Macrovascular Complications of Diabetes

Question 1

What are the main macrovascular disease in diabetes?

Answer 1

Early widespread atherosclerosis
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease

Question 2

What are the initial cells that develop in atherosclerosis?

Answer 2

Isolated foam cells

Question 3

What are the stages of actherosclerosis?

Answer 3

Initial lesion
Fatty streak
Intermediate
Atheroma
Fibroatheroma
Complicated

Question 4

Whats is atherosclerosis associated with?

Answer 4

Dyslipidaemia (high LDL, low HDL)

Question 5

When atheroma stage is reached, what is the growth in?

Answer 5

Smooth muscle

Question 6

In earlier atherosclerosis what is growth in?

Answer 6

Fat

Question 7

How is cardiovascular disease linked to diabetes?

Answer 7

Hyperglycaemia greatly increases the risk cardiovascular disease

Question 8

Out of morbidity and mortality, what do microvascular and macrovascular complications cause?

Answer 8

Microvascular: causes morbidity
Macrovascular: causes morbidity and mortality

Question 9

How does post MI survival differ in those living with diabetes vs without?

Answer 9

Survival is a lot lower if they are living with diabetes

Question 10

How does risk of CHD differ with ethnicity?

Answer 10

Risk is a lot higher in some ethnicities eg higher in south asians than white caucasians

Question 11

What is the major cause of morbidity and mortality in diabetes?

Answer 11

Ischaemic heart disease

Question 12

What is the relationship between cerebrovascular disease and diabetes?

Answer 12

Occurs earlier in those living w diabetes

Is more widespread

Question 13

What does renal artery stenosis contribute to?

Answer 13

Hypertension and renal failure

Question 14

How does treatment for hyperglycaemia affect cardiovascular risks?

Answer 14

Doesn’t reduce the risk much, doesn’t reduce mortality either

Question 15

How does renal artery stenosis occur?

Answer 15

Atherosclerosis

Question 16

How does insulin resistance affect risk of complications?

Answer 16

Resistance even before hyperglycaemia contributes to increased risk

Question 17

What are the non modifiable risk factors for macrovascular disease?

Answer 17

Age
Sex
Birth weight
Family history/genes

Question 18

What are the modifiable risk factors for macrovascular disease?

Answer 18

Dyslipidaemia
High BP
Smoking
Diabetes

Question 19

How do we treat those with diabetes to reduce risk of macrovascular complications?

Answer 19

Agressive treatment of multiple risk factors eg lipids, BP

Question 20

How does life expectancy change when there is multifactorial intervention?

Answer 20

Many years of life are gained (7.9 yrs average)

Question 21

What 2 main targets are managed to reduce macro vascular disease?

Answer 21

BP

Lipids

Question 22

What complication of diabetes is a major reason for bedstay in the UK?

Answer 22

Diabetic foot

Question 23

Describe the pathway to foot ulceration

Answer 23

Sensory neuropathy
Motor neuropathy
Limited joint mobility
Autonomic neuropathy
Peripheral vascular disease
Trauma- a repeated and minor/discrete episode
Reduced resistance to infection
Other diabetic complications eg retinopathy

Question 24

What are the 3 types of diabetic foot?

Answer 24

Neuropathic foot
Ischaemic foot
Neuro-ischaemic foot

Question 25

Describe the neuropathic foot

Answer 25

``` numb warm dry palpable foot pulses ulcers at points of high pressure ```

Question 26

Describe the ischaemic foot

Answer 26

cold pulseless ulcers at foot margins

Question 27

Describe the neuro-ischaemic foot

Answer 27

``` numb cold dry pulseless ulcers at points of high pressure and foot margins ```

Question 28

How do we assess the foot of a diabetic patient?

Answer 28

Appearance- is there deformity or callus Feel it- it is hot or cold? is it dry? Check for foot pulses Check for neuropathy- vibration sensation, temp, ankle jerk reflex, fine touch sensation

Question 29

What are some preventative measures for diabetic foot?

Answer 29

Control hyperglycaemia, lipids and BP Wear suitable footwear always, check the insides of it Cut nails straight

Question 30

How is ulceration managed?

Answer 30

``` Relief of pressure via bed rest Antibiotics Amputation Debridement Revascularisation ```

Question 31

Where on the foot is affected by osteomyelitis?

Answer 31

Forefoot: MIPs and IPs Hindfoot: calcaneus

Question 32

Where on the foot is affected by active charcot?

Answer 32

Midfoot and subarticular

Question 33

Out of active charcot and osteomyelitis which has ulcer?

Answer 33

Osteomyelitis

Question 34

Out of active charcot and osteomyelitis which has hot red foot?

Answer 34

Both

Question 35

What will show on MRI for osteomyelitis

Answer 35

Marrow oedema in forefoot and hindfoot near ulcer

Question 36

What will show on MRI for active charcot

Answer 36

Marrow oedema and midfoot subchondral

Question 37

Will active charcot or osteomyelitis show on xray?

Answer 37

Not in the first few weeks