Diabetic Complications

Question 1

What eye pathologies do people with diabetes get?

Answer 1

Diabetic Retinopathy

Diabetic Macular Oedema (Maculopathy)

Cataract- clouding of the lens (develops earlier in people with diabetes)

Glaucoma- increase in fluid pressure in the eye leading to optic nerve damage. 2 x more common in diabetes

Acute hyperglycaemia- visual blurring (reversible)

Question 1

What is the screening criteria for retinopathy in diabetic patients?

Answer 1

Biannually for those at low risk

Question 2

What are the stages of retinopathy?

Answer 2

Mild non-proliferative (Background)
Moderate non-proliferative
Severe non-proliferative
Proliferative

Question 3

What are the gradings of retinopathy and maculopathy?

Answer 3

Question 4

Why is referable maculopathy something important to target immediately?

Question 5

What are treatments for retinopathy?

Answer 5

Question 6

What is diabetic macular oedema and how is it assessed and treated?

Question 7

What is diabetic nephropathy and how is it diagnosed?

Answer 7

A progressive kidney disease caused by damage to the capillaries in the kidneys’ glomeruli. It is characterized by proteinuria and diffuse scarring of the glomeruli

Diagnosis:
1) Elevated Urine Protein (Albumin) AND/OR

2) Reduced renal function (eGFR<60) twice measured 3 months apart

3) In the context of a person with diabetes

Question 8

What are consequences of diabetic nephropathy?

Answer 8

Development of hypertension

Relentless decline in renal function
- reduction in GFR of 1 ml/min/month if untreated

Accelerated vascular disease

Question 9

What is a way to standardise urinary proteinuria?

Answer 9

ACR = Albumin:Creatinine Ratio
PCR = Protein:Creatinine Ratio

These are both measured in ratio to creatinine so that the concentration of urine does not affect reading

Question 10

What is microalbuminuria?

Question 11

What is the screening criteria for nephropathy?

Question 12

How is nephropathy treated?

Question 13

How does ACEi help with nephropathy?

Answer 13

They induce vasodilation in efferent arterioles of glomeruli so there is less pressure of infiltration

Question 14

What are the types of neuropathy diabetic patients might get and what is the most common version?

Answer 14

The most common type is peripheral neuropathy

1. Peripheral e.g. pain/ loss of feeling in feet, hands
2. Proximal e.g.pain in the thighs, hips or buttocks leading to weakness in the legs (Amyotrophy)
3. Autonomic e.g. changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure
4. Focal Neuropathy e.g. sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy, cranial nerve palsy

Question 15

What are risk factors for neuropathy?

Answer 15

Increased length of diabetes
Poor glycaemic control
Type 1 diabetes > Type 2 diabetes
High Cholesterol/ Lipids
Smoking
Alcohol
Inherited Traits (genes)
Mechanical Injury

Question 16

What are the symptoms of peripheral neuropathy?

Answer 16

Numbness/ insensitivity
Tingling/ burning
Sharp pains or cramps
Sensitivity to touch
Loss of balance and coordination

Question 17

What are consequences of peripheral neuropathy?

Question 18

What are treatments for painful neuropathy (before numbness comes in)?

Question 19

What is a clinical sign of autonomic neuropathy?

Answer 19

Loss of heart rate change in response to change in respiration