Updated: 7/24/2020

Complications of Diabetes

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
100%
0%
Evidence
1
0
0
Topic
  • Snapshot
    • A 58-year-old male presents to his primary care physician for a routine checkup. He states that he has noticed some swelling of his ankles bilaterally but otherwise feels well. The patient has a 15-year history of diabetes mellitus. He takes metformin. His father died of a myocardial infarction at age 61. Routine labs are drawn. Urine dipstick is negative for protein. A spot urine microalbumin/creatinine ratio is elevated. (Diabetic nephropathy)
  • Introduction
    • Introduction
      • demographics
        • diabetes is 1 of the top 10 leading causes of death in the US
        • majority of deaths in people with diabetes is due to cardiovascular disease
      • Complications of Diabetes
      • Short-Term
      • Category
      • Complication
      • Pathogenesis
      • Hyperglycemia
      • Diabetic ketoacidosis (DKA)
      •  Hyperosmolar hyperglycemia state (HHS) 
      • Poor glycemic control
      • Hypoglycemia
      • Life-threatening hypoglycemia
      • Secondary to therapy
      • Long-Term
      • Category
      • Complication
      • Pathogenesis
      • Macrovascular
      • Coronary artery disease (CAD) 
      •  Peripheral arterial disease (PAD) 
      • Stroke 
      • Accelerated atherosclerosis due to chronic inflammation and injury to arterial walls
      • Microvascular
      • Diabetic retinopathy
      • nonproliferative
      • proliferative
      • macular edema
      •  Diabetic nephropathy
      •  Diabetic neuropathy
      • peripheral neuropathy
      • central neuropathy
      • cranial nerve III palsy
      •  Autonomic dysfunction
      • gastroparesis
      • impotence neurogenic bladder/overflow incontinence
      •  Diabetic foot 
      • Chronic hyperglycemia causes glycation of proteins and lipids resulting in impaired cell membrane function, osmotic damage, and tissue injury
      • Immune dysfunction
      • Urinary tract infections (UTIs)
      •  Rhinocerebral mucomycosis
      • Pseudomonas malignant external otitis 
      • Hyperglycemic environment enhances virulence
      •  Lower secretions of inflammatory cytokines
      •  Decreased leukocyte adherence and chemotaxis
      •  Impaired neutrophil phagocytosis
      • Other
      • Necrobiosis lipoidica
      •  Non-alcoholic fatty liver disease (NAFLD) 
  • Diabetic Nephropathy
    • Diabetic nephropathy
      • pathogenesis
        • glycosylation of basement membrane
        • increased permeability and thickened glomerular basement membrane
    • Presentation
      • hypertension
      • foamy urine
      • signs of renal failure
    • Studies
      • urinalysis
        • proteinuria
          • microalbuminuria
            • earliest sign
          • progresses to nephrotic syndrome
      • renal biopsy
        • not necessary for diagnosis
        • glomerular basement membrane thickening
        • Kimmelstiel-Wilson nodules
          • pathognomonic
    • Treatment
      • angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB)
        • regardless of blood pressure
  • Diabetic Peripheral Neuropathy
    • Peripheral neuropathy
      • pathogenesis
        • glycosylation of axon proteins
    • Presentation
      • progressive, symmetric “stocking-glove” loss of sensation, burning, or pain in distal lower extremities
      • can progress to motor weakness and areflexia
    • Studies
      • monofilament test
      • pinprick test
    • Treatment
      • pain management
        • pregabalin or gabapentin
        • serotonin norepinephrine receptor inhibitors (SNRIs) (i.e., duloxetine or venlafaxine)
    • Complications
      • diabetic foot
  • Diabetic Foot
    • Diabetic foot
      • pathogenesis
        • combination of vascular (poor circulation) and nerve (loss of sensation) damage
    • Presentation
      • painless ulcer
        • most commonly on plantar metatarsal heads
      • neuropathic arthropathy (Charcot foot)
        • acute
          • nontender, erythematous, swollen, and warm joint
        • chronic
          • joint or foot deformity
            • most commonly collapse of tarsometatarsal joint and valgus angulation
    • Imaging
      • radiograph
      • magnetic resonance imaging (MRI)
        • if osteomyelitis is suspected
    • Studies
      • to rule out infection/osteomyelitis
        • white blood cell count
        • erythrocyte sedimentation rate
        • C-reactive protein
    • Treatment
      • conservative
        • immobilization and rest
        • accommodative footwear
        • wound care and dressing changes
      • antibiotics
        • indicated for infection
      • surgery
        • indicated for
          • infection requiring debridement or osteomyelitis
          • revascularization if underlying peripheral artery disease
          • severe deformities
    • Complications
      • secondary infection
        • cellulitis
        • osteomyelitis
        • spontaneous fractures
  • Diabetic Gastroparesis
    • Diabetic gastroparesis
      • pathogenesis
        • nerve damage leading to delayed gastric emptying
    • Presentation
      • nausea
      • vomiting
      • early satiety
      • bloating
      • constipation
      • weight loss
    • Imaging
      • scintigraphy
        • delayed gastric emptying
      • endoscopy
        • rule out obstructive lesion
      • computed tomography (CT)
        • rule out obstructive lesion
    • Treatment
      • prokinetics agents
        • first-line
          • metoclopramide
        • alternatives
          • domperidone
          • erythromycin
          • cisapride
    • Complications
      • risk of postprandial hypoglycemia
  • Necrobiosis Lipoidica
    • Necrobiosis lipoidica
      • demographics
        • majority associated with diabetes mellitus
        • can also be associated with thyroid disease
        • females > males
      • pathogenesis
        • collagen degeneration and lipid accumulation in skin
    • Presentation
      • pretibial skin lesions
        • sharply demarcated, reddish-brown, or yellowish plaques with irregular margins and central sclerosis/atrophy
    • Studies
      • skin biopsy
        • palisaded and interstitial granulomas in dermis and subcutaneous tissue
        • necrobiosis of collagen
        • infiltration of lymphocytes and plasma cells
      • if no known history of diabetes mellitus or thyroid disorders, patient should be evaluated for these
    • Treatment
      • first-line
        • high-potency topical steroid
      • alternatives
        • intralesional corticosteroid
        • topical tacrolimus

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
Cards
1 of 0
Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.EC.15.11) A 45-year-old male with a 15-year history of diabetes mellitus presents to his primary care provider for a routine checkup. His doctor is concerned about his renal function and would like to order a test to detect renal impairment. Which of the following is the most sensitive test for detecting renal impairment in diabetic patients?

QID: 104336

Cystatin C levels

0%

(0/63)

Urine microalbumin to creatinine ratio

95%

(60/63)

Hemoglobin A1C

0%

(0/63)

Urine protein dipstick

2%

(1/63)

Urinalysis

2%

(1/63)

M 6 D

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (1)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (0)
Private Note