diabetes complication

Question 1

relationship of risk with rising HbA1c

Answer 1

risk of microvascular complication:
highest=retinopathy
nephropathy,
lowest=neuropathy

also risk-microalbuminuria

Question 2

target HbA1c to reduce complications?

Answer 2

53mmol/mol

Question 3

what is a risk of hypertension (increasing blood pressure)

Answer 3

MI
microvascular complication

Question 4

other factors that increase risk of microvascular complications

Answer 4

duration of diabetes
smoking
genetic factors
hyperlipidaemia
hyperglycaemic memory

Question 5

mechanism of damage that cause microvascular complications

Answer 5

Hyperglycaemia

1. Increased mitochondrial superoxide free radicals in endothelium
2. Form glycated plasma proteins. Then form advanced glycation end products (AGEs)

3.Activation of inflammatory pathways

4.Damaged endothelium cause ‘Leaky’ capillaries/Ischaemia/microvascular complications

Question 6

3 factors that increase inflammatory signalling cascade in mechanism of damage

Answer 6

AGE–rage
oxidative stress
hypoxia

Question 7

background retinopathy

Answer 7

hard exudates (cheese colour, lipid)

microaneurysms (small dots)

blot haemorrhages

Question 8

pre-proliferative retinopathy

Answer 8

cotton wool spots- soft exudates =retinal ischaemia

haemorrhages (chunkier)

Question 9

proliferative retinopathy

Answer 9

visible new vessels
on disc/elsewhere in retina

Question 10

maculopathy

Answer 10

hard exudates/oedema near macula
same as background but near macula
can threaten vision
cotton wool spots can also be seen

Question 11

treatment of retinopathy and maculopathy

Answer 11

background-continued annual surveillance

pre-proliferative -early panretinal photocoagulation

proliferative -panretinal photocoagulation

diabetic maculopathy-
oedema: anti-VEGF injection in eye
grid photocoagulation

Question 12

annual urine sample for ACR
what is microalbuminuria, what is proteinuria

what to give pt’s with this

Answer 12

Microalbuminuria
>3 mg/mmol

Proteinuria = ACR > 30mg/mmol

either ACEi/ARB-even if normotensive

Question 13

what cause false positive for UARC

Answer 13

Fever, urine infection

Question 14

what happens when you get UACR positive

Answer 14

repeated to confirm microalbuminuria

Question 15

mechanism of diabetic nephropathy

Answer 15

1. diabetes=hyperglycaemia and hypertension

2.glomerular hypertension

3. proteinuria

4.glomerular and interstitial fibrosis

5. GFR declines
6. renal failure

Question 16

management of diabetic nephrapathy-HbA1c to what? What med? target BP? Lifestyle treatment? what to do if pt also have T2DM

Answer 16

HbA1c under 53
ACEi/ARB
reduce BP to 130/80mmHg
stop smoking
start SGLT-2 inhibitor if T2DM

Question 17

diabetic neuropathy when it occurs and name of blood vessel supplying verve

Answer 17

when vasa nervorum gets blocked

Question 18

diabetic foot ulceration what to look for in annual checks

Answer 18

annual foot check:
-foot deformity/ulceration
-sensation
-foot pulse

Question 19

risks of foot ulcerations in pts with:

Answer 19

peripheral neuropathy
-reduced sensation to feet
-poor vascular supply to feet

Question 20

management of diabetic foot disease peripheral neuropathy and peripheral neuropathy with ulceration

Answer 20

peripheral neuropathy
1. Regular inspection of feet by affected individual
2. Good footwear
3. Avoid barefoot walking
Podiatry and chiropody if needed

Peripheral neuropathy with ulceration
1.Multidisciplinary diabetes foot clinic
2.Offloading
3.Revascularisation if concomitant PVD(peripheral vascular disease)
4.Antibiotics if infected
5.Orthotic footwear
6.Amputation if all else fails

Question 21

mononeuropathy

Answer 21

-sudden motor loss-ie wrist/foot drop
cranial nerve palsy -double vision-(cn3)

Question 22

autonomic neuropathy

Answer 22

damage to sympathetic/parasympathetic nerve innervating:
1.GI
delayed gastric emptying-N+V
constipation/nocturnal diarrhoea

2.CV
-posturap hypotension
sudden cardiac death