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Endocrinology > Complications of DM > Flashcards

Complications of DM Flashcards

(51 cards)

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1
Q

Pathogenesis of Diabetic Tissue Damage (4)

A
  1. Oxidative Stress
  2. Inflammation
  3. Glucotoxicity–>Advanced glycosylation end products (AGE)
  4. Vasoconstriction, angiogenesis, coagulation,
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2
Q

Retinopathy Statistics: Onset/prevalence

A

Type1DM: Onset 3-5 yr after dx; nearly all patients have it within 20 years

Type 2DM: Onset 5-7yr before dx; 20% before dx; 40-80% incidence after 20 years

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3
Q

Pathophysiology of Diabetic Retinopathy (3)

A

Hyperglycemia: dysregulated retinal blood flow, oxidative stress, increased vascular permeability, microthrombosis (ischemia), endothelial proliferation

Genetics
Hypertension

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4
Q

Mild NPDR Signs (3)

A

Microaneurysms
Dot hemorrhages
Hard exudate (lipid leakage within mø)

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5
Q

Moderate/Severe NPDR Signs (3)

A

Soft exudates: “Cotton wool spots” (nerve infarcts)
Venous beading
Intraretinal microvascular abnormalities (IRMA)–>Occluded vessels, dilated/tortuous capillaries

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6
Q

What risk increases with severity of NPDR?

A

Risk of progression to PDR

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7
Q

Macular Edema:

A

Edema and thickening of retina
Accounts for 75% of blindness

Requires special fundoscopic exam

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8
Q

Proliferative Diabetic Retinopathy Signs (4)

A

Neovascularization (new blood vessels leaky–>hemorrhage)
Preretinal and vitreous hemorrhage–>acute vision loss that resolves spontaneously
Fibrosis–>Retinal traction/detachment
Ischemia

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9
Q

Prevention of retinopathy: Cornerstones (2) and Weaker links (3)

A 
Glycemic control and antihypertensives
Weaker evidence for: 
Lipid lowering meds
Antiplatelet meds
Carbonic anhydrase inhibitors
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10
Q

Effect of Glycemic Control on Retinopathy

A

Best as primary prevention (metabolic memory)–>Favorable effects persist for up to 10 years
Positive but less pronounced effect on mild/moderate NPDR
More effective in T1DM than T2DM

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11
Q

Treatment of Retinopathy:
NPDR
High Risk/severe PDR
Vitrectomy

A

NPDR: focal photocoagulation
High-risk/severe PDR:
panretinal photocoagulation (PRP)
Meds: VEGF-inhibitors, intravitreal glucocorticoids

Vitrectomy for nonresponsive shit

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12
Q

Nephropathy: Epidemiology–Onset and Risk

A

Onset 5-20 yr after diabetes (lifetime=25-35%
More common in T2DM
Most common cause of kidney failure (40% of dialysis patients)

Risk factor for CV/overall mortality

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13
Q

Risk factors for nephropathy (8)

A

Poor glycemic control, obesity, race, hypertension, age, tobacco use, retinopathy

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14
Q

Pathologic changes of Nephropathy: Glomerular changes (3)

A

Mesangial expansion
Thickening of glomerular basement membrane
Glomerular sclerosis

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15
Q

Course of Nephropathy (6)

A

Hyperfiltration (increased kidney size)–>Microalbuminuria–>Regress to normal–>Macroalbuminuria–>Decresed GFR–>ESRF

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16
Q

Prevention of Nephropathy (3)

A

Glycemic control

Blood pressure control (

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17
Q

Treatment of Nephropathy (4)

A

ACE Inhibitors/ARB: Improves albuminuria but not prevent onset
Other hypertensive agents: diltiazem/verapamil
Dietary restriction: salt/protein
Weight loss

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18
Q

Neuropathy: Prevalence

A

50-70% lifetime

Most common microvascular complication

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19
Q

Risk Factors for Diabetic Neuropathy (big list)

A

Age, duration of diabetes, poor glucose controls, blood vessel damage, mechanical injury to nerves, genetics, HTN, dyslipidemia, tobacco use, alcohol use

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20
Q

Peripheral Neuropathy (aka distal, symmetric polyneuropathy): Symptoms (4) and Distribution

A

Stocking glove distribution

Decreased sensation, paresthesia, hyperesthesia, worse at night

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21
Q

Polyneuropathy: clinical findings
Physical exam (2)
Electrodiagnostics (2)

Study These Flashcards
A

Physical exam: sensory loss (proprioception/vibration), loss of ankle reflexes
Electr Tests: Decreased nerve conduction velocity and amplitude of evoked potentials

