Diabetes Mellitus

Question 1

Diabetes and its complications account for what percentage of mortality worldwide in 20-79 year olds?

Answer 1

14.5%

Question 2

What percentage of the NHS budget is spent on diabetes and related problems?

Answer 2

10%

Question 3

Which factor increases the risk of developing complications in diabetes?

Answer 3

Worsening glycaemic state

Question 4

Name three macrovascular complications?

Answer 4

Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease

Question 5

Name three microvascular complications?

Answer 5

Retinopathy
Nephropathy
Neuropathy

Question 6

What forms atherosclerotic plaques?

Answer 6

Macrophages and foam cells
Intracellular lipids
Extracellular lipids
Fibrotic and calcified layers
Damage to surface resulting in exposure to platelets and clotting

Question 7

Describe the dyslipidaemia present in people with diabetes?

Answer 7

HDL cholesterol is lower

Triglycerides are higher

LDL cholesterol is in the form of a small dense particle which are worse

Question 8

What additional issues are resultant of atherosclerosis in diabetes? (one is dyslipidaemia)

Answer 8

Endothelial dysfunction

Hypercoagulability

Question 9

What is the result of peripheral vascular disease?

Answer 9

Causes lower limb ischaemia, which can lead to ulcers and poor healing .

Amputation is a potential outcome.

Question 10

How can you prevent macrovascular disease?

Answer 10

Good diabetic control

Blood pressure control

Lipid control

Smoking cessation, weight, exercise

Question 11

What is the limit for HbA1c?

Answer 11

<58 mmol/mol

Question 12

How would you manage a foot ulcer?

Answer 12

Debridement
Specialist podiatrist
IV antibiotics
X-ray to check for osteomyelitis

Rest and avoid pressure on ulcer

Question 13

Describe the two types of retinopathy?

Answer 13

Non-proliferative diabetic retinopathy (retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality)

Proliferative Diabetic Retinopathy (Retinal ischaemia, new vessel formation, vitreous haemorrhage, retinal tears/detachment - treat with laser photocoagulation)

Question 14

What percentage of people with Type 1 and Type 2 diabetes will develop some form of retinopathy 20 years after diagnosis?

Answer 14

100% Type 1

60% Type 2

Question 15

What treatments are recommended for retinopathy in diabetics?

Answer 15

Improve glycaemic control

Laser photocoagulation

Question 16

What is nephropathy?

Answer 16

Microalbuminuria (leak of albumin)

Question 17

What changes can be observed in nephropathy resulting in renal dysfunction?

Answer 17

Glomerular basement membrane changes
Mesangial tissue proliferation
Glomerular hypertension

Question 18

What can happen if renal disease is unchecked?

Answer 18

Progressive renal failure leading to end-stage renal disease.

Question 19

What is the mortality caused by renal failure in Type 1 and Type 2 diabetes?

Answer 19

21% in Type 1

11% in Type 2

Question 20

How can we prevent/treat nephropathy?

Answer 20

Screen urine for albumin!!

Diabetes control
Renin-angiotensin system blockade (angiotensin inhibitor, ACEi, renin inhibitor)
Hypertension control

Question 21

Describe sensory neuropathy?

Answer 21

Objective loss, particularly in feet or lower legs

Subjective symptoms especially paresthesia

Question 22

What can lack of sensation lead to?

Answer 22

Development of neuropathic ulcers, which alongside poor macrovasculature, leads to severe foot infections.

Question 23

Describe autonomic neuropathy?

Answer 23

Can cause GI effects and CVS (tachycardia, BP fluctuations).

Question 24

What does CPR stand for in foot care?

Answer 24

Check
Protect
Refer

Question 25

What other conditions can be complications associated with diabetes?

Answer 25

Erectile dysfunction

Depression