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BRS ENDOCRINOLOGY > 1b Micro and Macro-Vascular Complications of Diabetes > Flashcards

1b Micro and Macro-Vascular Complications of Diabetes Flashcards

1
Q

What are the three main microvascular complications of diabetes?

A

retinopathy
nephropathy
neuropathy

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2
Q

What are the three main macrovascular complications of diabetes?

A

Cerebrovascular Disease
Ischaemic Heart Disease
Peripheral vascular Disease

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3
Q

What is the target HbA1c level to reduce risk of microvascular complications?

A

< 53 mmol/mol

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4
Q

What does prevention of microvascular complications involve?

A

Reduction in HbA1c and Blood Pressue

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5
Q

What are some other factors which influence the development of microvascular complications of diabetes?

A

Smoking
Duration of Diabetes
Genetics
Hyperlipideamia
Hyperglycaemic memory

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6
Q

What is meant by hyperglycaemia memory?

A

When inadequate glucose control early on can result in higher risk of complications LATER - even if HbA1c is improved

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7
Q

What forms as a result of endothelial damage?

A

Mitochondrial superoxide free radicals in the endothelium

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8
Q

What are AGEs?

A

Glyctaed plasma proteins - forms Advanced Glycation End Products

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9
Q

What does the formation of AGE’s result in?

A

Kick starts the inflammatory pathways

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10
Q

What are the consequences of a damaged endothelium?

A

Leaky Capillaries
Ischaemia

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11
Q

What causes the blurred vision which is sometimes seen in patients with diabetes?

A

Swelling of the lens due to more glucose in the blood = not the same as retinopathy

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12
Q

Why is screening for retinopathy needed?

A

Early stages of retinopathy is asymptomatic , therefore screening is needed to detect it early on before it causes a visual disturbance

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13
Q

What are the three main characteristics of background retinopathy?

A

Hard exudates
Microaneurysms (dots)
Blot Haemorrhages (paint splatters)

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14
Q

What are hard exudates?

A

Leakages of lipid from the capillary

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15
Q

What are the signs of pre-proliferative retinopathy?

A

Cotton wool Spots / soft exudates
haemorrhage

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16
Q

What do the changes associated with pre-proliferative retinopathy indicate?

A

Retinal ischaemia

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17
Q

What is the sign of proliferative retinopathy?

A

Visible new blood vessels - on the disc or elsewhere in the retina

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18
Q

What is maculopathy?

A

Same disease as background retinopathy - hard exudates, but NEAR THE MACULA

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19
Q

Why is maculopathy particularly threatening?

A

Macula is important for nearby colour vision, so loss can threaten vision significantly

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20
Q

What is the first step in treating any stage of retinopathy?

A
  1. improve HbA1c, Stop Smoking, Lower Lipids
  2. Good blood pressure control
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21
Q

What is the treatment of background retinopathy?

A

Continued annual surveillace

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22
Q

What is the treatment of pre-proliferative retinopathy?

A

panretinal photocoagulation

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23
Q

What is the treatment of proliferative retinopathy?

A

Panretinal photocoagulation

24
Q

What is the treatment of maculopathy?

A

Anti-VEGF (Vascular Endothelial Growth Factor) injections directly into the eye

Grid Photocoagulation

25
Q

What is the side effect of pan-retinal photocoagulation?

A

reduces peripheral vision

26
Q

What is diabetic nephropathy associated with?

A

increase risk of Cardiovascular events

27
Q

What is the early sign of diabetic kidney damage?

A

Microalbuminuria - >2.5 mg/mol

28
Q

What is needed for a diagnosis of nephropathy?

A
  1. Progressive proteinuria
  2. Increased blood pressure
  3. Deranged renal function
  4. Peripheral oedema - advanced
29
Q

how is proteinuria measured?

A

Albumin:Creatinine Ratio (ACR)

30
Q

What is the mechanism of diabetic nephropathy?

