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Year 2 Endocrine > Microvascular Complications of diabetes > Flashcards

Microvascular Complications of diabetes Flashcards

1
Q

What types of microvascular complications are common?

A

Neuropathy
Nephropathy
Retinopathy

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2
Q

What other complications are common as a result of diabetes?

A

Cognitive dysfunction
Erectile dysfunction
Psychiatric

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3
Q

What is believed to cause the pathophysiology behind microvascular disease?

A

Hyperglycaemia

Hyperlipidaemia

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4
Q

What is the presenting complaint in peripheral neuropathy?

A

Burning tingling sensation
Loss of feeling
Loss of coordination
Gloves and Stockings - distribution

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5
Q

What are the three screening tests done at each annual review?

A

Digital retinal screenig
Foot risk assessment
Urine albumin:creatinine ratio

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6
Q

What are the risk factors for developing neuropathy?

A

Duration of diabetes, smoking, alcohol, high LDL,

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7
Q

What are the common injures associated with peripheral neuropathy?

A

Painless trauma
Diabetic foot ulcer
Charcot foot

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8
Q

What increases the likely hood of complications?

A

Macrovascular peripheral vascular disease

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9
Q

What is Charcot foot?

A

Destructive inflammatory process which leads to the breakdown of bones within the foot.

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10
Q

How does Charcot foot present?

A

Hot swollen foot

To differentiate from deep cellulitis - MRI

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11
Q

What is the treatment for Charcot foot?

A

Avoid all weight bearing

Total contact cast

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12
Q

What is a low risk on diabetic foot screening?

A

Normal sensation and pulses

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13
Q

What is a moderate risk in diabetic foot screening

A

Absent sensation or pulse

Unable to care for own feet

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14
Q

What is a high risk in diabetic foot screening?

A

Absent sensation and pulse

Scars from ulcer

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15
Q

In painful neuropathy what is the treatment?

A

Amitriptyline
gabapentin
Pregablin

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16
Q

If pain in neuropathy is localised and patient wishes to avoid the side effects of other drugs what can be used?

A

Topical Capsaicin cream

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17
Q

What is diabetic amyotrophy?

A

Self resolving painful muscle loss

Usually proximal limbs hips thighs gluteals

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18
Q

Autonomic neuropathy

A 
Affects Heart rate
Blood pressure
Sexual function
Sweating
Digestion
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19
Q

What affect on the GI system does autonomic neuropathy have?

A

Gastric Slowing (gastroparesis)
Persistant nausea and vomiting
oesophageal nerve damage dysphagia

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20
Q

What is the impact on Blood glucose levels in autonomic neuropathy affecting the GI tract

A

Constantly fluctuating due to abnormal digestion

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21
Q

What drugs are used to promote GI motility in autonomic neuropathy?

A

Metoclopramide

Erythromycin

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22
Q

What drugs are used to alleviate nausea in autonomic neuropathy?

A

Odansetron 5-HT3 antagonist

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23
Q

What toxin is used in GI autonomic neuropathy?

A

Botulinum toxin

Injected into the pyloric sphincter to relax it

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24
Q

What is a highly successful treatment used to control GI autonomic neuropathy?

A

GI pacemaker

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25
Q

What can be used to control pain in GI autonomic neuropathy?

A

NSAIDs
Gabapentin
Tramadol

26
Q

What can be other autonomic neuropathy complications?

A

Postural hypertension - usually ride hypertensive

Sweat - Gustatory sweating after eating

27
Q

Nephropathy

A

Damage to capillary beds found within the glomeruli leading to poor filtration, inflammation and subsequent scarring.

28
Q

What is characteristic if diabetic nephropathy?

A

Developmental Hypertension
Relentless decline in renal function
Accelerated vascular disease

29
Q

What is the average loss of function in diabetic nephrology?

A

10% per year

30
Q

If the urine dipstick come back +ve what should be done?

A

Send a sample of for quantitive results

31
Q

What is the normal range for ACR?

A

<3.5 female

<2.5 male

32
Q

Microalbuminuria is classed as what?

A

ACR of 3.5 - <30 females

2.5 - <50 males

33
Q

In microalbuminuria will the dipstick test work?

A

No dipstick will come back as negative

34
Q

Proteinuria

A

ACR of >30 women

>50 men

35
Q

What will a dipstick show in proteinuria?

A

Positive

36
Q

In screening what happens?

A

Abnormal test results confirmed by first pass (first urine of the day) urine sample

37
Q

What causes fluctuations in microalbuminuria levels?

A

Time of the day
Exercise
Protein load
Gender

38
Q

How many samples should be tested for microalbuminuria?

A

3x

39
Q

What is the first line treatment for diabetic nephropathy?

A

ACE or ARB inhibitors

Discuss Angiotensen II antagonist therapy

40
Q

Example of ARB

A

Losartan

41
Q

Example of ACE inhibitor

A

Lisinopril

42
Q

What do ACE inhibitors do within the kidney?

A

They dilate the efferent tubule reducing filtration pressure

43
Q

In type II diabetes what should everyone with renal issues be prescribed?

A

SGLT2i

reduces risk of both CVD and renal related mortality

44
Q

At what EGFR should metformin be stopped?

A

30 this is usually in severe Nephropathy

metformin is excreted via the kidneys so can build up triggering lactic acidosis

45
Q

Can DDP-4 inhibitors be used in nephropathy?

A

Dose should be reduced but continue

46
Q

In acute hyperglycaemia what is a common symptom?

A

Blurred vision

47
Q

What can be the ocular conditions associated with diabetes?

A

Glaucoma
Cataracts
Diabetic macular oedema

48
Q

What is a maculopathy?

A

Abnormalities focused within the macula

49
Q

What is the macula?

A

Dense collection of rods and cones, appears a dark patch

Responsible for most of the vision

50
Q

What is the centre of the macula called?

A

Fovea

51
Q

What is a sign of a bleed within the eye?

A

Sudden loss vision without trauma

floaters

52
Q

What is the main reason behind bleeds in regards to retinopathy?

A

Ischaemic drive within eye causes new vessel growth which have weaker walls

53
Q

What is main treatment in retinopathy?

A

Pan retinal photocoagulation

54
Q

What is the effect of laser therapy on the eye?

A

By killing cells it reduces the ischaemic drive which reduces the stimulation that results in new vessel development.

55
Q

Where are the lasers focused?

A

Around the periphery

Vision is hardly affected might have some blurriness in periphery

56
Q

What is the treatment for a bleed within the eye?

A

Vitrectomy - removal of blood

57
Q

Diabetic macular oedema

A

Fluid build up resulting in out-bulging of the retina causing blind spots and possibly blindness.

58
Q

What is treatment for diabetic macular oedema?

A

Intravitreal Anti - VEGF

59
Q

What is VEGF

A

Vascular epidermal growth factor

60
Q

What is the effect of anti VEGF on retinopathy?

A

Inhibits stimulus that drives new vessel growth and reduces oedema

Year 2 Endocrine (21 decks)

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