Complications of Diabetes Flashcards by Sasha Murdoch

What are the 4 groups of complications that can occur

Macrovascular
Microvascular
Erectile Dysfunction
Psychiatric

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What are the two main problems within macrovascular problems

IHD

Stroke

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What are the three main problems within the microvascular complications

Neuropathy
Nephropathy
Retinopathy

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Diabetes is traditionally the leading cause of what 3 things

Blindness
Dialysis
Amputation

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What percentage of patients with diabetes will develop some degree of neuropathy

60-70%

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What are the 4 types of neuropathy

Peripheral
Autonomic
Proximal
Focal neuropathy

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Give examples of peripheral neuropathy

Pain/ loss of feeling in hands or feet

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Give examples of autonomic neuropathy

Changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure, hypoglycaemic unawareness

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Give examples of proximal neuropathy

Pain in the thighs, hips or buttocks leading to weakness in the legs (amyotrophy)

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Give examples of focal neuropathy

sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy

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What are some of the risk factors for developing neuropathy

Increased length of diabetes 
poor glycemic control 
Type 1 diabetes > type 2 diabetes 
High cholesterol / lipids 
Smoking 
Alcohol
Inherited Traits (genes)
Mechanical injury

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What are some symptoms of peripheral nerve damage

Numbness/ insensitivity 
Tingling/ burning 
Sharp pains or cramps 
Sensitivity to touch 
Loss of balance and coordination

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What are some complications of nerve damage

infections/ulcers
Charcot
Deformities
Amputations

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Buzzword for charcot

rocker bottom foot

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how is charcot treated

surgery to prevent chronic ulceration and then put in a cast for as long as a year

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Describe the treatment for painful neuropathy

simple analgesia 
TCAs (amitryptiline) 
Gabapentin
Duloxetine / pre-gabalin
stronger opiods

Topical capsaicin cream
allodynia

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What is the difficulty in treating patients with gastroparesis

They have slow stomach emptying and so they may need to take their insulin after they have eaten to prevent hypoglycaemia

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What is gustatory sweating

Sweating after eating

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Describe the effect of autonomic neuropathy on the cardiovascular system

Nerve damage interferes with the body’s ability to adjust blood pressure and heart rate

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Describe the blood pressure of a patient with autonomic neuropathy

May drop sharply after sitting or standing, causing a person to feel light-headed or faint

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Describe the heart rate of a patient with autonomic neuropathy

It may stay high, instead of rising and falling in response to normal body functions and physical activity

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How does autonomic neuropathy affect the eyes

Make the pupils less responsive to changes in light as they don’t dilate and contract as normal

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How can we diagnose neuropathy

Nerve conduction studies or electromyography
Heart rate variability
Ultrasound
Gastric emptying studies

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What is focal neuropathy

Study These Flashcards

sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy

How do we screen for neuropathy

Aim to prevent foot ulcers or unnecessary amputations Foot examination at least once a year Advice for patients self care

Charcot Foot is cause by infection. True or False

False - it is inflammatory only

What is diabetic nephropathy

``` Kimmelsteil Wilson Syndrome or Nodular Glomeruloscelrosis Microvascular changes (antipathy of capillaries ) ```

Describe the appearance histologically of diabetic nephropathy

Sclerotic and filled with angiosclerotic matrix

What is the most common cause of kidney failure/ dialysis

Diabetes

What are some consequences of diabetic nephropathy

Development of hypertension Relentless decline in renal function Accelerated vascular disease

What is used to screen for diabetic kidney disease

Urinary albumin creatinine ratio (ACR)

What patients are screened for nephropathy

All patients over the age of 12

What are the normal measurements for microalbuminuria and macroalbuminuria

``` Micro = 30-300mg/ml Macro = >300mg/ml ```

What can give some else positives of microalbuminuria

``` Menstruation Vaginal discharge UTI pregnancy Non-diabetic renal disease ```

What does UAER varies what

``` Day:night Day: day Exercise Protein load Fluid load ```

Why do we have to repeat microalbuminuria

It varies so much and can have many false positives

How often does microalbuminuria have to be repeated and positive

2/3

What are some risk factors for nephropathy progression

``` Hypertension Cholesterol Smoking Glycaemic control Albuminuria ```

Why are ACE inhibitors good for diabetic patients with microalbuminuria or proteinuria

They lower the blood pressure and improve mortality

How do ACE inhibitors work

Dilation of renal arterioles Decrease filtration pressure Decrease proteinuria DECREASE GFR

What blood pressure should diabetics be maintained at

What stage of Chronic kidney disease (CKD) indicates dialysis

Stage 5

What eye pathologies do diabetics get

Diabetic retinopathy Cataract Glaucoma Acute hyperglycaemia

What are cotton wool spots referring to

Ischaemic areas

What are hard exudates referring to l

lipid real down products

What are haemorrhages referring to

Dot/ blot or flame

What is IRMA

Intra-retinal microvascular abnormalities

What is classed as severe non-proliferative Retinopathy

IRMA, venous beading and haemorrhages

What can be seen in pre proliferative retinopathy

Micro aneurysms, hard exudates, haemorrhages

What is seen that indicates severe proliferation

New vessel formation

Why do new blood vessels grow

The eye has become ischaemic and tries to compensate - they are very fine and are at a high risk of haemorrhage

What is a typical patient presentation of bleeding in the eye

Sudden change in vision or floaters

What are some other eye complications

Secondary glaucoma | Retinal detachment

What percentage of male diabetics are affected by erectile dysfunction

At least 50%

Why does erectile dysfunction in diabetes occur

Vascular and neuropathic

What are some general measures to manage erectile dysfunction

Improve glycemic control / lose weight/ improve lipids reduce alcohol intake withdraw causative drugs where possible correct associated endocrine disease where present involve partner as appropriate

What medication can be given to improve erectile dysfunction

Sildenafil (viagra) Vardenafil (levitra) Tadalafil (cialis)

What are some contraindications for erectile dysfunction medication

``` Nitrates/ nicorandil medication Recent stroke / MI within 3 months Hypotension Severe hepatic dysfunction Hereditary degenerative retinal disorders ```

Complications of Diabetes Flashcards

(58 cards)