healthy weight, exercise
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6
Q

What drug therapy is used for smoking cessation?

A

Zyban (bupropion, also used as as antidepressant)

Champix (varenicline)

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7
Q

What 3 pathologies are caused by diabetic microvascular disease?

A
  • Retinopathy
  • Neuropathy
  • Nephropathy
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8
Q

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

A

Diabetic retinopathy

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9
Q

What are some retinal abnormalities seen in diabetes?

A
  • Microaneurysms (small red dots)
  • White spots from lipid aggregates
  • Blot haemorrhages
  • Hard exudates
  • Cotton wool spots
  • New vessel formation
  • Vitreous haemorrhage
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10
Q

How can proliferative retinopathy be treated?

A

Laser photocoagulation

Vitrectomy

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11
Q

What affects vision in maculopathy?

A
  • Exudates and blot haemorrhages at macula
  • Macular ischaemia
  • Macular oedema deforms the macula, affecting visual acuity
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12
Q

What is used to treat diabetic maculopathy?

A

Grid laser therapy

BP and blood glucose control

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13
Q

How much does risk of cataracts increase in diabetic patients?

A

2X increase

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14
Q

What are the 3 subtypes of diabetic neuropathy?

A

o Peripheral neuropathy (diffuse nerve disease) – most common
o Mononeuritis (single nerve palsy) – less common
o Autonomic neuropathy

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15
Q

What are some symptoms of peripheral neuropathy?

A

Gloove and stocking distribution of:

  • feet insensitive to trauma: risk of feet ulcers
  • paraesthesia (abnormal sensation)
  • burning pain
  • numbness
  • small muscle wasting
  • can be asymptomatic!!
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16
Q

How can peripheral neuropathy be managed?

A

• Early detection – screening for diabetic foot disease
• Self care education
• Protection of feet
• Pain relief
– Capsaisin cream (local treatment)
– Amitriptyline, gabapentin, duloxetine (systemic treatment, pain)

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17
Q

What local treatment can be given for pain caused by peripheral neuropathy?

A

Capsaisin cream

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18
Q

What systemic treatment can be given for pain caused by peripheral neuropathy?

A

Amitriptyline
Gabapentin
Duloxetine

19
Q

What techniques are used for foot screening and risk scoring for ulcer prevention?

A

Microfilament - record sensation

Peripheral pulses

20
Q

How can foot ulcers be prevented?

A 
Foot screening
Education on foot care
Regular podiatry for those at high risk
Avoidance of trauma
Avoid fitted footwear
21
Q

What is Charcot foot/Charcot neuro-arthropathy, and why is prevention important?

A
  • Progressive degeneration of a weight bearing joint, a process marked by bone destruction, bone resorption, and eventual deformity due to loss of sensation and an initial small trauma. Onset is usually insidious (gradual)
  • If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity.
22
Q

What factors indicate high risk of complications of the feet?

A
  • Impaired circulation
  • Impaired sensation
  • Impaired vision
  • Foot shape changes
  • Abnormal pressures
23
Q

What is acute sensorial peripheral neuropathy, and what causes it?

A

Rapid onset of neuropathic symptoms
Precipitating factors
– Rapid tightening of control e.g. trying to get pregnant
– Acute metabolic upset

24
Q

What can happen after a rapid tightening of glycemic control or an acute metabolic upset?

A

Acute sensorial peripheral neuropathy

25
Q

What is proximal motor neuropathy/diabetic amyotrophy?

A

A nerve disorder that results as a complication of diabetes mellitus. It can affect the thighs, hips, buttocks or lower legs. Proximal diabetic neuropathy is a peripheral nerve disease (diabetic neuropathy) characterized by muscle wasting or weakness, pain, or changes in sensation/numbness of the leg. Diabetic neuropathy is an uncommon complication of diabetes. It is a type of lumbosacral plexopathy, or adverse condition affecting the lumbosacral plexus.

26
Q

Who is primarily affected with proximal motor neuropathy/diabetic amyotrophy?

A

Elderly men with type 2 DM

27
Q

What are some symptoms and signs of proximal motor neuropathy/diabetic amyotrophy?

A 
Leg muscle wasting
Weakness in legs
Pain
Loss/changes in sensation/numbness
Weight loss (due to muscle atrophy)
28
Q

What does amyotrophy mean?

A

Muscle atrophy

29
Q

What is mononeuritis?

A

Inflammation of a single nerve

30
Q

What can be seen in patients with mononeuritis of the oculomotor nerve (CN III)?

A

Affected eye has downward and outer gaze

31
Q

What can be seen in patients with mononeuritis of the trochlear nerve (CN IV)?

A

Affected eye has upward and slightly inwards gaze

32
Q

What can be seen in patients with mononeuritis of the abducens nerve (CN VI)?

A

Affected eye cannot look to lateral side (cannot abduct)

33
Q

What can be seen in patients with mononeuritis of the peroneal nerve?

A

Acute foot drop (inability to lift the front of your foot off the ground, tested by dangling legs over bed and ask to bring ball of feet up)

34
Q

What are some signs of autonomic neuropathy?

A 
Erectile dysfunction
Postural hypotension
Gastric stasis/recurrent vomiting
Diarrhoea
Abnormal sweating
Peripheral oedema
Urinary retention
35
Q

How can erectile dysfunction be treated?

A

– Phosphodiasterase inhibitors e.g. Viagra, Cialis

– Prostaglandins, mechanical devices, implants

36
Q

How is postural hypotension treated?

A

– NSAIDs

– Fludrocortisone

37
Q

What is given to those with gastric stasis and recurrent vomiting?

A

Domperidone (dopamine D2 receptor antagonist, antiemetic)

38
Q

What 2 drugs are given for diarrhoea?

A

Loperamide

Codeine phosphate

39
Q

What % of patients will develop nephropathy after 30 years of diabetes?

A

25%

40
Q

How do we screen for early kidney disease?

A

Microalbuminuria - test using first pee in the morning

41
Q

Is any stage of kidney disease reversible?

A

Microalbuminuria, before it progresses to proteinuria

42
Q

What is the definitive test for microalbuminuria?

A

Definitive test- timed over night urine collection for albumin excretion rate (AER)

o Normal < 20μg/min
o Microalbuminuria 20-200μg/min

43
Q

How can we manage early kidney disease to try and prevent its progression?

A
  • Optimise glycaemic control
  • Tight BP control - aim for <125/75 in type 1 diabetes
  • ACE inhibitor therapy slows progression
  • Cardiovascular risk factor management

Endocrine system (27 decks)

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