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The Endocrine System > Microvascular Complications of Diabetes > Flashcards

Microvascular Complications of Diabetes Flashcards

(47 cards)

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1
Q

What are the 3 main microvascular complications of diabetes?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
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2
Q

Why do microvascular complications occur in diabetes?

A

Hyperglycaemia and hyperlipiaemia contribute to hypoxia, oxidative stress, inflammation, mitochondrial dysfunction and damaged nerves

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3
Q

What are the 4 types of neuropathy experienced in diabetes?

A
  1. Peripheral
  2. Autonomic
  3. Proximal
  4. Focal neuropathy
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4
Q

Neuropathy is more associated with which type of diabetes?

A

Type 1

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5
Q

Which things increase an individuals risk of developing neuropathy?

A
  1. Poor glycaemic control
  2. Increased length of time with diabetes
  3. Alcohol
  4. High cholesterol
  5. Smoking
  6. Inherited
  7. Mechanical injury
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6
Q

What is the most common neuropathy?

A

Peripheral

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7
Q

What is peripheral neuropathy and how does it present?

A

Distal or sensorimotor neuropathy

  1. Numbness/insensitivity
  2. Tingling/burning
  3. Sharp pains/cramps
  4. Sensitivite touch is maintained
  5. Loss of balance and coordination
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8
Q

What are some complications of peripheral neuropathy?

A
  1. Charcot foot
  2. Painless trauma
  3. Foot ulcer
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9
Q

What is a Charcot foot?

A

Progressive degeneration of a weight bearing joint, marked by bony destruction, bone resorption, and eventual deformity

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10
Q

Why is it so key that intensive treatment is started from the outset of diabetes?

A

Good glycaemic control from the start decreases long term risks

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11
Q

Why are injuries obtained from peripheral neuropathy particularly dangerous?

A
  1. They can worsen more than normal due to lack of pain
  2. Infection may occur and healing is poor
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12
Q

Which treatment may slow progression of Charcot foot?

A

Bisphosphonates

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13
Q

How may peripheral neuropathy be treated if it is painful?

A
  1. Amitriptyline
  2. Duloxetine
  3. Gabapentin
  4. Pregabalin
  5. Capsaicin cream
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14
Q

What is focal neuropathy?

A

Acute neuropathy affecting specific nerves, or groups of nerves most often in the head, torson or leg

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15
Q

How may focal neuropathy present?

A
  1. Inability to focus eye
  2. Double vision
  3. Aching behind eye
  4. Bell’s palsy
  5. Pain in thigh/chest/lower back/pelvis
  6. Pain on outside of foot
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16
Q

What is entrapment neuropathy and give an example?

A

Weakness in one nerve or group of nerves causing muscle weakness or pain

Carpal tunnel

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17
Q

What is proximal neuropathy and how does it present?

A
  1. Lumbosacral plexus neuropathy
  2. Femoral neuropathy
  3. Diabetic amyotrophy

Presents with:

  • Pain in thighs, hips, buttocks or legs
  • Usually occurs on one side
  • More common in elderly T2DM
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18
Q

What is proximal neuropathy associated with?

A

Weight loss

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19
Q

What is autonomic neuropathy?

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A

Neuropathy affecting the nerves of the autonomic nervous system

20
Q

How may autonomic neuropathy present?

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A
  1. Changes in HR/BP
  2. GI motility changes e.g. gastroparesis
  3. Sexual function change
  4. Urination
  5. Vision
21
Q

How may gastroparesis present?

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A
  1. Becoming full easily
  2. GORD
  3. Vomiting
  4. Diarrhoea
22
Q

How is gastroparesis best treated?

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A
  1. Improve glycaemic control
  2. Lower fat intake
  3. Smaller meals
  4. Promotility drugs
  5. Botox into sphincter
  6. Gastric pacemaker
23
Q

Why may someone with diabetes experience “gustatory sweating”?

Study These Flashcards
A

Autonomic neuropathy affecting sweat glands

24
Q

How can autonomic neuropathy of sweat glands be treated?

Study These Flashcards
A
  1. Topical glycopyrrolate
  2. Clonidine
  3. Botuliunum toxin (botox)
25
When autonomic neuropathy affects the heart how is blood pressure generally affected?
Postural hypotension
26
How does autonomic neuropathy affect the eyes?
Makes pupils less responsive to light
27
In terms of neuropathy, what may USS be used for in terms of diagnosis?
Bladder or urinary tract to show normal emptying and function
28
What is the use of nerve conduction studies or electomyography?
Determines type and extent of nerve damage in neuropathy (how well muscles respond)
29
What does the FRAME project stand for?
Foot Risk Awareness and Management Education
30
What is diabetic nephropathy?
Progressive disease Damage to capillaries surrounding glomeruli Leads to scarring and renal failure
31
What are the key consequences of diabetic nephropathy?
1. Hypertension 2. Renal function decline 3. Increased protein in urine 4. Accelerated disease
32
When is nephropathy screened for?
At diagnosis and annually
33
How is nephropathy screened for?
Dipstick
34
What are the key risk factors for nephropathy progression?
1. Hypertension 2. Cholesterol 3. Smoking 4. Poor glycaemic control 5. Albuminuria
35
What is the hypertension aim for all diabetic patients?
Should be below 130/80mmHg | (SIGN says 130/70mmHg is the goal)
36
What is the hypertension medication of choice?
ACEI | (ARB 2nd line)
37
What is the HbA1c of someone with good glycaemic control in diabetes?
\<53mmol/mol
38
What are the main eye pathologies of diabetics?
1. Retinopathy 2. Cataracts 3. Glaucoma 4. Acute hyperglycaemia can cause visual blurring
39
What are the two key areas of the retina which become damaged in retinopathy?
Macula and fovea
40
Damage at the macula and fovea cause what type of visual disturbance?
Central vision
41
What is proliferative retinopathy?
The most severe type of retinopathy Involves development of many new small and esily friable vessels which may bleed
42
How often are the retina of diabeteics screened?
Annually
43
How may a patient describe the experience of a severe proliferative retinopathy?
Curtain coming down over eye | (due to new vessel rupture)
44
What are some secondary complications of diabetic retinopathy?
1. Glaucoma 2. Retinal detachment
45
What are the treatments for retinopathy?
1. Laser 2. Virectomy 3. Anti-VEGF injections
46
Which complication may occur in up to 50% of diabetic men?
Erectile dysfunction
47
Which medications may induced erectile dysfunction?
1. Beta blockers 2. Thiazide diuretics 3. Antidepressants 4. Sedatives 5. Analgesics

The Endocrine System (35 decks)

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