A
  1. Hyperglycaemia and Hypertension causes pressure to build up in the glomerulus
  2. This causes proteinuria as pressure is forced out into the urine
  3. This leads to glomerular and interstitial fibrosis which damages the glomerulus
  4. GFR declines, leading to renal failure
31
Q

Describe how the RAS system works?

A
  1. Liver releases Angiotensinogen
  2. Renin from the kidney converts Antiotensinogen to Angiotensin I
  3. Angiotensin I -> Angiotensin II through ACE
32
Q

What are the two main effects of Angiotensin II?

A
  1. vasoconstriction
  2. Acts on the zona glomerulosa of the adrenal cortex to promote water reabsorption
33
Q

What are the two antihypertensive medications which are given to treat nephropathy

A

ACEi
ARB

34
Q

All diabetes patients with microalbuminuria/proteinuria should be given what?

A

ACEi / ARB, even if they have a normal blood pressure

35
Q

Microalbuminuria is a risk factor for what?

A

Cardiovascular complications

36
Q

What is the management of diabetic nephropathy?

A
  1. tighter glycaemic control
  2. ACEi/ARB
  3. Reduce BP
  4. Stop smoking
37
Q

What is neuropathy?

A

Damage to nerves

38
Q

What is the name of the small blood vessels which supply nerves called?

A

Vasa nervorum

39
Q

When does neuropathy occur?

A

When vasa nervorum get blocked

40
Q

Describe the effect of height in diabetic nephropathy?

A

Taller = longer nerves = more vulnerable to neuropathy

41
Q

Why is diabetic neuropathy most common in feet?

A

Longest nerves supply the feet - so more common

42
Q

What is the most common distribution of diabetic neuropathy?

A

Glove and Stocking distribution - worse at night

43
Q

What two things are assessed for in the foot clinic for patients at risk of diabetic neuropathy?

A

Assess Sensation
Assess Foot Pulses

44
Q

What is looked for in the annual foot check?

A

Foot ulceration

45
Q

Which patients have a higher risk of foot ulceration?

A

When you have reduced sensation to the feet - peripheral neuropathy

When you have poor vascular supply to the feet - peripheral vascular disease

46
Q

What is the management of peripheral neuropathy?

A
  1. regular foot checks
  2. Good footwear / avoid being barefoot
47
Q

What is the management of peripheral neuropathy with ulceration?

A
  1. Diabetes foot clinic
  2. Offloading
  3. revascularisation if needed
  4. Antibiotics if infected
  5. Orthotic footwear
  6. Amputation
48
Q

What is mononeuropathy?

A

Sudden motor loss eg foot drop / wrist drop

49
Q

What palsy is an example of mononeuropathy?

A

3rd nerve palsy - eye looks down and out

50
Q

What is autonomic neuropathy?

A

Damage to the sympathetic and parasympathetic nerves innnervating the GI Tract, bladder and CV system

51
Q

What are the GI effects of autonomic neuropathy?

A

Delayed gastric emptying: nausea and vomiting
Constipation / nocturnal diarrhoea

52
Q

What are the cardiovascular complications of autonomic neuropathy?

A

Postural hypertension when the blood pressure gets too low
Cardiac autonomic supply - sudden cardiac death

53
Q

What does the prevention of macro-vascular disease involve?

A

aggressive management of multiple risk factors

54
Q

What are the non-modifiable risk factors for macrovascular disease?

A

Age
Sex
birth Weight
FH/genes

55
Q

What are the modifiable risk factors for macrovascular complications?

A

Dyslipidaemia
Hypertension
Smoking
DM
Central Obesity

56
Q

How is the CV risk managed in DM?

A

Smoking Cessation
Blood Pressure - might need multiple agents
Lipid profile
Weight - discuss lifestyle intervention
Annual microalbuminuria screen

BRS ENDOCRINOLOGY (20 decks)

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