Long Term Complications of Diabetes

Question 1

List some of the potential macrovascular complications of diabetes.

Answer 1

Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease

Question 2

List some of the potential microvascular complications of diabetes.

Answer 2

Retinopathy
Nephropathy
Neuropathy

Question 3

What are some of the heart and vessel based conditions which diabetic patients are at increased risk of?

Answer 3

CVD
Atherosclerosis
Stroke
MI

Question 4

Which is ‘good’ cholesterol- HDL or LDL?

Answer 4

HDL

Question 5

In those with diabetes, what is higher, LDL or HDL?

Answer 5

LDL

-> therefore, this is why those with type 2 diabetes are at higher risk of atherosclerosis

Question 6

Diabetes also causes dysfunction of the endothelium. How does this link to increased risk of atherosclerosis as a complication?

Answer 6

Disruption of smooth endothelium which is required to prevent clots and build up of fat

Question 7

What can atherosclerosis lead to?

Answer 7

Ischaemic heart disease
Peripheral vascular disease
Ischaemic cerebrovascular disease

Question 8

What are some of the ways macrovascular disease can be prevented in diabetics?

Answer 8

Good control of diabetes
Blood pressure control
Lipid control
Smoking cessation, weight management and exercise

Question 9

What can be done in the management of severe foot ulcers?

Answer 9

Foot ulcer care
IV antibiotics
Sometimes xrays for osteomyelitis
Rest and avoidance of pressure on ulcer
Improve glycaemic status

-> ulcers have a slow healing process

Question 10

Retinopathy?

Answer 10

Disease of the retina

Question 11

What are the two types of diabetic retinopathy?

Answer 11

Non proliferative diabetic retinopathy
Proliferative diabetic retinopathy

Question 12

What happens in non-proliferative diabetic retinopathy?

Answer 12

Retinal capillary dysfunction
Platelet dysfunction
Blood viscosity abnormality

Question 13

What happens in proliferative diabetic retinopathy?

Answer 13

Retinal ischaemia
New blood vessel formation
Vitreous haemorrhage
Retinal tears/detachment

Question 14

What is more serious- non-proliferative diabetic retinopathy or proliferative diabetic retinopathy?

Answer 14

Proliferative diabetic retinopathy

-> can lead to blindness

Question 15

What is the treatment for proliferative diabetic retinopathy?

Answer 15

Treated with laser photocoagulation

->this blocks off areas of ischaemia and prevents it from spreading

Question 16

In those with type 1 diabetes, what % of patients will have some form of diabetic retinopathy?

Answer 16

100%

Question 17

In those with type 2 diabetes, what % of patients will have some form of diabetic retinopathy?

Answer 17

60%

Question 18

What are some of the other eye conditions that diabetic patients are at greater risk of?

Answer 18

Glaucoma
Cataracts

Question 19

Nephropathy?

Answer 19

Deterioration in kidney function

Question 20

What happens in diabetes which causes nephropathy?

Answer 20

Microalbuminuria, there’s a leak of albumin
This means the blood pressure ratio changes and the renal filter system is not able to function properly

-> kidneys and retina are effected due to having many tiny blood vessels in a small place

Question 21

What happens if renal function is not checked in those with diabetes?

Answer 21

May end up with end stage renal disease and require dialysis

-> diabetes is the biggest single cause of end stage renal disease requiring dialysis

Question 22

What % of all diabetic patients have some renal complications?

Answer 22

75%

-> 20% go on to overt kidney disease which needs treatment

Question 23

What can be done to prevent complications of nephropathy?

Answer 23

Screening of urine for albumin is vital
Good diabetic control
Hypertension control
Renin-angiotensin system blockade

Question 24

Neuropathy?

Answer 24

Nerve damage causing numbness or various parts of the body

Question 25

Neuropathy can also contribute to which other complication of diabetes?

Answer 25

Foot ulcers ->[patient has reduced sensation so cannot feel the ulcer

Question 26

What are the three types of neuropathy?

Answer 26

Sensory Motor Autonomic

Question 27

Where does sensory neuropathy typically effect?

Answer 27

Feet and lower legs

Question 28

What is the name of the foot related condition that can occur in diabetic patients?

Answer 28

Charcot Foot

Question 29

What happens in Charcot Foot?

Answer 29

Foot becomes enlarged and bones become soft and bulky

Question 30

What causes Charcot Foot?

Answer 30

Broken bones which settle in strange positions after not healing correctly. Diabetic patients often do not feel this due to neuropathy affecting the perception of pain