Chronic Complications Of Diabetes

Question 1

name some macrovascular complications of diabetes

Answer 1

IHD, stroke

Question 1

name 3 microvascular complications of diabetes

Answer 1

neuropathy, nephropathy, retinopathy

Question 1

name some other complications of diabetes

Answer 1

cognitive dysfunction, erectile dysfunction, psychiatric complications

Question 2

what is usually done at a patient’s yearly diabetic review ? (3)

Answer 2

digital retinal screening
foot risk assessment
urine albumin/creatine ratio and serum creatine

Question 3

how do advanced glycation end products form

Answer 3

glucose binds irreversibly to methyl glyoxal

Question 4

result of the formation of advanced glycation end products

Answer 4

tissue injury and inflammation via stimulation of pro-inflammatory factors e.g. cytokines and complement

Question 5

what is sorbitol formed from

Answer 5

glucose + aldose reductase

Question 6

effect of increased flux of glucose through the sorbitol-polyol pathway

Answer 6

sorbitol and fructose accumulate causing changes in vascular permeability, cell proliferation and capillary structure via the stimulation of protein kinase C and TGF-β

Question 7

what is another name for diabetic eye disease

Answer 7

retinopathy

Question 8

what is retinopathy

Answer 8

damage to the retina

Question 9

pathophysiology of non-proliferative retinopathy

Answer 9

damage to the wall of small vessels cause microaneurysms and then intraretinal haemorrhages
blood leaves hard exudates
ischaemia due to occluded vessels cause cotton wool spots

Question 10

what are the 3 types of haemorrhage associated with diabetic retinopathy

Answer 10

dot, blot and flame

Question 11

what occurs in proliferative retinopathy

Answer 11

blockage of blood vessels leads to areas of non-perfusion and ischaemia
abnormal blood vessels begin to grow on the surface of the retina -> very fragile

Question 12

management of retinopathy

Answer 12

laser: panretinal photocoagulation
vitrectomy in a vitreal haemorrhage

Question 13

how does panretinal photocoagulation work

Answer 13

reduces oxygen requirement of the retina so reduces the ischaemia that is driving the retinopathy

Question 14

what happens in diabetic macular oedema

Answer 14

retinal thickening and oedema including the macula, hard exudates and macula ischaemia

Question 15

how is diabetic macular oedema investigated

Answer 15

optical coherence tomography

Question 16

management of diabetic macular oedema

Answer 16

intravitreal anti-VGEF

Question 17

name 3 other eye complications of diabetes

Answer 17

earlier development of cataracts
glaucoma is more likely
hyperglycaemia can cause reversibly vision blurring

Question 18

what is diabetic nephropathy

Answer 18

progressive kidney disease caused by damage to the capillaries in the glomeruli

Question 19

what are other names for diabetic nephropathy

Answer 19

kimmelsteil-wilson syndrome or nodular glomerulosclerosis

Question 20

what is diabetic nephropathy characterised by

Answer 20

proteinuria and diffuse scarring of the glomeruli

Question 21

dipstick investigation of diabetic nephropathy

Answer 21

may show proteinuria

Question 22

how do we establish microalbuminuria in diabetic nephropathy

Answer 22

ACR <30 or PCR<50

Question 23

management of diabetic nephropathy

Answer 23

microalbuminuria: ACEi/ARB to decrease filtration proteinuria should also be started on SLGT2i with microalbuminuria manage other vascular complications

Question 24

how do we reduce the risk of diabetic nephropathy

Answer 24

good glycaemic control

Question 25

complications of diabetic nephropathy

Answer 25

hypertension, decline in renal function, accelerated vascular disease

Question 26

what is diabetic neuropathy

Answer 26

damage to peripheral nervous tissue

Question 27

risk factors for diabetic neuropathy

Answer 27

increased length of diabetes, poor glycaemic control, smoking, drinking, mechanical injury

Question 28

what type of diabetes is neuropathy more commonly associated with

Answer 28

T1DM

Question 29

what is peripheral neuropathy

Answer 29

symmetrical pain/loss of feeling in hands and feet

Question 30

what kind of distribution is said to be seen in peripheral neuropathy

Answer 30

glove and stocking

Question 31

symptoms of peripheral neuropathy

Answer 31

numbness, tingling/burning, sharp pains, sensitivity to touch, loss of balance and coordination

Question 32

name 4 complications of peripheral neuropathy

Answer 32

foot ulcer claw foot and callus formation charcot foot painless trauma

Question 33

name a clinical sign that can be seen in peripheral neuropathy

Answer 33

argyll robertson pupil

Question 34

what is argyll robertson pupil

Answer 34

small bilateral pupils that don't constrict when exposed to bright light but do constrict when focused on a nearby object

Question 35

symptoms of charcot foot

Answer 35

acute onset of hot, swollen foot +/- pain deformation due to destruction of bone if treatment is delayed radiological consolidation and stabilisation after 6-12 months

Question 36

investigation of charcot foot

Answer 36

MRI to differentiate between infection

Question 37

management of charcot foot

Answer 37

minimise bony destruction by keeping pressure off the foot

Question 38

what does charcot foot predispose patients to

Answer 38

ulceration

Question 39

what is claw foot

Answer 39

interosseous wasting results in unbalanced traction by the long flexor muscles

Question 40

why does neuropathy cause callus formation

Answer 40

abnormal distribution of pressure on walking

Question 41

name 4 drugs that can be used in the management of painful neuropathy

Answer 41

amitriptyline, duloxetine, gabapentin or pregabalin

Question 42

what can be used to manage painful neuropathy in patients who don't want systemic treatment

Answer 42

topical capsaicin cream

Question 43

what is autonomic neuropathy

Answer 43

affects the nerves regulating the heart rate and blood pressure as well as control of internal organs

Question 44

what is autonomic neuropathy usually associated with

Answer 44

a long history of very poor diabetes

Question 45

affect of autonomic neuropathy on digestion

Answer 45

gastric slowing gastroparesis dysphagia due to oesophagus nerve damage

Question 46

management of gastroparesis in diabetes

Answer 46

improve glycaemic control diet: smaller, more frequent meals metoclopramide (promotility) anti-nausea analgesia

Question 47

management of severe gastroparesis in diabetes

Answer 47

consider botox or a gastric pacemaker

Question 48

give 2 examples of anti-nausea meds

Answer 48

ondansetron, prochlorperazine

Question 49

how can autonomic neuropathy affect the sweat glands

Answer 49

lack of thermoregulation profuse sweating at night or gustatory sweating

Question 50

what is gustatory sweating

Answer 50

sweating while eating

Question 51

effects of autonomic neuropathy on the heart and blood vessels

Answer 51

postural hypertension tachycardia ECG: loss of R-R variability

Question 52

what causes proximal neuropathy

Answer 52

damage to the nerves of the lumbosacral plexus

Question 53

who commonly presents with proximal neuropathy

Answer 53

elderly T2DM

Question 54

what is proximal neuropathy commonly associated with

Answer 54

weight loss

Question 55

clinical presentation of proximal neuropathy

Answer 55

pain in the buttocks, hips, thighs or legs followed by variable weakness in the proximal muscles of the lower limbs and then muscle wasting

Question 56

what is focal neuropathy

Answer 56

sudden weakness in one nerve or a group of nerves can cause pain

Question 57

give examples of focal neuropathy

Answer 57

carpal tunnel syndrome, cranial nerve palsy