22
Q

Treatment of painful neuropathy (6)

Study These Flashcards
A 
Anticonvulsants
TCAs
SNRIs
Topical agents
Opioids
Antioxidants
TENS (nerve stim)
23
Q

Types of autonomic neuropathy (4)

Study These Flashcards
A

CV, GI, genitourinary, peripheral

24
Q

CV Neuropathy Symptoms (4): P-MET

Study These Flashcards
A

Postural hypertension
MI
Exercise intolerance
Tachycardia

25
GI Autonomic Neuropathy: Esophageal enteropathy (2)
Gastro-esophageal reflux disease | Transient Lower Esophageal Sphincter relaxation
26
GI Autonomic Neuropathy: Diabetic enteropathy (3)
Small bowel dysfunction: diarrhea, steatorrhea Colonic dysfunction: constipation Anorectal dysfunction: fecal incontinence
27
GI Neuropathy: Gastroparesis--Symptoms (2)
Early satiety, nausea, vomiting | Worsening of glycemic control
28
GI Neuropathy: Gastroparesis--treatment (3)
Glycemic control Diet (decrease fat/fiber) Prokinetic agents: erythromycin/azithromycin
29
Genitourinary Autonomic Neuropathy: Px (2)
Urinary retention: UTIs and incontinence | ED
30
Peripheral Autunomic Nueorpathy (sudomotor neuropathy): Presentation (4)
Impaired perspiration: dry skin, itchiness Peripheral edema Callus formation (can form ulcers) Neuroarthropathy
31
Describe Acute Onset Mononeuropathy: Onset and resolution
Sudden weakness or pain in single nerve that resolves spontaneously
32
How does acute onset mononeuropathy present? CN and Peripheral locations
CN: Opthalmoplegia (CN III,IV,VI) or Bell's Palsy (CNVII) Peripheral: Carpal tunnel or foot drop
33
Acute Onset Radiculopathy: Types (2), location and px
Diabetic amyotrophy: L2-L4 Acute asymmetric pain and weakness in proximal legs, hips and butt Truncal polyradiculopathy: T4-T12 Severe abdominal pain in band-like patter
34
Prevention of Neuropathy (5)
``` Glucose control BP control Treatment of dyslipidemia Smoking cessation Decreased alcohol intake ```
35
Diabetic Foot Ulcers: Risk factors (4)
Neuropathy: decreased pain sensation/dry skin/calluses Foot deformity Peripheral vascular disease Poor glycemic control (impaired wound healing)
36
Prevention of Foot Ulcers (6)
Avoid walking barefoot, proper fitting shoes, trim toe nails, daily foot inspection, daily foot washing, moisturizer
37
What are main chronic macrovascular complications? (3)
Coronary artery disease Cerebrovascular disease Peripheral vascular disease
38
CVD in DM Stats:
75% all diabetes deaths 2-4x risk of CVD Disease more likely to be asymptomatic and more likely to have worse outcomes than non-DM
39
Risk factors for CVD (big list)
age, duration of DM, poor glucose control, HTN, dyslipidemia, renal disease/albuminuria, Women, obesity, smoking, sedentary lifestyle
40
What is most important factor for microvascular disease in T1DM? When is risk highest?
Duration of diabetes-- risk highest after 20-25 years
41
What are factors for microvascular disease in T2DM?
Usually pre-existing--insulin resistance and presence of multiple other risk factors
42
Prevention of microvascular disease (7)
Glucose control, BP control lipid control, reduction of microalbuminuria, weight loss/exercise, smoking cessation, aspirin
43
What are results of DCCT for T1DM?
Intensive therapy reduces retinopathy, nephropathy and neuropathy Nonsignificant decrease in CVD
44
What are results of EDIC for DCCT follow up?
A1c converged Metabolic memory: risk reduction persisted Reduction in CVD and death
45
What are results of UKPDS for T2DM?
Intensive therapy reduces microvascular diseases | No difference in CV outcomes
46
What are results of BP control in UKPDS?
Reduction in retinopathy and loss of visual acuity
47
What are results of monitoring post-trial for UKPDS?
Decrease in MI, diabetes-related death | Metabolic memory: decreased risk of microvascular complications persisted
48
Retinopathy Screening
Annual dilated eye: T1DM (5 years) T2DM (at dx) Counsel preggers on risk
49
Nephropathy Screening
Annual urine microalbumin: T1DM (5 years) T2DM (at dx) Confirm abnormal tests and initiate ACE inhibitor
50
Neuropathy Screening
Annual exam : T1DM at 5yr T2DM at dx
51
CV Screening
Check BP at first visit (goal

Endocrinology (26 decks)

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