3: Microvascular complications of diabetes

Question 1

What are the three main microvascular complications of diabetes?

Answer 1

Neuropathy

Nephropathy

Retinopathy

Question 2

What are the end-stage outcomes of

retinopathy

nephropathy

neuropathy?

Answer 2

Retinopathy - blindness

Nephropathy - dialysis

Neuropathy - amputation

Question 3

The (better / poorer) your glycaemic control, i.e the higher your level of ___, the greater your risk of microvascular complications.

Answer 3

poor glycaemic control

higher HbA1c levels

more complications

Question 4

Good glycaemic control should be achieved ___ to avoid microvascular complications.

Answer 4

early

Question 5

What causes microvascular complications in hyperglycaemia?

Answer 5

Hypoxia

Oxidative stress

Build-up of end products

leading to inflammation

something about mitochondrial dysfunction

Question 6

What is peripheral neuropathy?

Answer 6

Loss of feeling

Pain

in the hands and feet.

Question 7

What is autonomic neuropathy?

Answer 7

Damage to autonomic nerves producing:

changes in bowel habit, bladder function, sexual function, sweating, HR, BP…

basically everything controlled by autonomic nerves.

Question 8

Peripheral neuropathy tends to have a “_____” distribution.

Answer 8

glove and stocking

Question 9

What kind of pain do patients with peripheral neuropathy have?

Answer 9

Burning / tingly pain

Question 10

Patients with peripheral neuropathy often develop numbness.

What can this lead to?

Answer 10

Accumulation of injuries (burns, ill-fitting shoes)

Question 11

What eponymous name is given to the “bag of bones” appearance of a foot in peripheral neuropathy?

Answer 11

Charcot foot

Question 12

Can drugs treat the loss of sensation in peripheral neuropathy?

Answer 12

No

Pain only

Question 13

What are the treatment options for painful peripheral neuropathy?

Answer 13

Amitriptyline

Duloxetine

Gabapentin

Pregabalin

i.e atypical analgesics

Topical capsaicin cream

Question 14

How can Charcot foot be avoided?

Answer 14

Appropriate footwear

Regular checking of feet

Question 15

What are some presentations of autonomic neuropathy?

Answer 15

Tachycardia

Postural hypotension

Gastroparesis

Dysphagia

Question 16

Why does gastroparesis pose a concern in diabetics?

Answer 16

Affects blood glucose levels due to abnormal digestion, vomiting, diarrhoea etc.

Question 17

What drug is commonly used to treat gastroparesis in diabetics with autonomic neuropathy?

Answer 17

Metoclopramide

Question 18

Improving ___ control often improves the symptoms of diabetes complications.

Answer 18

glycaemic

Question 19

How is gastroparesis treated?

Answer 19

Dietary - smaller, more frequent meals, low fat and fibre

Promotility drugs (revise these)

Botox

Gastric pacemaker

Question 20

What are two cardiovascular presentations of autonomic neuropathy?

Answer 20

Hypertension / postural hypotension

Tachycardia

Question 21

How is peripheral neuropathy screened for?

Answer 21

Hand / foot exam once a year

Question 22

What other investigations can be done for neuropathy?

Answer 22

Nerve conduction studies, EMG

Heart rate

Ultrasound of bladder for prolonged emptying

Gastric emptying study

Question 23

What is a kidney complication of diabetes?

Answer 23

Nephropathy

Question 24

Many patients on ___ also have diabetes.

Answer 24

dialysis

Question 25

What are the consequences of diabetic nephropathy?

Answer 25

**Hypertension** \> accelerated CVD **Renal dysfunction**

Question 26

How is diabetic nephropathy screened for?

Answer 26

**Albumin / creatinine ratio (ACR)**

Question 27

What is the name for an increase in albumin found in the urine, and is an indicator of renal damage?

Answer 27

**Microalbuminuria**

Question 28

Renal disease secondary to diabetes accelerates ___ disease.

Answer 28

**cardiovascular**

Question 29

What is the blood pressure target for diabetic patients?

Answer 29

**\< 130 / 80 mmHg**

Question 30

What is the HbA1c target for patients with diabetes?

Answer 30

**\< 53 mmol/mol** **ideally \< 48**

Question 31

What is an eye symptom of **acute** hyperglycaemia?

Answer 31

**Visual blurring**

Question 32

Chronically, diabetes can lead to which eye complications?

Answer 32

**Retinopathy** **Cataracts** **Glaucoma**

Question 33

Which structures of the retina are damaged in diabetic neuropathy?

Answer 33

**Macula** **Fovea** (dip within macula) both responsible for central vision

Question 34

What are the two stages of diabetic retinopathy?

Answer 34

**Non-proliferative** **Proliferative** (leading to bleeding and vision disturbance)

Question 35

If no or minor retinopathy is found on retinal screening, what is done?

Answer 35

**Rescreening later**

Question 36

If significant retinopathy is found on retinal screening, what is done?

Answer 36

**Referral to an opthalmologist**

Question 37

Apart from retinal photographs, what other imaging can be used to view the eye?

Answer 37

**Optical coherence tomography**

Question 38

How is retinopathy treated?

Answer 38

**Laser treatment** **Anti-VEGF injections**

Question 39

What is a complication of diabetes in men?

Answer 39

**Erectile dysfunction**