Long Term Complications of Diabetes

Question 1

Name the main system affected by long term complications of diabetes

Answer 1

Cardiovascular

Question 2

What are the 3 parts of the body mainly affected by micro- and macro- vascular complications?

Answer 2

Eyes
Kidneys
Nerves

Question 3

Name 3 macrovascular complications of diabetes

Answer 3

Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease

Question 4

Name 3 microvascular complications of diabetes

Answer 4

Retinopathy
Nephropathy
Neuropathy

Question 5

What is present in nearly all people with diabetes?

Answer 5

Dyslipidaemia

Question 6

Describe HDL, triglyceride and LDL levels in dyslipidaemia (from atherosclerosis)?

Answer 6

HDL cholesterol = lower
Triglyceride = higher
LDL cholesterol = in form of small dense particles which are worse

Question 7

What happens to LDL particles in dyslipidaemia?

Answer 7

Oxidisation of these particles promotes the features that lead to plaque formation (+ glycation of the particles worsens the effect)

Question 8

What 2 other features (other than dyslipidaemia) are found in atherosclerosis in diabetes?

Answer 8

Endothelial dysfunction

Hypercoagulation

Question 9

Name 3 major effects of atherosclerosis in diabetes

Answer 9

Ischaemic cerebrovascular disease - strokes
Ischaemic heart disease - angina, MI, heart failure
Peripheral vascular disease

Question 10

What is heart failure related to?

Answer 10

Coronary disease and abnormal cardiac myocyte glucose handling

Question 11

What does peripheral vascular disease cause?

Answer 11

Lower limb ischaemia - leading to ulcers + poor healing of ulcers (possibly lead to amputations)

Question 12

Name 4 methods of prevention of macrovascular disease in diabetes

Answer 12

• Good diabetes control
• Blood pressure control
• Lipid control
• Lifestyle: smoking cessation, weight, exercise

Question 13

What are the 2 types of diabetic retinopathy?

Answer 13

Non proliferative

Proliferative

Question 14

Describe non-proliferative diabetic retinopathy

Answer 14

Retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality

Question 15

Describe proliferative diabetic retinopathy

Answer 15

Retinal ischaemia, new blood vessel formation, vitreous haemhorrage, retinal tears/detachment

Question 16

How is proliferative diabetic retinopathy treated?

Answer 16

Laser photocoagulation

Question 17

20 years post-diagnosis, what percentage of people with type 1 diabetes will have retinopathy?

Answer 17

100% (some form mild to severe)

Question 18

20 years post diagnosis, what percentage of those with type 2 diabetes will have retinopathy?

Answer 18

60% (some form mild to severe)

Question 19

Name 2 other eye effects of diabetes

Answer 19

Glaucoma (50% increase)

Cataracts (3-fold)

Question 20

How does nephropathy begin?

Answer 20

Microalbuminuria (leak of protein (albumin) starts)

Question 21

Name 3 boring sounding things in nephropathy contributing to renal dysfunction

Answer 21

Glomerular basement membrane changes
Mesangial tissue proliferation
‘Glormerular hypertension’

Question 22

What can progressive renal failure progress to if left unchecked?

Answer 22

End-stage renal disease

Question 23

What happens to the appearance of kidneys in diabetic nephropathy?

Answer 23

They do NOT shrink (one of only kidney conditions where this does not happen)

Question 24

What percentage of people with diabetes will have some renal effects?

Answer 24

75%

Question 25

What percentage of people with renal effects will go on to have overt kidney disease that may need treatment?

Answer 25

20%

Question 26

What is the biggest single cause of end stage renal disease needing renal replacement therapy (dialysis)?

Answer 26

Diabetes

Question 27

What ultimately happens to 21% of type 1 diabetics and 11% of type 2 diabetics with renal failure?

Answer 27

Death

Question 28

Name 4 methods of prevention and treatment of nephropathy

Answer 28

Screening of urine for albumin Diabetes control Renin-agiotensin system blockade (ACEI, ARB - v gd results, renin inhibition) Hypertension control

Question 29

Describe sensory neuropathy in diabetes

Answer 29

Objective loss, particularly in feet and lower legs (subjective symptoms, esp parasthesia)

Question 30

What can lack of sensation lead to?

Answer 30

Development of neuropathic ulcers, which, alongside macro-vasculature, leads to severe foot infections

Question 31

Describe autonomic neuropathy in diabetes

Answer 31

Can cause GI effects (stomach, intestines), or CVS (tachycardia, BP fluctuations)

Question 32

What is important to watch out for in a patient with diabetic neuropathy?

Answer 32

Silent myocardial infarction

Question 33

What is acronym for foot care in diabetes?

Answer 33

CPR - check, protect, refere

Question 34

Name 2 other conditions found in diabetics

Answer 34

Erectile dysfunction/sexual dysfunction | Depression

Question 35

Look at case studies

Answer 35

.