18. Long Term Diabetic Complications

Question 1

microvascular complications

Answer 1

retinopathy
nephropathy
neuropathy
take many years to develop

Question 2

which cells are affected in microvascular complications of diabetes?

Answer 2

retinal endothelial cells
mesangial cells of glomerulus
Schwann and peripheral nerve cells

cells are not able to reduce glucose transport in response to extracellular hyperglycaemia

Question 3

retinopathy

Answer 3

second most common cause of blindness in those of working age
risk of blindness increases 10-20fold
glaucoma and cataract increased

Question 4

retinal microcirculation

Answer 4

low density of capillaries
little functional reserve
flow needs to respond to local needs
pericytes = key to local regulation

Question 5

pathological findings in diabetic retinopathy

Answer 5

loss of pericytes
basement membrane thickening
capillary closure
ischaemia (VEGF production, inc capillary permeability

Question 6

clinical stages of retinopathy

Answer 6

non-proliferative (background_
proliferative
macular oedema - sight vs non-sight threatening

Question 7

diabetic retinopathy treatment

Answer 7

good diabetic control
blood pressure control
laser treatment
intra-vitreal anti-VEGF antibody

Question 8

diabetic neuropathy

Answer 8

affects up to 50%

15% have painful neuropathy

Question 9

different types of neuropathy

Answer 9

peripheral
mononeuropathy
autonomic neuropathy
+ entrapment neuropathy increased

Question 10

charcoal foot

Answer 10

bone deformity

good vasculature, but bone grow incorrectly as walk on foot incorrectly (can’t feel)

Question 11

peripheral neuropathy

Answer 11

affects peripherals: hands and feet
calluses
ulcers
charcoal foot

Question 12

mononeuropathy

Answer 12

one nerve affected

Question 13

autonomic neuropathy

Answer 13

gastroparesis 
postural hypotension 
erectile dysfunction 
gustatory sweating 
diarrhoea

Question 14

nephropathy

Answer 14

most common cause of ESRD in western world

accounts for 21% T1 deaths and 21% T2 deaths

Question 15

renal microcirculation

Answer 15

fenestrated glomerular capillaries

basement membrane highly specialised podocytes

Question 16

pathological findings in diabetic nephropathy

Answer 16

basement membrane thickening
podocyte loss
glomerular sclerosis s
mesangial expansion

Question 17

nephropathy treatment

Answer 17

blood pressure control
RAAS blockers preferred
glucose control important (less so when proteinuria)
associated with increased CVD risk
ultimately: renal replacement/transplantation

Question 18

macrovascular disease

Answer 18

IHD, CVD, PVD
dramatic increase in risk diabetes 
T2 have multiple risk factors 
T1 have long duration of disease 
presentation depends on vascular bed affected (angina/MI, stroke, PVD)

Question 19

diabetic foot

Answer 19

most common cause of non-traumatic lower limb amputation
PVD (peripheral vascular disease)
neuropathy
impaired leucocyte function