DIABETIC COMPLICATIONS

Question 1

Macrovascular complications

Answer 1

• Peripheral arterial disease
• MI
• Stroke

Question 2

Macrovascular complications - treatment

Answer 2

• ACEi
• Low dose aspirin
• Lipid regulating drugs (statins)

Question 3

When is a low-dose atorvastatin considered?

Answer 3

Considered in all type 1 pts
* Offered to age: 40+
* diabetic for 10+ yrs
* nephropathy or other CVD factors
* Qrisk > 10%

Question 4

Microvascular complications

Answer 4

• Neuropathy
• Retinopathy
• Nephropathy

Question 5

Diabetic nephropathy

Answer 5

• Kidney damage due to diabetes
• Test ACR
• Higher ACR = more severe

Question 6

What ACR level is considered nephropathy?

Answer 6

3mg/mmol +

Question 7

Diabetic nephropathy - Treatment

Answer 7

• ACEi/ARB (even if BP normal)
• ACEi can potentiate hypo effect of antidiabetic drugs/insulin

Question 8

Risk of ACEi in nephropathy

Answer 8

• Hyperkalaemia
• ACEi can potentiate effect of insulin and other ADDs = HYPO

Question 9

Diabetic neuropathy: types

Answer 9

Painful peripheral neuropathy
Autonomic neuropathy
Neuropathic postural hypotension
Gustatory sweating
Erectile sysunction

Question 10

What is diabetic neuropathy?

Answer 10

• High blood sugars = reduced blood flow and death of nerves

Question 11

Painful peripheral neuropathy

Answer 11

• Treat with antidepressants (duloxetine licensed, amitriptylline/ nort not licensed)
• Gabapentin, pregabalin

This can lead to diabetic foot - treat pain and manage infection

Question 12

Autonomic neuropathy

Answer 12

Causes diarrhoea
Treat with codeine or tetracycline

Question 13

Neuropathic postural hypotension

Answer 13

Increase salt intake
Fludrocortisone

Question 14

Gustatory sweating

Answer 14

Antimuscarinic
Propantheline bromide

Question 15

Diabetic retinopathy

Answer 15

• High blood sugar = damage to retina
• REPORT changes
• Loss of vision if left untreated

Question 16

Erectile dysfunction + diabetes

Answer 16

• Refer to GP
• High blood sugar over a long period of time can damage the nerves and blood vessles
• Can cause problems with getting or keeping an erection

Question 17

Sildenafil pt counselling

Answer 17

• Take before food
• Onset of effect may be delayed if taken with food

Question 18

Visual impairment

Answer 18

Yearly eye tests

Question 19

Periodontitis

Answer 19

• Chronic inflammatory gum disease
• Gingivitis (mild form) > periodontitis
• Good oral hygiene
• Regular check ups

Question 20

Gastroparesis

Answer 20

• Long term condition = stomach cannot empty itself on the normal way
• Bloating, feeling full, N+V
• Treat vomiting: erythromycin, metoclompramide

Question 21

DKA

Answer 21

Severe hyperglycaemia
More common in Type 1
- Body breaks down fat at an accelarated rate.
- Ketones are produced as a byproduct.
- Ketones = acidic = blood becomes acidic.

Question 22

Symptoms of DKA

Answer 22

Polyurea
Thirsty
Pear drop breath smells (ketones)
Deep or fast breathing
Lethargy / Unconsciousness
Confusion

Question 23

Diagnosing DKA

Answer 23

1. Check blood sugar level if displaying symptoms of DKA
2. If blood sugar is above 11mmol/L, check ketone levels (urine/blood)
   * 0.6 - 1.5mmol = slight risk (retest in 2 hours)
   * 1.6 - 2.9mmol = increased risk (contact GP)
   * 3mmol+ = medical emergency

Question 24

How are ketone levels checked?

Answer 24

urine or blood

Question 25

0.6 - 1.5mmol

Answer 25

slight risk (retest in 2 hours)

Question 26

1.6 - 2.9mmol

Answer 26

increased risk (contact GP)

Question 27

3mmol+

Answer 27

medical emergency

Question 28

DKA - initial treatment

Answer 28

- replacement of fluid and electrolytes - administration of soluble insulin

Question 29

DKA treatment

Answer 29

1. If BP <90, restore volume with 500ml IV NaCl 0.9% 2. Once BP > 90, give maintenance IV NaCl 0.9% 3. Start IV Insulin mixed with NaCl and administer at a rate so that - Ketone concentration falls at 0.5mmol/L/hr - Blood glucose concentration falls at 3mmol/L/hr 4. When blood glucose ‹ 14 mmol/L → IV Glucose 10% 5. Continue insulin till ketone <0.3mmol/L and PH > 7.3 6. When patient able to eat → give fast-acting insulin with a meal 7. Stop treatment 1 hour after food

Question 30

1. If BP <90

Answer 30

restore volume with 500ml IV NaCl 0.9%

Question 31

2. Once BP > 90

Answer 31

give maintenance IV NaCl 0.9%

Question 32

3. Start IV Insulin mixed with NaCl and administer at a rate so that

Answer 32

- Ketone concentration falls at 0.5mmol/L/hr - Blood glucose concentration falls at 3mmol/L/hr

Question 33

4. When blood glucose ‹ 14 mmol/L →

Answer 33

IV Glucose 10%

Question 34

5. Continue insulin till ketone

Answer 34

<0.3mmol/L and PH > 7.3

Question 35

6. When patient able to eat →

Answer 35

give fast-acting insulin with a meal

Question 36

7. When do you stop treatment?

Answer 36

1 hour after food