Met 1: Diabetes Complications

Question 1

What is the leading cause of death in diabetes pts?

Answer 1

CVD (MI)

Question 2

Name 3 processes that contribute to CVD in T2D

Answer 2

1. Without insulin input, liver can’t properly regulate lipid levels
   
   • Get low HDL and high triglycerides
   • Lipids are NORMAL in T1D, but BAD in T2D
2. Increased plasminogen activator inhibitor prevent tPA from effectively degrading clots
3. Associated HTN and hyperlipidemia damage endothelial cells
   
   • This leads to decreases NO, increased platelet adherence

Question 3

T2D pts should be on medication to control ______ and _______, in addition to sugars .

Answer 3

T2D pts should be on medication to control HTN and dyslipidemia, in addition to sugars .

Question 4

What are the 3 microvascular complications of diabetes?

Answer 4

1. Retinopathy
2. Neuropathy
3. Nephropathy

Question 5

Name 4 causes of microvascular dz in diabetic pts

Answer 5

1. Glycosylated end products causes endothelial injury and forms cross-links
2. ROS formation
3. Polyol pathway induces osmotic stress
   
   • These enzymes only present in kidneys, eyes, and nerves
4. PKC Activation

Question 6

Why do the microvascular complications occur primarily in eyes, kidneys, and nerves?

Answer 6

Aldose reductase is only functional in these cells.

This enzyme (part of the polyol pathway) creates sorbitol, which builds up and induces osmotic stress.

Question 7

Describe the pathogenesis of retinopathy

Answer 7

1. Death of tiny neurons
2. Blood gets re-distributed in eye
3. Some parts of eye become hypoxic
4. This hypoxia sends signals for angiogenesis

Question 8

What are two ways to prevent/tx retinopathy?

Answer 8

Early, agressive glucose control

Yearly eye exams

Question 9

Describe the pathogenesis of nephropathy

Answer 9

1. Increased osmotic load due to high sugar
2. Increased filtration in kidneys
3. Renal HTN
4. Basement membrane thickening
5. Mesangial proliferation
6. Glomerular damage

Question 10

What is the name of the nodules seen in diabetic kidneys?

Answer 10

Kimmelstiel-Wilson nodules

(thickened, hyaline glomerulus)

Question 11

What medication can slow diabetic nephropathy?

Answer 11

ACE-Inhibitors

Question 12

What type of neuropathy is most common in diabetics?

What are two complications?

Answer 12

Distal, symmetric polyneuropathy (glove and stocking)

Complications: foot ulcers/amputation, poor motor control

Question 13

How do you screen for kidney damage in diabetics?

Answer 13

Microalbumin/creatinine ratio