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My Endocrine > Vascular Complications of DM > Flashcards

Vascular Complications of DM Flashcards

1
Q

What is normal hemoglobin A1C

A

under 6

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2
Q

What do you want all diabetic’s blood pressure to be?

A

120 or less

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3
Q

What does it mean if a type 1 diabetic has hypertension?

A

-kindeys are failing

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4
Q

What is the leading cause of end stage renal disease in the US?

A

-nephropathy

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5
Q

Which ethnic groups have a higher prevelance of nephropathy?

A

Indians, hispanics, african americans

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6
Q

What happens to the kidneys in nephropathy?

A
  • basement membrane thickens and causes nodular glomerular sclerosis
  • cause impaired blood flow, nodular lesions in glomerular capillaries(only in diabetics), proteins leak through damaged membrane
  • kidneys and nephrons hypertrophy (blood flow impaired)
  • hyperfilitration occurs in early disease
  • microabulinuria–will cause edema
  • decline in GFR
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7
Q

What does renal artery stenosis lead to?

A
  • increased bp b/c of increased renin release

- edema from increased volume

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8
Q

What is the leading indicator of developing nephropathy?

A

microalbuminuria

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9
Q

What is the strongest independent risk factor of cardiovascular disease?

A

microalbuminuria

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10
Q

Levels of microalbuminuria vs macro

A

micro: 30-300 mg in 24 hours
macro: >300 mg in 24 hours
- -remember to always check creatinine to albumin ration

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11
Q

How do you slow the decline from nephropathy?

A
  • TIGHT GLUCOSE CONTROL!
  • bp control
  • protein restricted diet
  • smoking cessation
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12
Q

Drugs that help nephropathy

A

ACE-inhibitors
Angiotensin II receptor blockers–antiproteinuric effect and are cardioprotective
-can also consider calcium channel blockers and beta blockers–but probably bad idea–UGH!

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13
Q

When would you use an ARB over and ACEI?

A

when ACEI causes cough or angioedema

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14
Q

When should screening for nephropathy be done?

A

type 1: every 5 years after dx

type 2: starting at the time of dx

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15
Q

How do you decide if you need to send a pt to the nephrologist for dialysis?

A

uremic symptoms (CNS changes), fluid overload that you can’t control, high potassium, metabolic acidosis, GFR 15, creatinine 6

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16
Q

What is the leading cause of acquired blindness in the US?

A

-diabetic retinopathy

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17
Q

Nonproliferative retinopathy signs

A
  • increase capillary permeability
  • dilation of venules
  • microaneurysms–appear as dots
  • hard exudates–yellow
  • microinfarcts–cotton wool spots
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18
Q

Proliferative retinopathy signs

A
  • neovascularization (can cause glaucoma)
  • sudden vision loss
  • senile cataracts–snowflake lens opacities
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19
Q

Treatment of Diabetic Retinopathy

A
  • TIGHT GLUCOSE CONTROL!
  • aggressive HTN tx
  • statins to decrease lipid deposition
  • laser photocoagulation
  • vitrectomy if severe macular edema
20
Q

What is the pathophysiology behind the damage causing peripheral neuropathy?

A
  • thickening of the walls of vessels that supply the nerve which causes ischemia
  • segmental demyelination of schwann cells which slows nerve conduction
21
Q

Peripheral polyneuropathy

A

glove and stocking distribution–pain, numbness, hyperesthesias, and paraesthesias–eventual sensory loss of proprioception and vibration

22
Q

Can neuropathy be treated?

A

-only the symptoms, can’t be reversed

23
Q

What would you check and what tests would you do to check a diabetic’s feet?

A

-check color, sores, pressure areas, feel for pulses, cap refill, monofiliment test, reflexes, vibratory sensation, proprioception

24
Q

Treatment medications for pain and sensory issues

A

TCAs work well: Elavil (Amitryptilene)

  • aspirin, tylenol, NSAIDs
  • neurontin (gabapentin)-helps w/ neuropathic pain
  • lyrica
  • cymbalta-neuropathic pain and depression
25
Q

What are 5 types of autonomic neuropathy?

A
  • gastic dysmotility
  • orthostatic hypotension
  • cardiac rhythm distrubances
  • bladder involvement
  • erectile dysfunction
26
Q

What symptoms can be seen with gastroparesis and what can be used for treatment?

A
  • delayed emptying, constipation, n/v, diarrhea (which can all lead to hyperglycemia)
  • tx: erythromycin, imodium
27
Q

What can be done to help with orthostatic hypotension?

A

elevate head of bed
gradually change position from supine to upright
use support stockings
meds: florinef (Fludrocortisone) and midodrine (ProAmatine)

28
Q

What can be done for bladder involvement, both retention and incontinence?

A
  • retention: diuretics, self cath

- incontinence: detrol (med)

29
Q

What are two medications for erectile dysfunction?

A
  • viagra (sildenafil)

- cialis (tadalafil)

30
Q

Which cranial nerves are usually affected by mononeuropathy?

A

3,4,6,7–usually self-limiting

31
Q

Which limbs are commonly affected by mononeuropathy?

A

-femoral, sciatic, or peroneal

32
Q

What is diabetic amyotrophy?

A
  • muscle atrophy and weakness

- most commonly the anterior thigh and pelvic girdle

33
Q

How many diabetics will die from a macrovascular event?

A

-70-80%

34
Q

What are the 3 major macrovascular complications?

A

cadiovascular disease
cerebrovascular disease
peripheral arterial disease

35
Q

What mechanisms can cause atherogenesis in diabetes?

A 
abnormal lipoproteins
hypertension
insulin resistance and hyperinsulinemia
procoagulant state
hormones, growth factor, and cytokines (foam cell formation)
36
Q

What happens to the vessels in atherosclerosis?

A
  • narrowing from plaque build up causes ischemia
  • vessel obstruction from plaque rupture
  • thrombosis and formation of emboli
  • aneurysm formation from weakened vessel wall
37
Q

What is the leading cause of death of men and women in the US?

A

coronary artery disease

38
Q

What is the number one thing diabetics can do to help prevent cardiovascular, peripheral and cerebral disease?

A
  • control HTN
  • -use ace inhibitors, arb’s, and beta blockers (but becareful b/c beta blockers can mask warning signs of hypoglycemia)
  • also stop smoking, manage weight and hyperlipidemia, exercise the same amount everyday and tightly control BG
39
Q

What should dietary cholesterol be?
What should LDL be?
HDL?
TG?

A

HDL: 40 men, >50 women
TG: <200

40
Q

Healthy weight management is represented by a BMI of _____ and a waist circumference of_____

A

BMI: 18.5-24.9
Waist: men <35

41
Q

What age should someone be put on preventative low dose aspirin?

A

40

42
Q

What 4 questions should every office intake form include regarding peripheral vascular disease?

A
  1. Pain/cramping in legs when walking?
  2. Pain in legs when walking uphill or hurrying?
  3. Pain improves when sitting or standing still?
  4. Pain improves within 10 minutes of resting?
43
Q

What are the primary sites of peripheral vascular disease?

A
  • femoral and popliteal (80-90%)
  • tibial and peroneal (40-50%)
  • aorta and iliac (30%)
44
Q

What do ulcers require to heal?

A

oxygen

45
Q

What is the ankle-brachial index?

A 
SBP in ankle (doraslis pedis or post. tib.) / SBP in upper arm (brachial artery)
normal: >.90
claudication: .50-.90
rest pain: .21-.49
tissue loss: <.20
*diabetics may give false reading*

My Endocrine (4 decks)

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