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Semester 4 > case 6 - disease complications > Flashcards

case 6 - disease complications Flashcards

(44 cards)

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1
Q

what is the epidemiology of diabetes 1

A

10% of global health expenditure is spent on diabetes - 80% spent on managing complications
1,110,100 children and adolescents have type 1 diabetes

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2
Q

what are the microvascular complications of type 1 diabetes

A

diabetic retinopathy

diabetes nephropathy

diabetes neuropathy

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3
Q

what are the macrovascular complications of type 1 diabetes

A

stroke

heart disease

peripheral vascular disease

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4
Q

what is the macula responsible for

A

responsible for out central vision, most of the colour vision and detailed vision

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5
Q

what is the diabetic retinopathy classification and what is the scale used

A

Retinopathy scale:
Goes from R0 —> R3

Maculopathy:
Goes from M0-M1

Photocoagulation:
Goes from P0 —>P1
Had previous surgery - photocoagulation scars for P1

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6
Q

what is the prevalence of exudates and haemorrhages (R1) in type 1 diabetes

A

Any retinopathy 77%
Proliferative retinopathy 32%

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7
Q

what is the prevalence of exudates and haemorrhages (R1) in type 2 diabetes

A

25% any retinopathy
3% proliferative retinopathy

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8
Q

what are the venous changes that can happen (R2)

A

beading, looping and reduplication

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9
Q

what are the proliferative changes (R3)

A

new vessels
On disc or elsewhere
fibrous proliferation
On disc or elsewhere
haemorrhages
Pre-retinal
Vitreous

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10
Q

what are the prevention methods for diabetic retinopathy

A

glycemic control (UKPDS, DCCT)
Blood pressure control
Annual screening

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11
Q

what are the treatment options for diabetic retinopathy

A

photocoagulation
anti-VEGF therapy
Surgery

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12
Q

what are the different diabetic neuropathy characteristics

A

Distal symmetrical sensorimotor polyneuropathy and small fibre neuropathy

Radiculopathies

Mononeuropathy - can affect cranial nerves

Autonomic neuropathy

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13
Q

what is the pain in peripheral neuropathy

A

Burning
Paraesthesia
Persistent hyperaesthesia
Nocturnal exacerbation

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14
Q

what is the loss of sensation in peripheral neuropathy

A

postural hypotension
Diabetic gastroparesis
Small bowel bacterial overgrowth
Cardiac autonomic neuropathy
Urogenetic

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15
Q

what are the first line agents for neuropathy pain

A

Duloxetine
Pregabalin
Gabapentin
Amitryptiline

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16
Q

what are the treatments for gastroparaesis

A

Prokinetics
Botox to pylorus,
gastric pacemakers

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17
Q

what are the treatments for postural hypotension

A

Fludrocortisone
Midodrine
Compression stockings

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18
Q

what is diabetic foot

Study These Flashcards
A

neuropathy
Deformity increased pressure, ulcer
Ischemia - peripheral vascular disease
Infection

19
Q

what are the statistics of foot complications in diabetes

Study These Flashcards
A

20-40% have neuropathy
5% have a foot ulcer
5-7% 10 year cumulative incidence of amputation
Increased morbidity, mortality and reduced quality of life

20
Q

what is the prevention for foot ulcers

Study These Flashcards
A

education
Good glucose control
Regular foot checks to identify high risk feet
Regular podiatry review of high risk feet
Appropriate footwear

21
Q

what is the treatment for foot ulcers

Study These Flashcards
A

foot MDT
Off-loading, debridement
Antibiotics
Surgery
Revascularisation

22
Q

what is the most common cause of renal failure

23
Q

what percentage of people with diabetes develop diabetic nephropathy

Study These Flashcards
A

30% of T1DM and 40% of T2DM

24
Q

how is diabetic nephropathy defined

Study These Flashcards
A

moderately increased albuminuria:
Increased albumin creatine ratio (ACR)
ACR > 2.5mg/mmol (men)
ACR > 3.5mg/mmol (women)
OR: urinary albumin concentration >20mg/L in men and women
OR: positive microalbumintest results from 2 first morning urine specimens (sensitivity 93% specificity 80% )

nephropathy
Dipstick positive proteinuria
OR: ACR >30mg/mmol
OR: urinary albumin concentration >< 200mg/L

