Diabetes Mellitus Complications

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  • Created by: Becca
  • Created on: 26-12-13 16:22
What are the acute complications of diabetes?
Hypoglycaemia, diabetic ketoacidosis (hyperglycaemia) & hyperosmolar hyperglycaemic state (severe hyperglycaemia without ketosis (type 2), managed as diabetic ketoacidosis)
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What causes hypoglycaemia?
Type 1: insulin overdose, excessive exercise, inadequate CHO intake. Type 2: sulphonylureas (stimulates insulin release, elderly), hepatic or renal disease, some drugs
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What are the symptoms of hypoglycaemia?
Counter-regulatory activity of SNS: palpitations/tremors/sweating/anxiety. Glucose deficiency in brain: loss of concentration/slurred speech/behavioral or mood changes/seizures/loss of consciousness
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What is the treatment for hypoglycaemia?
If conscious: sugary drink/food (10-15 mins recovery, also need snack for CHO slow release to maintain insulin levels, Glucogel). If unconscious: emergency, glucose (intra-venous) or glucagon (intra-muscular/intra-venous/sub-cutaneous)
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What is diabetic ketoacidosis? What causes it?
Diabetic coma: hyperglycaemia & metabolic acidosis (ketosis). Causes: omission/reduction in insulin dose, illness/infection, emotional upset, menstruation/pregnancy ketosis & rare syndromes of insulin resistance
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What is the treatment for diabetic ketoacidosis?
Requires urgent hospital admission, replacement of fluids/electrolytes (K+ & HCO- replacement), insulin (intra-venous) & treat underlying cause
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How are insulin levels monitored?
Urine testing (ketones/glucose), blood glucose testing & HbA-1c test (indicator of glycaemic control during the last 2-3 months)
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What are the long-term complications of diabetes?
Microvascular (damage of small vessels by hyperglycaemia & glycation of proteins): retinopathy, nephropathy, neuropathy. Macrovascular (accelerated atherosclerosis): cardiovascular disease, cerebral vascular (stroke) & peripheral vascular disease
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How is retinopathy classified?
Background (simple - microaneurysm, haemorrhages, exudates = lipid deposits), pre-proliferative & proliferative. Maculopathy - when the macula is affected
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What is nephropathy? How is it staged?
Angiopathy of capillaries of glomeruli, glomerulosclerosis. Staging: early (microalbuminuria), later (proteinuria, increased BP, decreased eGFR) & advanced (end-stage renal disease). ACEi help limit nephropathy (renoprotective) even if BP normal
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What is neuropathy? What are the symptoms?
Family of nerve disorders caused by diabetes, may affect cranial/autonomic/peripheral NS, mainly in feet (foot ulcers). Symptoms: loss of sensation, tingling, shooting pains, cramps, causalgia
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What causes macrovascular complications?
Type 1: glycaemic control. Type 2: glycaemic control, genetic predisposition & metabolic syndrome
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What is metabolic syndrome? What are the risk factors?
Clustering of CV risk factors associated with insulin resistance. Risk factors: glucose intolerance/diabetes, dyslipidaemia (high LDL, low HDL, high triglycerides), hypertension, abdominal obesity, coagulation abnormalities, etc.
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What is diabetic relevance of ischaemic heart disease?
Develops prematurely, leading cause of death in diabetes, myocardial infarction increases risk of complications, need for vigorous management of risk factors in diabetes patients (hypercholesterolaemia, hypertension)
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What are the risk of peripheral vascular disease?
Risk of gangrene/amputation/other vascular events. Diabetic foot ulcers: poor blood supply, neuropathy (poor sensation, poor healing), susceptible to infection
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What is the management of complications?
Microvascular: good glycaemic control, control of hypertension (ACEi, target = 130/80). Macrovascular: good glycaemic control, control of hypertension & dyslipidaemia (statins/fibrates), use antiplatelet drugs (LD aspirin, clopidogrel)
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Card 2

Front

What causes hypoglycaemia?

Back

Type 1: insulin overdose, excessive exercise, inadequate CHO intake. Type 2: sulphonylureas (stimulates insulin release, elderly), hepatic or renal disease, some drugs

Card 3

Front

What are the symptoms of hypoglycaemia?

Back

Preview of the front of card 3

Card 4

Front

What is the treatment for hypoglycaemia?

Back

Preview of the front of card 4

Card 5

Front

What is diabetic ketoacidosis? What causes it?

Back

Preview of the front of card 5
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