Diabetic Complications

Question 1

Name some diabetic complications

Answer 1

• Diabetic neuropathy,
• Diabetic foot disease
• Diabetic retinopathy

Question 2

Describe some features of diabetic foot disease

Answer 2

Occurs due to:
Neuropathy (loss of protective sensation)
PAD (increases risk factor for both macro and microvascular ischaemia.

Question 3

What are the complications of diabetic foot disease

Answer 3

Calluses, ulcerations, Charcot’s arthropathy, cellulitis, osteomyelitis, gangrene.

Question 4

Explain the screening for diabetic foot disease

Answer 4

Bi-annual screening for ischemia where all pulses should be felt. Neuropathy should be assessed for with a 10g monofilament test.

Question 5

What are the different types of diabetic neuropathy

Answer 5

• Distal Symmetrical sensory neuropathy
• Small-fibre predominate neuropathy,
• Diabetic amyotrophy,
• Mononeuritis multiplex,
  Autonomic neuropathy

Question 6

Describe features of distal symmetrical sensory neuropathy

Answer 6

This is caused by loss of large sensory fibres. It results in a glove and stocking distribution and affects touch, vibration and proprioception

Question 7

Describe features of Small-fibre predominate neuropathy

Answer 7

Deficits in pain and temp in glove and stocking distribution

Question 8

Describe features of diabetic amyotrophy neuropathy

Answer 8

Inflammation of the lumbosacral plexus or cervical plexus.
Severe pain around hips and thighs
Proximal weakness

Question 9

Describe features of mononeuritis multiplex

Answer 9

Occurs when neuropathy affects more than 2 peripheral nerves

Question 10

Describe features of autonomic neuropathy

Answer 10

Postural hypotension, gastroparesis*, constipation, urinary retention, arrhythmias, erectile dysfunction.

Question 11

What is gastroparesis

Answer 11

Paralysis of the stomach resulting in erratic blood glucose, bloating and vomiting. Management is with prokinetic agents (to help gastric emptying) eg, Metoclopramide

Question 12

What is the management for diabetic neuropathy?

Answer 12

First line is amitriptyline, gabapentin or pregabalin

Question 13

What is the screening and treatment for diabetic nephropathy

Answer 13

Screen - Early morning specimen of urine for albumin:creatinine ratio
Treatment - Dietary protein restriction. BP control < 130/80. Start ACEi or ARB

Question 14

Explain the development of diabetic retinopathy

Answer 14

Diabetic patients with poor glycaemic control can have vascular occlusion and vascular leakage of capillaries supplying the retina. This can cause retinal ischaemia, new vessel formation and loss of sight.

Question 15

What is the classification of diabetic retinopathy

Answer 15

• Non-proliferative diabetic retinopathy
• Proliferative diabetic retinopathy

Question 16

What are fundoscopy signs of mild diabetic retinopathy

Answer 16

• Microaneurysms (dots)
• Lipid deposits (hard exudates)
• Haemorrhages (blobs)

Question 17

What are fundoscopy signs of severe diabetic retinopathy?

Answer 17

• Engorged tortuous veins,
• Cotton wool spots
• Large blot haemorrhages

Question 18

What is maculopathy?

Answer 18

Macular oedema caused by leakage of vessels close to the macula. It can significantly threaten vision and needs treated urgently.