Presentation of T2DM and its complications

Question 1

Diabetes has an insidious onset. True or false.

Answer 1

True. T2DM patients may spend months to years not knwing they have diabetes at all.

Question 2

What are the symptoms of TD2M due to.

Answer 2

Slowly rising glucose.

Question 3

What are the symptoms of slowly rising glucose. (5)

Answer 3

Tiredness. 
Lethargy. 
Polyuria. 
Polydipsia.
Often drinking lucozade (or coke) because of thirst.

Question 4

What ion rises with T2DM.

Answer 4

Sodium.

Question 5

Why does sodium rise with T2DM. (3)

Answer 5

The patients are very thirsty, and so drink a lot of (usually) sugary drinks.
There is consequent osmotic diuresis, which causes a loss of water and a rise in sodium.
Eventually, the sodium and the glucose are both very high.

Question 6

How is osmolality calculated.

Answer 6

2(cations) + glucose + urea.

2(Na+K) + glucose + urea

Question 7

How does T2DM affect the osmolality.

Answer 7

It causes a hyperosmolar state.

Question 8

Give an example of the osmolar state of a patient with T2DM.

Answer 8

430mM

Question 9

How many patients with T2DM do not actually know that they have it.

Answer 9

About 50%

Question 10

What is the glycaemic state of patients with undiagnosed T2DM.

Answer 10

Hyperglycaemic.

Question 11

Do patients with undiagnosed T2DM have acidosis.

Answer 11

No.

Question 12

If patients ignore the first symptoms of polyuria, what might be the initial reason for presenting to the doctor. (T2DM)

Answer 12

With a complication.

Question 13

What are the two broad categories of complications arising from T2DM.

Answer 13

Microvascular.

Macrovascular.

Question 14

What is the cause of the microvascular complications of T2DM. (2)

Answer 14

Glycosylation of basement membrane proteins.

This leads to leaky capillaries.

Question 15

What are the causes of the macrovascular complications of T2DM. (3)

Answer 15

Dyslipidaemia.
Hypertension.
Hypercholesterlaemia.

Question 16

What are the potential microvascular complications of T2DM. (3)

Answer 16

Nephropathy.
Neuropathy.
Retinopathy.

Question 17

What are the potential macrovascular complications of T2DM. (3)

Answer 17

Cerebrovascular events.
Ischaemic heart disease.
Peripheral gangrene.

Question 18

What is seen in background diabetic retinopathy. (3)

Answer 18

Hard exudates.
Microaneurysms.
Blot haemorrhages.

Question 19

What are hard exudates caused by.

Answer 19

Cholesterol deposits.

Question 20

What do microaneurysms look like.

Answer 20

Small ‘dots’.

Question 21

What is the treatment of choice for a patient with background diabetic retinopathy.

Answer 21

Improve blood glucose control.

Warn patients that there are warning signs.

Question 22

What is seen in pre-proliferative diabetic retinopathy. (4)

Answer 22

Hard exudates.
Microaneurysms.
Blot haemorrhages.
Cotton wool spots.

Question 23

What are cotton wool spots suggestive of.

Answer 23

Retinal ischaemia.

Question 24

What can retinal ischaemia lead to.

Answer 24

New vessel growth.

Question 25

Why is retinal ischaemia a problem.

Answer 25

Because the new vessels that grow are sensitive and may bleed.

Question 26

What is the treatment for pre-proliferative diabetic retinopathy.

Answer 26

Pan retinal photocoagulation.

Question 27

What is the treatment for proliferative diabetic retinopathy.

Answer 27

Pan retinal coagulation.

Question 28

What is the main characteristic of pre proliferative retinopathy.

Answer 28

Cotton wool spots.

Question 29

What is the main characteristic of proliferative retinopathy.

Answer 29

Visible new vessel growth.