Complications of DM 1 W1

Question 1

Treatment aims

Answer 1

Initially to control/treat the symptoms of diabetes and minimise the occurrence of hypoglycaemia

Long-term to prevent development or slow the progression of complications associated with the disease

Question 2

Two major categories of diabetic complications

Answer 2

One’s caused by microvascular disease

One caused by secondary two macrovascular disease

Question 3

Microvascular disease effect

Answer 3

Eyes/retinopathy

Kidneys/nephropathy

Nerves/neuropathy

Question 4

Macrovascular disease effect

Answer 4

hypertension
hyperlipidaemia
Athlerosclerosis
Coronary artery disease

Question 5

Major controllable risk factors

Answer 5

raised blood glucose
raised blood pressure
Smoking
Weight
Diet
Physical inactivity

Question 6

HbA1c relationship with CV risk

Answer 6

For every one percent increase in glycaemia/HbA1c:

10-18% increase in cardio events

Question 7

Why are the eyes/kidneys and nerves vulnerable to damage?

Answer 7

Because the endothelial cells of the retina kidney and peripheral nervous system allow glucose to enter the cells even in the absence of insulin

Question 8

Diabetic eye disease

Answer 8

Blurred vision

Cataracts at an earlier age

Glucoma which is resistant to treatment

And most commonly written apathy

Question 9

Diabetic retinopathy is the…

Answer 9

Most common cause of blindness in people age 30 to 65 in the UK

Can be present in one third of newly diagnosed type two diabetics

Start a small haemorrhages and abnormal spots of hardened leaked fluids

Progresses to infraction of the retina

Question 10

Risk factors for diabetic retinopathy

Answer 10

• Hyperglycaemia
• Hypertension
• Duration of diabetes
• Hypercholesteraemia
• Pregnancy
• Rapid improvement in control of blood sugar (in a site threatening disease you must stabilise the retina before improving glycaemic control)

Question 11

Prevention and treatment of diabetic retinopathy

Answer 11

Development or progress progression can be prevented by:
- Good glycaemic control (blood glucose)
- Effective management of hypertension
- Avoidance of smoking
- Regular screening
- Laser treatment to seal off the leaking blood vessels

Question 12

Diabetic nephropathy is the…

Answer 12

Leading cause of N stage renal failure in Westworld

Occurs 10 to 25 years after onset of diabetes

Responsible for more than one third of patience starting renal replacement therapy

Once dialysis is required most patients will also have other complications such as retinopathy, neuropathy and autonomic dysfunction

Question 13

Proteinuria

Answer 13

Presence of protein in urine (mainly albumin)

Common sign of renal disease

Detected using urine dipstick

Question 14

Microalbuminauria

Answer 14

Presence of small amounts of albumin in the urine

Detected with specialist dipsticks

Early indicator of diabetic nephropathy

Check allium creatinine ratio

Question 15

Prevention and treatment of diabetic nephropathy

Answer 15

Improve control of blood glucose to slow progression

Aim for a HbA1c of less than or equal to 48mmol/L (6.5%)

Or less than 53 (7%) if a Type II taking oral medication which causes hypoglycaemia

Question 16

Type one NICE targets

Answer 16

<80 years old:
- ACR <70mg/mmol = <140/90
- ACR ratio >70mg/mmol = <130/80

> 80 years old:
- <150/90 regardless of ACR

Question 17

Type two NICE targets

Answer 17

<80 years old:
- ACR <70mg/mmol = <140/90
- ACR ratio >70mg/mmol = <150/80

> 80 years old:
- <150/90

Same targe as non-diabetics

Question 18

Treatment – high blood pressure

Answer 18

1st line = ACEi and ARB
2nd line id still not controlled = CCB and thiazide

Regular monitoring

Question 19

SGLT2Is e.g. dapagliflozin

Answer 19

Licensed for CKD inpatient both with and without type two

Appropriate type two(not type one) who are taking optimise dose of a CEI/ARB with ACR between 3 and 30mg/mmol