Complications of diabetes

Question 1

3 main complications of diabetes

Answer 1

Neuropathy, nephropathy, retinopathy

Question 2

Symptoms of peripheral neuropathy

Answer 2

Numbness, burning, tingling, sharp pain, sensitivity to touch, loss of balance/coordination

Question 3

Examination findings of peripheral neuropathy

Answer 3

Clawing of toes, dry/cracked skin, loss of leg hair, absent pulses, cold feet

Question 4

What are the symptoms of Charcot arthropathy

Answer 4

Red, hot, swollen foot in someone with neuropathy

Question 5

Pathogenesis of Charcot arthropathy

Answer 5

Weakening of bones in the foot + progressive joint destruction due to inflammation –> dislocations, fractures, foot deformity

Question 6

Treatment of Charcot arthropathy

Answer 6

Non-weight bearing + cast

Question 7

Treatment of peripheral neuropathy

Answer 7

IF painful= Amitriptyline, duloxetine, gabapentin, pregabalin (if not tolerated/localised –> Capcaisin cream)

Question 8

What is autonomic neuropathy

Answer 8

Uncontrollable autonomic functions start to weaken such as changes in bowel and bladder function, sexual response, sweating, heart rate + BP changes

Question 9

Symptoms of gastroparesis

Answer 9

Nausea, vomiting, bloating, anorexia

Question 10

Treatment of gastroparesis

Answer 10

Improved glycaemic control, smaller portions, pro motility drugs (metaclopramide), anti-nausea (prochlorperazine)

Question 11

What are the endocrine related symptoms of autonomic neuropathy

Answer 11

Sweat glands have inability to regulated temperature causing sweating at night, gustatory sweating, anhidrosis vs hyperhidrosis

Question 12

Treatment of endocrine related symptoms of autonomic neuropathy

Answer 12

Topical glycopyrrolate, clonidine, botox

Question 13

What are the cardio related symptoms of autonomic neuropathy

Answer 13

Postural hypotension + tachycardia

Question 14

Pathogenesis of nephropathy

Answer 14

Increased glucose in the blood damages the capillaries of glomeruli causing glomerulosclerosis and resulting in proteinuria which also increases blood pressure causing further kidney damage and leading to kidney failure

Question 15

Pathogenesis of diabetic retinopathy

Answer 15

Chronic hyperglycaemia results in blood flow changes and dilation o small blood vessels –> damage of the retina

Question 16

Symptoms of diabetic retinopathy

Answer 16

Sudden changes in vision, floaters

Question 17

Signs of non-proliferative diabetic retinopathy

Answer 17

Dot + blot haemorrhages, hard exudate, cotton wool spots, intraretinal microvascular abnormalities (IMRA), abnormalities of venous calibre

Question 18

Signs of proliferative diabetic retinopathy

Answer 18

Neovascularisation of the choroid via VEGF, these vessels are fragile and haemorrhage easily causing scarring

Question 19

Treatment for diabetic retinopathy

Answer 19

Glycaemic control, pan retinal photocoagulation, victerctomy (for proliferative)

Question 20

Pathogenesis of diabetic muscular oedema

Answer 20

Increased capillary permeability results in fluid and protein deposits on the macula of the eye causing thickening and swelling

Question 21

Symptoms of diabetic macular oedema

Answer 21

Vision blurring

Question 22

Signs of diabetic macular oedema

Answer 22

Dots + blot haemorrhages, cotton wool spots, hard exudates, IMRAs

Question 23

Treatment of diabetic macular oedema

Answer 23

Glycaemic control, intravitreal anti-VEGF + ranibizumab