Endo 16 - Microvascular and Macrovascular Complications of DM

Question 1

State the three main sites of microvascular complications.

Answer 1

Retinal artiers
Glomerular arteries
Vasa Vasorum

Question 2

What factors correlate with the risk of microvascular and macro complications?

Answer 2

HbA1c - glycaemic control

hypertension

Question 3

Describe the mechanism of glucose damage to blood vessels

Answer 3

Hyperglycaemia leads to oxidative stress and hypoxia

triggers inflammatory cascade which leads to damage

Question 4

What are the 4 types of diabetic retinopathy?

Answer 4

Background
Pre-proliferative
Proliferative
Maculopathy

Question 5

What 3 things do you see in background retinopathy?

Answer 5

hard exudates
microaneurysms
blot haemiorrhages

Question 6

What are hard exudates caused by?

Answer 6

leakage of lipid contents - looks cheesy

Question 7

Describe pre-proliferative diabetic retinopathy.

Answer 7

soft exudates - cotton wool

haemorrhages

Question 8

What do soft exudates indicated?

Answer 8

Retinal ischaemia

Question 9

Describe proliferative retinopathy.

Answer 9

formation of new blood vessels in response to retinal ischaemia

new blood vessels are fragile and can bleed easily

Question 10

Describe maculopathy

Answer 10

presence of hard exudates in the macula

threatens direct vision

Question 11

How would you manage background retinopathy?

Answer 11

control blood glucose

Question 12

What is the treatment for pre-proliferative and proliferative retinopathy?

Answer 12

pan-retinal photocoagulation

Question 13

Describe the treatment of maculopathy.

Answer 13

grid of photocoagulation

Question 14

What is the overproduction of matrix in diabetic nephropathy caused by?

Answer 14

prolonged exposure to high glucose

angiotensin II

Question 15

State 3 clinical features of diabetic nephropathy.

Answer 15

Progressive proteinuria
increased blood pressure
deranged renal function

Question 16

Whatis the normal range for proteinuria?

Answer 16

<30mg/24 hours

Question 17

Why do patients with diabetic nephropathy get oedematous?

Answer 17

increased proteinuria = decreased serum albumin = decreased osmotic potential = less fluid drawn back in

Question 18

Describe some strategies for intervention for patients with diabetic nephropathy.

Answer 18

Better blood glucose control
blood pressure control
inhibition of RAAS system

Question 19

What effect does angiotensin II have on endothelial cells?

Answer 19

makes endothelial cells more rigid

Question 20

Where is renin produced?

Answer 20

Juxtoglomerular cells

Question 21

What can stimulate renin release?

Answer 21

low renal perfusion e.g. low blood pressure

Question 22

Where is ACE found?

Answer 22

Lungs

Question 23

State some drug target sites in the RAAS.

Answer 23

ACE inhibitors

ARB

Question 24

What causes diabetic neuropathy?

Answer 24

occlusion of vasa vasorum

Question 25

State 6 different types of diabetic neuropathy.

Answer 25

``` Peripheral polyneuropathy Mononeuropathy Mononeuritis multiplex Radiculopathy Autonomic neuropathy Diabetic amyotrophy ```

Question 26

What can peripheral neuropathy lead to?

Answer 26

loss of sensation can lead to damage not being noticed loss of ankle verks and vibrational sense

Question 27

How would you test for peripheral neuropathy?

Answer 27

Monofilament examination - produces a certain amount of force, see if patient can feel

Question 28

What is mononeuropathy?

Answer 28

Sudden motor loss .e.g wrist drop

Question 29

Why is the pupil spared in pupil sparing third nerve palsy?

Answer 29

parasympathetic fibres that are responsible for the diameter of the pupil run on the outside of the main nerve so don't lose blood supply

Question 30

How would an aneurysm causing third nerve palsy present | differently to third nerve palsy caused by diabetes?

Answer 30

There would be fixed pupil dilation | This is because the parasympathetic fibres would also be affected

Question 31

What is mononeuritis multiplex?

Answer 31

random combination of peripheral nerve lesions

Question 32

What is radiculopathy?

Answer 32

pain over spinal nerves

Question 33

What are the effects of autonomic neuropathy on the GI?

Answer 33

difficulty swallowing late gastric emptying constipation

Question 34

What are the effects of autonomic neuropathy on the CVS?

Answer 34

Postural hypotension