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Year 2 - T2 Theme 1 > L18 - Long term diabetic complications > Flashcards

L18 - Long term diabetic complications Flashcards

1
Q

Long term microvascular complications of diabetes

A
  • Retinopathy
  • Nephropathy
  • Neuropathy
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2
Q

Long term macrovascular complications of diabetes

A
  • IHD
  • CVD
  • PVD
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3
Q

How do most cells respond to hyperglycaemia

A
  • Most cells are able to reduce glucose transport in response to extracellular hyperglycaemia
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4
Q

Features of microvascular complication development

A
  • Microvascular complications take many years to develop
  • Rare before 5 years of type 1 diabetes
  • May be detected at presentation of type 2 diabetes
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5
Q

Features of retinopathy

A
  • Second commonest cause of blindness in those of working age
  • 4000+ in England blind from diabetic retinopathy
  • Risk of blindness increased 10-20 fold by DM
  • Glaucoma and cataract risk increased
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6
Q

Features of retinal microcirculation

A

Low density of capillaries

  • Little functional reserve
  • Flow needs to respond to local needs
  • Pericytes key to local regulation of flow
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7
Q

What are pericytes

A
  • Pericytes are contractile cells that wrap around the endothelial cells that line the capillaries and venules throughout the body
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8
Q

Pathological findings of diabetic retinopathy

A
  • Loss of pericytes
  • Basement membrane thickening
  • Capillary closure
  • Ischaemia - VEGF production + increased capillary permeability
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9
Q

What is VEGF

A

Vascular endothelial growth factor (VEGF), originally known as vascular permeability factor (VPF),[1] is a signal protein produced by cells that stimulates the formation of blood vessels

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10
Q

Clinical stages of retinopathy

A
  • Non-proliferative
    • Background
    • Pre-proliferative
  • Proliferative
  • Macular Oedema
    • Sight threatening
    • Non sight threatening
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11
Q

Features of diabetic retinopathy management

A
  • Diabetic control important
  • Blood pressure control important
  • Laser treatment
    • Pan retinal
    • Focal
  • Intra-vitreal anti VEGF Ab
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12
Q

What percentage of diabetic patients are affected by neuropathy

A
  • Affects up to 50% of diabetic patients
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13
Q

Types of neuropathy

A
  • Peripheral neuropathy
  • Mononeuropathy
  • Autonomic neuropathy
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14
Q

Complications of autonomic neuropathy

A
  • Gastroparesis
  • Postural hypotension
  • Erectile dysfunction
  • Gustatory sweating
  • Diarrhoea
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15
Q

What is entrapment neuropathy

A

Nerve compression syndrome or compression neuropathy, also known as entrapment neuropathy, is a medical condition caused by direct pressure on a nerve

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16
Q

Features of renal microcirculation

A
  • Fenestrated glomerular capillaries
  • Basement membrane
  • Highly specialised podocytes
17
Q

Pathological findings of diabetic nephropathy

A 
· Basement membrane thickening
	- Loss of negative charge 
· Podocyte loss
	- Loss of integrity of filtration barrier
· Glomerular sclerosis
· Mesangial expansion
18
Q

At what level does the dipstick test become positive for albuminuria

A
  • > 200ug.min^-1

- >300 mg.24hr^-1 - GFR

19
Q

Features of diabetic neuropathy management

A

· Blood pressure control important
· Blockers of RAS system preferred
· Glucose control important but less so once overt proteinuria
· Associated with increased CVD risk
· Ultimately renal replacement / transplantation

20
Q

Duration of macrovascular disease in patients with T1DM

A
  • Patients with type 1 diabetes have long disease duration
21
Q

What does the presentation of macrovascular disease depend on

A
  • Angina/MI
  • Stroke
  • PVD
22
Q

Modifiable risk factors linked to macrovascular disease

A
  • Blood pressure
  • Lipids
  • Smoking
  • Glucose control
23
Q

Causes of diabetic foot ulcers

A

· Diabetes is the commonest cause of non-traumatic lower limb amputation
• PVD
• Neuropathy (neuropathic ulcer, Charcot change)
• Imapaired leucocyte function

24
Q

Link between HbA1c levels and risk of microvascular complications

A
  • Direct positive correlation

Year 2 - T2 Theme 1 (20 decks)

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