Chronic Complications of Diabetes Flashcards
(28 cards)
What should you monitor every year?
- Check injection sites
- Assess for CVS risk factors (smoking, waist circumference, blood glucose control, BP, lipid profile, fhx of CVD)
- Screen for eye disease, kidney disease, foot problems
- Screen for thyroid disease (T1DM)
What should you do if you see diabetic retinopathy?
Refer to an ophthalmologist if pre proliferative changes or if any uncertainty at or near the macula
What is background retinopathy?
Microaneurysms (dots) Haemorrhages (blots) Hard exudates (liquid deposits)
What is pre proliferative retinopathy?
Cotton wool spots (infarcts)
Haemorrhages (venous bleeding)
- These are the signs of retinal ischaemia and needs urgent referral
What is proliferative retinopathy?
New vessels form
- Needs urgent referral
What is maculopathy?
Suspect if decreased visual acuity
- Needs urgent laser, intravitreal steroids, or anti-angiogenic agents if macula oedema
What is the pathogenesis of maculopathy?
- Capillary endothelial change causes vascular leaks
- Leads to microaneurysms which occludes capillaries
- Leads to local hypoxia and ischaemia so new vessels have to form
What other eye complication occurs with diabetes?
Cataracts
What injection complications should you look for and how do you stop this?
- Infection/lipohypertrophy
- Advise on rotating injection sites if present
How do you assess for diabetic nephropathy?
- Microalbuminuria is when urine dipstick is -ve for protein but urine albumin:creatinine ratio is over >3mg/mmol (3-30 is micro)
- Bring morning urine sample and send for ACR
- Check serum creatinine to check for eGFR too
What are the target BP’s for a type 1 diabetic?
Treat if BP >135/85 unless albuminuria or 2+ features of metabolic syndome, then it should be <130/80
What are the target BP’s for a type 2 diabetic?
Target BP <140/90 or <130/80 if kidney, eye or cerebrovascular damage
What should you prescribe for erectile dysfunction?
A PDE-5 inhibitor - sildenafil
What is diabetic neuropathy?
- Loss of sensation in a stocking distribution
What are some signs of diabetic neuropathy?
- No sensation with a 10g monofilament fibre
- Absent ankle jerk reflexes
- Neuropathic deformity (charcot joint)
- Claw toes
- Rocker bottom sole
How do foot problems occur in diabetes?
- Diabetic neuropathy means they don’t have the pain sensation
- Increased mechanical stress and repeated joint injury
- Causes swelling, instability and deformity
How do you manage diabetic foot ischaemia?
- If foot pulses cannot be felt, do Doppler pressure assessments
- Educate by making the patient do a daily foot inspection
- Wear comfortable shoes
- Regular chiropody to remove callus as hemorrhage and necrosis can occur below
- Treat fungal infections
How do you assess a diabetic foot ulcer?
Assess degree of:
- Neuropathy
- Ischaemia (clinically plus Doppler +/- angiography)
- Bony deformity (clinically and X-ray)
- Infection (swabs, blood cultures, probe ulcer to reveal depth)
What is the management for a diabetic foot ulcer?
Mild - Oral flucloxacillin QDS for 14 days
Moderate - Flucloxacillin, ciprofloxacin, metronidazole for 14 days
Severe - IV piperacillin plus IV vancomycin for 7 days
What is the management for charcot joint?
- Bed rest, crutches, total contact cast
- Until oedema and local warmth reduce and bony repair is complete
- About 8 weeks
What are the indications for surgery on a diabetic foot ulcer?
- Abscess or deep infection
- Spreading anaerobic infection
- Gangrene
- Rest pain
- Suppurative arthritis
What is the surgery for a diabetic foot ulcer, if required?
Amputation
What is the management for symmetric sensory polyneuropathy? (glove and stocking)
What symptoms will the patient describe if they have this?
- Paracetamol
- Amitryptyline 10-25mg at night, increase if required
- Duloxetine
- Opiates
- Numbness, tingling, pain that is worse at night
What is mononeuritis multiplex?
A painful, symmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 seperate nerve areas
