L4: Microvascular Complication in DM

Question 1

what are microvascular complications of DM?

Answer 1

1) Diabetic Retinopathy

2) Diabetic Nephropathy

3) Diabetic Neuropathy

Question 2

Mechanism of Hyperglycemia induced Damage

Answer 2

• Increased Polyol - sorbitol Pathway flux
• Increased AGES formation
• Activation of protein kinase C
• Increased Hexosamine pathway flux.

Question 3

what are Eye complications of DM?

Answer 3

• Catarct
• Retinopathy

Question 4

Stages of Retinopathy

Answer 4

1) Background

2) Pre-proliferative

3) Proliferative

4) Advanced diabetic eye disease

5) Maculopathy

Question 4

Mechanism of Cataract in DM

Answer 4

• Non enzymatic glycation of lens protein and subsequent cross linking
• Sorbitol accumulation could also lead to osmotic swelling of the lens but evidence of involvement in cataract formation is less strong

Question 5

Prevelance & Incidence of Ritonapthy in DM

Answer 5

• DR is the leading cause of blindness in the working population of the Western world
• The prevalence increase with the duration of the disease
• (Few within 5 years, 80 – 100% will have some form of DR after 20 years)

Question 6

Maculopathy is most common in type ….. patients and can cause severe visual loss

Answer 6

2

Question 7

Charactes of Background Retinopathy

Answer 7

• Micro aneurysms ( 1st to occur )
• Scattered exudates
• Hemorrhages (flame shaped, Dot and Blot)
• Cotton wool spots (<5)
• Venous dilatations

Question 8

Charactes of Pre-Proliferative Retinopathy

Answer 8

• Rapid increase in amount of micro aneurysms
• Multiple hemorrhages
• Cotton wool spots (>5)
• Venous beading, looping and duplication

Question 9

Charactes of Proliferative Retinopathy

Answer 9

• Proliferative Retinopathy
• New vessels (on disc, elsewhere)
• Fibrous proliferation (on disc, elsewhere)
• Hemorrhages (preretinal, vitreous)

Question 10

Charactes of Advanced Diabetic Eye Disease

Answer 10

• Advanced Diabetic Eye Disease
• Retinal detachment with or without retinal tears.
• Rubeosis iridis.
• Neovascular Glaucoma

Question 11

Characters of Maculopathy in DM

Answer 11

• Macular edema ( focal or diffuse )
• Ischemic maculopathy

Question 12

what are other ocular Complications?

Answer 12

Question 13

Prevelance in Diabetic Nephropathy

Answer 13

• Diabetes has become the most common cause of end stage renal failure in the US and Europe
• 50 % of dialysis patients have DM
• About 20 – 30 % of patients with diabetes develop evidence of nephropathy
• The prevalence of DN is higher in Black Americans than in Whites

Question 14

Stages of Diabetic Nephropathy

Answer 14

Question 15

Which Stages of nerphropathy are reversible with TTT?

Answer 15

Incipient nephropathy (reversible with ttt)

Question 16

Which Stages of Diabetic Nephropathy are Irreversibel with TTT?

Answer 16

Overt nephropathy

Question 17

What are other Renal Complications of DM?

Answer 17

• Infection: as cystitis, Pyelonephritis & acute necrotizing papillitis
• Increase incidence of renal stones d.t. recurrent infection & stasis

Question 18

what are types of Diabetic Neuropathy?

Answer 18

Question 19

what is the most common type of Diabetic Neuropathy?

Answer 19

Sensory Neuropathy

Question 20

Symptoms of Sensory Neuropathy

Answer 20

Question 21

Early symptoms of Sensory Neuropathy

Answer 21

pain & paresthesia. It bilateral & symmetrical, starting in the lower limb then upper limb

Question 22

Late Symptoms of Sensory Neuropathy

Answer 22

stock & glove hyposthesia occur

Question 23

Tendon Jerk in Sensory Neuropathy

Answer 23

There may be lost ankle & preserved knee jerk

Question 24

Deep Sensations in Sensory Neuropathy

Answer 24

- There's loss of deep sensations except muscle sense leading to tender calf - The earliest sensation to be lost in diabetic neuropathy is vibration sense then 10 gm monofilaments test

Question 25

Complications in Sensory Neuropathy

Answer 25

Question 26

Motor Neuropathy in DM

Answer 26

- Distal muscle weakness - Wrist & foot drop

Question 27

Symptoms of Autonomic Neuropathy

Answer 27

Question 28

Autonomic Neuropathy (Another Classification)

Answer 28

Question 29

Types of Mononeuropathies

Answer 29

Question 30

Entrapment Neuropathies

Answer 30

Question 31

Proximal Motor Neuropathy

Answer 31

Question 32

What are other neurological Complications of DM?

Answer 32

Question 33

Screening of eye disease in DM

Answer 33

Question 34

When to refer a Diabetic Patient to an ophthalmologist?

Answer 34

Question 35

Management of Diabetic Retinopathy

Answer 35

Question 36

Screening for Nephropathy disease

Answer 36

Question 37

Why we do screening for Micro albuminuria?

Answer 37

- Increased risk for overt nephropathy - Increased cardiovascular mortality - Increased risk of Retinopathy - Increased all-cause mortality **So Microalbuminuria is an indication for screening for possible vascular disease and aggressive intervention to reduce all cardiovascular risk factors.**

Question 38

Screening test for micro albuminuria

Answer 38

Question 39

who to Screen For Microalbuminuria Type 1 Diabetes Type 2 Diabete?

Answer 39

Question 40

Management of nephropathy in DM

Answer 40

Question 41

Screening for Neuropathy disease

Answer 41

Question 42

Management of neuropathy in DM

Answer 42

Question 43

Complications of DM (PPT)

Answer 43

Question 44

Definition of Diabetic Nephropathy

Answer 44

Question 45

Risk Factors of Diabetic Nephropathy

Answer 45

Question 46

Pathology of Diabetic Nephropathy

Answer 46

Question 47

Clinical Picture of Diabetic Nephropathy

Answer 47

Question 48

Investigations in Diabetic Nephropathy

Answer 48

Question 49

Transient microalbuminuria occurs in the following: .......

Answer 49

1) Exercise 2) Fever 3) Heart failure 4) Poor glycemic control