Diabetes (Microvascular & Macrovascular Complications)

Question 1

Small vessels of which organs are particularly affected by diabetic microvascular disease?

Answer 1

Retina
Glomeruli
Nerve sheaths

Question 2

What are the two types of diabetic retinopathy?

Answer 2

Non-proliferative

Proliferative (more common in T2DM)

Question 3

What are the risk factors for diabetic retinopathy?

Answer 3

Poor glycaemic control
Smoking
Hypertension
Pregnancy

Question 4

Describe non-proliferative diabetic retinopathy

Answer 4

Usually asymptomatic
Occurs after 8-10y DM
Can progress into proliferative diabetic retinopathy

Question 5

What features of NPDR can be seen on fundoscopy?

Answer 5

Micro-aneurysms
Exudates
Haemmorhages (dot, blot, flame)
Cotton wool spots

Question 6

Describe proliferative diabetic retinopathy

Answer 6

Development of new vessels on optic disc/retina, as a response to retinal ischaemia
Fragile vessels, often bleed
Can lead to fibrosis/retinal detachment
Can cause acute angle closure glaucoma (rubeosis iridis)

Question 7

What other ocular conditions can occur in DM?

Answer 7

Diabetic maculopathy
Glaucoma
Cataract formation

Question 8

What is diabetic sensorimotor neuropathy?

Answer 8

Damage to vessels supplying nerves leading to eventual damage to/loss of function of peripheral nerves

Question 9

What neurological syndromes can develop because of DM?

Answer 9

Symmetrical polyneuropathy
Acute painful neuropathy
Mononeuropathy
Diabetic amyotrophy
Autonomic neuropathy

Question 10

Describe symmetrical polyneuropathy

Answer 10

‘glove and stocking’ sensory loss - Vibration, pain, temp loss first
Loss of balance (worse when eyes closed)
Interosseous foot wasting
Foot ulcers

Question 11

Describe acute painful neuropathy

Answer 11

Burning pains in feet, shins, anterior thighs
Typically worse at night
Associated w/ poor glycaemic control
Treated by improving glycaemic control (3/12)

Question 12

Describe mononeuropathy

Answer 12

Cranial nerve lesions/isolated peripheral lesions

• CN III, IV & VI (ocular palsies)
• Foot drop (sciatic)

Question 13

Describe diabetic amyotrophy

Answer 13

Progressive wasting of muscle, typically quadriceps
Variable course
Rare, develops in middle aged men

Question 14

What are the symptoms of autonomic neuropathy affecting the SNS?

Answer 14

Postural hypotension
Ejaculatory failure
Reduced sweating
Horner’s syndrome

Question 15

What are the symptoms of autonomic neuropathy affecting the PNS?

Answer 15

Erectile dysfunction
Constipation
Urinary retention
Holmes-Adie pupil

Question 16

What are the macrovascular complications of DM?

Answer 16

Risk factor in development of atherosclerosis

• 2x risk of stroke
• 4x risk of MI
• 50x risk of amputation for gangrene

Question 17

What is diabetic foot disease?

Answer 17

DM patients are at a greater risk of PAD/neuropathy and developing infections they cannot clear leading to frequent/severe foot problems

Question 18

What are the risk factors for diabetic foot disease?

Answer 18

PAD
Peripheral neuropathy
Previous amputation
Previous ulceration
Presence of callus
Joint deformity
Vision/mobility problems
Male sex

Question 19

What are the consequences of diabetic foot disease?

Answer 19

Foot complications common (10%)

0.5-5% diabetics receive major amputation

Question 20

What is the management of NPDR?

Answer 20

Good glycaemic control

Question 21

What is the management of PDR?

Answer 21

Pan-retinal photocoagulation

Vitrectomy (if persistent vitreous haemorrhage)

Question 22

What is diabetic maculopathy?

Answer 22

A specific form of retinopathy affecting the macula

Question 23

How does diabetic maculopathy present?

Answer 23

Blurring of vision

Question 24

What is the management of diabetic maculopathy?

Answer 24

Focal laser
Mixed maculopathies (focal, diffuse, ischaemic) need complex treatment

Question 25

How do cataracts present?

Answer 25

Age-related (post sub-capsular most common)

Trouble w/ bright sun/headlights & reading

Question 26

How does glaucoma present?

Answer 26

Open-angle glaucoma

Asymptomatic unless extremely restricted fields

Question 27

What is Charcot’s foot?

Answer 27

Neuropathic arthropathy

Weakened bones & repeated fractures lead to the foot changing shape

Question 28

What is Horner’s Snydrome?

Answer 28

Sympathetic trunk lesion causing characteristic sx

• Miosis
• Partial Ptosis
• Hemifacial anhidrosis

Question 29

What is a Holmes-Adie Pupil?

Answer 29

Neurological disorder affecting pupil and ANS

• Dilated pupil
• Reacts slowly to light
• Absent deep tendon reflexes

Question 30

What is the underlying pathology of diabetic renal disease?

Answer 30

Direct glomerular damage - BM thickening, leakiness of capillary wall, proteinuria –> CKD
Ischaemia - Atherosclerosis causing reduced eGFR & glomerular ischaemia
Ascending infection

Question 31

What is the most common cause of death in young diabetics?

Answer 31

CKD

Question 32

What is the most important aspect of managing diabetic nephropathy?

Answer 32

BP control (<130/80)

Question 33

What is microalbuminuria?

Answer 33

Presence of low levels of albumin in the urine

Signifies glomerular damage

Question 34

What investigations show microalbuminuria?

Answer 34

-ve urine dip

Early morning albumin:creatinine ratio >3

Question 35

How often should pts be tested for microalbuminuria?

Answer 35

6 monthly

Question 36

What is the key management step in microalbuminuria?

Answer 36

Start ACEi, regardless of BP