microvascular complications of diabetes W6

Question 1

what causes diabetic foot ulcer?

Answer 1

peripheral neuropathy
-> neuropathic trauma
-> infection
-> delayed wound healing (due to hyperglycaemia), potentially exacerbated by persistent trauma and peripheral vascular disease

Question 2

management of diabetic foot ulcer

Answer 2

antibiotics
debridement of underlying ulcer (reveal what’s going on, take away some infection)
off loading (take away pressure from end of toe)
improve glycaemic control (improve wound healing)
vascular assessment (pulse? imaging?)

Question 3

commonest microvascular complication in diabetes?

Answer 3

diabetic retinopathy

Question 4

diabetic neuropathy risk in type 2 diabetes?

Answer 4

risk in type 2 diabetes depends on duration and severity of hyperglycaemia

Question 5

pathophysiology of microvascular complications of diabetes?

Answer 5

sugar alcohol accumulation has been linked to microaneurysm formation, thickening of basement membranes and loss of pericytes
cells are also though to be injured by glycoproteins
oxidative stress? growth factors?

Question 6

diabetic retinopathy classification?

Answer 6

mild no proliferative diabetic retinopathy (NPDR) - localised swelling of the small blood vessels in the retina

moderate NPDR - mild NPDR + small bleed, leaks or closure of small blood vessels

severe NPDR - moderate NPDR + further damage to blood vessels

PDR - new vessel formation or vitreous/preretinal haemorrhage or tractional retinal detachment

Question 7

diabetic nephropathy?

Answer 7

the chronic loss of kidney function in those with diabetes mellitus
leading cause of ends stage renal disease globally

Question 8

pathophysiology of diabetic nephropathy?

Answer 8

initial constriction of efferent arterioles, dilation of afferent
resultant glomerular HTN and hyperfiltration
gradually changes to hypotension through time
thickening of basement membrane, widening of podocytes, increased mesangial cells
eventually shutting off glomerular filtration

Question 9

how to halt microvascular complications of diabetes?

Answer 9

good bp control
improving glycaemic control
ACEI (reduce glomerular BP)