25
what is the treatment for diabetic nephropathy
blood pressure control Renin aldosterone system (RAS) blockade e.g ACEI, ARB (ramipril and irbesartan) glycemic control Cardiovascular disease risk management Management of the complications of renal failure Dialysis Haemodialysis Peritoneal renal, pancreas and islet transplantation
26
what is the first manifestation of CHD in DM
angina - 50% - people with diabetes may not have classic angina therefore symptoms arent classic
27
what are the life years lost in relation to age at onset of type one diabetes
development of type 1 diabetes before 10 years of age resulted in a loss of 17 life-years for women and 14 life years for men
28
what does hypoglycaemia result from
Absolute or relative hyperinsulinemia And/or defective glucose counter-regulation
29
what are the acute implications of hypoglycaemia
hypos disrupt everyday activities, provokes unpleasant symptoms Severe hypoglycaemia can cause coma, seizures, strokes, arrhythmias and even death negative effects on mood and emotions Impairs cognitive function; can affect performance of many activites Interference with balance, coordination, vision and level of consciousness can precipitate falls and injury
30
what are the long term effects of hypoglycaemia
fear of hypoglycaemia, elevated HbA1c —> complications Reduced quality of life Weight gain Restrictions on employment Driving licensing restrictions Personal relationships disrupted Acquired hypoglycaemia-induced syndromes Cognitive declines
31
what are the factors that contribute to high HbA1c sub optimal diabetes
fear and burden of hypoglycaemia Lack of access/non-engagement with high quality structured education Burden of carbohydrate counting, injections, time and life pressures Depression, anxiety and lack of motivation Not monitoring glucose Variable insulin absorption and problems with insulin injection sites Lack of access to technology Clinical inertia Lack of access to insulin
32
what is DAFNE
dose adjustment for normal eating structured patient education: provide vital knowledge and skills to manage T1D Carbohydrate counting, hypoglycaemia, dynamic insulin adjustment Dealing with exercise, inter-current illness, alcohol, partying, sex, pregnancy, periods, anxiety and depression
33
what has DAFNE shown to improve
HbA1c and reduces hypoglycaemia
34
what are the rapid acting analogues (meal insulin)
Novorapid Humalog Apidra
35
what are the long acting insulins (16 to 24 hours)
levemir lantus
36
what is an example of ultra-rapid acting analogue (meal insulin)
fiasp
37
what are examples of ultra long acting insulins (24hrs+)
Tresiba Toujeo
38
what is an analogue insulin
laboratory grown and genetically modified sequence
39
what is the current technology used to treat type one diabetes
Insulin delivery: insulin pen Insulin pump Conventional pump Patch pump Glucose sensing: capillary blood glucose Continuous glucose monitoring Flash glucose monitoring Conventional Implantable Data management: health care professional centred Data and/or web portals patient centred Data and/or web portals Remote monitoring Mobile apps Glucose responsive insulin delivery: threshold based suspension Predictive low glucose suspension Hybrid single hormone closed loop
40
what are the benefits of insulin pumps
CSII allows more physiological replacement of basal insulin requirements On demand modulation of basal insulin to match individual needs; e.g exercise or stress Lower variability of absorption of basal insulin
41
NICE TA151 - CS11 Continuous subcutaneous insulin infusion or insulin pump therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if:
- attempts to reach target haemoglobin A1c levels with multiple daily injections result in the person having disabling hypoglycamia or Hb1Ac levels have remained high (8.5% or above) with multiple daily injections despite the person and/or their carer carefully trying to manage their diabetes
42
what are smart glucose meters
majority of patients either do not correct for high glucose at all or et the calculations wrong Meter programmed with insulin:carb ratio and correction factor. Each bolus consists of insulin for carbs and insulin for correcting high glucose Studies have shown improved HbA1c, reduced hypos and improved quality of life
43
what are sensory augmented pumps
continuous glucose monitoring data are displayed on the pump screen predictive low glucose suspend technology
44
what is the closed loop system compontents
autonomous, graduated modulation of insulin delivery to achieve target glucose Hybrid = meal bolus still required

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