Microvascular Complications of Diabetes

Question 1

What are the 3 main sites of microvascular complications in diabetes?

Answer 1

Retinal arteries
Renal glomerular arterioles
Vasa nervorum

Question 2

What are the vasa nervorum?

Answer 2

Tiny blood vessels that supply nerves

Question 3

What is the main factor in increasing risk for developing microvascular complications?

Answer 3

High BP

Question 4

What are the main 2 targets when reducing risk of complications?

Answer 4

Reduce HbA1c

Control BP

Question 5

What is hyperglycaemic memory and how does it affect complications of diabetes?

Answer 5

Inadequate glucose control early on which increases risks of complications developing later on

Question 6

How is HbA1c risked to MI?

Answer 6

Higher HbA1c increases risk of MI

Question 7

What are the main mechanisms of damage in microvascular complications?

Answer 7

Oxidative stress
Formation of AGEs
Hypoxia

Question 8

What are AGEs?

Answer 8

Advanced gylcolated end products- other proteins that become glycated eg on the walls of blood vessels

Question 9

What are the 3 main microvascular complications called?

Answer 9

Retinopathy
Nephropathy
Neuropathy

Question 10

How is retinopathy detected in diabetics?

Answer 10

Via screening- diabetics undergo once a year screening

Question 11

What is mainly damaged in retinopathy?

Answer 11

The endothelium

Question 12

What are the 3 stages of retinopathy?

Answer 12

Background
Pre-proliferative
Proliferative

Question 13

What can occur alongside all stages of retinopathy?

Answer 13

Maculopathy

Question 14

What can be seen during background retinopathy?

Answer 14

Hard exudates (cheese colour, made of lipid)
Micro aneurysms
Blot haemorrhages

Question 15

What can be seen during pre-proliferative retinopathy? What does it indicate

Answer 15

Cotton wool spots= soft exudates

Represent retinal ischaemia

Question 16

What can be seen during proliferative retinopathy?

Answer 16

Visible new vessels

On disk or elsewhere in retina

Question 17

What is maculopathy?

Answer 17

Hard exudates near the macula
Same as background retinopathy but happens near the macula
Can threaten direct vision

Question 18

What stage of retinopathy interferes with direct vision?

Answer 18

Maculopathy

Question 19

How is background retinopathy treated?

Answer 19

Continued annual surveillance

Feedback to person

Question 20

How is pre-proliferative retinopathy treated?

Answer 20

Early panretinal photocoagulation

Question 21

How is proliferative retinopathy treated?

Answer 21

Panretinal photocoagulation

Question 22

How is diabetic maculopathy treated?

Answer 22

Oedema: anti-VGF injections

Grid photocoagulation

Question 23

What is measured when screening for diabetic nephropathy?

Answer 23

Urine albumin:creatinine

Question 24

How does diabetic nephropathy present?

Answer 24

Hypertension
Increasing proteinuria
Deteriorating kidney function
Histological features

Question 25

What is required if theres renal failure?

Answer 25

Haemodialysis

Question 26

What glomerular changes are seen in diabetic nephropathy?

Answer 26

Mesangial expansion Basement membrane thickening Glomerulosclerosis

Question 27

What constitutes a diagnosis of microalbuminuria?

Answer 27

above 2.5 mg.mmol for men | above 3.5 mg/mmol for women

Question 28

What happens to BP and eGFR in diabetic nephropathy?

Answer 28

BP increases | eGFR is deranged

Question 29

What type of oedema occurs if diabetic nephropathy is advanced?

Answer 29

Peripheral oedema

Question 30

What are the 4 steps of diabetic nephropathy treatment?

Answer 30

1. Aim for tighter glycaemic control 2. Reduce BP via ACE inhibitors 3. Stop smoking 4. Start a SGLT-2 inhibitor if T2DM

Question 31

What happens to the vasa nervorum in diabetic nephropathy?

Answer 31

They get blocked

Question 32

What is the main concern in diabetic neuropathy?

Answer 32

Damage to the feet- the longest nerves supply the feet so if there is a foot injury they may not notice and complications can arise

Question 33

How often do people living with diabetes have a foot check?

Answer 33

Once a year

Question 34

What are clinical features of peripheral neuropathy?

Answer 34

``` Loss of sensation Loss of vibration Loss of temperature sensation Loss of proprioception Loss of ankle jerks Glove and stocking distribution ```

Question 35

If there is foot ulceration what must be done?

Answer 35

Its a medical emergency so admit them to hospital

Question 36

What is mononeuropathy?

Answer 36

One nerve is affected so usually there is sudden motor loss, wrist and foot drop, cranial nerve palsy

Question 37

What is mononeuritis multiplex?

Answer 37

A random combo of peripheral nerve lesions

Question 38

What is radiculopathy?

Answer 38

Pain over spinal nerves affecting dermatome on abdomen or chest wall

Question 39

What is autonomic neuropathy?

Answer 39

Loss of sympathetic and parasympathetic nerves to GI tract, bladder, cardiovascular system

Question 40

When does autonomic neuropathy develop?

Answer 40

If diabetes has been very poorly managed

Question 41

What are presentations of autonomic neuropathy?

Answer 41

``` Difficulty swallowing Nausea and vomitting Constipation Nocturnal diarrhoea Bladder dysfunction Postural hypotension Cardiac autonomic supply ```