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Flashcards in FN: diabetic Complications Deck (31):
1

Summary of complications

HyperglycaemiaL DKA, HONK
Hypo
Infetion
Macrovascular: MI, CVA
Microvascular

2

Macrovascular complication sinclude

MI: may be silent due to autonomic neuropathy
2. PVD: claudication, foot ulcers
3. 1. CVA

3

Management of macrovascular ocmplications

Manage CV risk factors
BP - aim for 130/80
Smoking
Lipids
HBa1c

4

Prevention of macrovascular complications

1. good glycaemic control (e.g. HBA1c

5

Diabetic foot two types

Ischaemia
Neuropathy

6

ISchaemia

Critical toes
Absent pulses (do AMPI)
UlcersL painful, punched-out, foot margins, pressure points

7

Neuropathy

1. Loss of protective sensation
2, Deformity: Charcots joints, pes cavus, claw toes
3. Injury or infection over pressure points
4. Ulcers: painles, pnched out, metatarsal heads, calcaneum

8

Management of diabetic feet conservative

Daily foot inspection (e.g. with mirror)
Comfortable/therapeutic shoes
Regular chirody (remove callus

9

Medical management of diabetic foot

Treat infection: benpen + fluclox ± metronidazole

10

Surgical management of diabetic foot types of conditions treated

Abscess or dep infection
Spreading cellulitis
Gangrene
Suuprative arthritis

11

Neuropathy pathophysiology

Hyoerglycaemia --> nephron loss and glomerulosclerosis

12

Neuropathy features

1. Microalbuminaemia: urine albumin: CR (ACR) >30mg/mM
2. If present -> ACEi/ARA
3. Refer if UCR>70

13

retinopathy path

Microvascular disease --> retinal ischaemia -> leads to raised VEGF
VEGF leads to new vessel formation

14

Retinopathy presentation

1. Retinopathy and maculopathy
2. Cataracts
3. Ruberosus iris: new vessels on iris --> glaucoma
4. CN palsies

15

Investigations for retinopathy and maculopathy

Refer if pre-proliferative retinopathy/maculopathy
Fluorescein angiograohy

16

Treatment or retinopathy or maculopathy

Laser photocoagulation

17

Types

BAckgroun retinopathy
Pre-proliferative retinopathy
Proliferative retinaopthy
Maculopathy

18

BAckground retinopathy

Dots: microaneuryms
Blot haemorrhages
Hardexudates: yello lipid patches

19

Pre-proliferative retinopathy

Cotton-wool spots (retinal infarcts)
Venous vleedings
HAemorrhages

20

prolfierative retinopathy

New vessels
Pre-retinal or vitreous haemorrhage

21

Nephropathy pathophysiology

Hyoerglycaemia --> nephron loss and glomerulosclerosis

22

Nephropathy features

1. Microalbuminaemia: urine albumin: CR (ACR) >30mg/mM
2. If present -> ACEi/ARA
3. Refer if UCR>70

23

Background retinopathy

Dots: microaneuryms
Blot haemorrhages
Hardexudates: yello lipid patches

24

Maculopathy

reduced acuity may be only signs
Hard exudates w/i one disc width of macula

25

Neuropathy path

MEtabolic: glycosylation, ROS sorbitol accumulation
IschaemiaL
loss of vasa nervorum

26

Symmetric sensory polyneuropthy

1. Glove and stocking: length-dependent (therefore feet1st) - loss of all modalities
2. absent ankle jerks
3. Numbness, tingling, pain (worse @ night)

27

Symmetric sensory polyneuropathy Rx

1. Paracetamol
2. Amytroptyline, Gabapentin, SSRI
3. Capsaicin cream
4. Baclofen

28

Mononeuropathy/Mononeuritis Multiplex exampe

CN3/6 palsiy

29

Femoral Neuropathy/Amyotrophy

1. Painful asymmetric weakness and wasting of quads with loss of knee jerks

30

Femoral Neuropathy/amyotrophy

Nerve conductino studies and electromyography

31

Autonomic Neuropathy

1. Postural hypotension - RX fludrocortison
2. Gastroparesis --> early satiety, GORD, bloating
3. Diaarrhoea: Treatment with codein phosphate
4. urinary retentino
5. ED

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