3.20 Micro and Macro vascular complications

Question 1

What are the 3 microvascular complications of diabetes?

Answer 1

retinopathy
nephropathy
neuropathy

Question 2

What are the 3 macrovascular complications of diabetes?

Answer 2

cerebrovascular disease
ischemic heart disease
peripheral vascular disease

Question 3

What increases the risk of microvascular complications?

Answer 3

HbA1c > 53 (direct relationship between risk of microvascular complications and glycaemic control)
hypertension

Question 4

What are some risk factors for the development of microvascular complications?

Answer 4

duration of diabetes
smoking
hyperlipidemia
hyperglycemic memory

Question 5

Why is screening needed for diabetic retinopathy?

Answer 5

main cause of blindness in working age people

early stages are asymptomatic

Question 6

How often do screenings for diabetic retinopathy occur?

Answer 6

annually

Question 7

What are the 3 stages of diabetic retinopathy?

Answer 7

background retinopathy
pre-proliferative retinopathy
proliferative retinopathy

Question 8

What other eye problems can diabetes form?

Answer 8

diabetic maculopathy - similar to retinopathy but near macula

Question 9

How is background retinopathy treated?

Answer 9

continued annual surveillance
improve glycemic control
stop smoking
weight loss
blood pressure control

Question 10

How to treat pre proliferative and proliferative retinopathy?

Answer 10

panretinal photocoagulation

Question 11

How to treat diabetic maculopathy?

Answer 11

anti-VEGF injection into the eye

grid photocoagulation

Question 12

Why is diabetic nephropathy important?

Answer 12

associated with progression to end stage renal failure

increased risk of cardiovascular events

Question 13

What is the first sign of diabetic nephropathy?

Answer 13

microalbuminuria >2.5

Question 14

What are further signs of diabetic nephropathy?

Answer 14

proteinuria (ACR increase)
increased blood pressure
decreased eGFR (renal function)
peripheral oedema

Question 15

How do ACE inhibitors work?

Answer 15

block conversion of angiotensin 1 to angiotensin 2

Question 16

How do angiotensin receptor blockers (ARBs) work?

Answer 16

block angiotensin receptors

Question 17

What does angiotensin do?

Answer 17

increase BP (by vasoconstriction) and acts on zona glomerulosa of adrenal cortex to produce aldosterone

Question 18

How is diabetic nephropathy managed?

Answer 18

glycaemic control
ACEi/ARB even if no hypertension as preventative
stop smoking
SGLT-2 inhibitor (if T2D)

Question 19

What is diabetic neuropathy?

Answer 19

vasa nervosum (small vessels supplying nerves) get blocked

Question 20

What does the distribution of diabetic neuropathy look like?

Answer 20

glove and stocking

Question 21

What is the danger of diabetic neuropathy?

Answer 21

will not sense injury to foot

Question 22

What to look for when checking feet?

Answer 22

foot deformity/ulceration
sensation
foot pulses

Question 23

How do we manage diabetic foot (caused by diabetic neuropathy)

Answer 23

regular inspection
good footwear
avoid barefeet

Question 24

What other neuropathies can be caused by diabetes?

Answer 24

mononeuropathy - cranial nerve palsy (3 nerve - occulomotor)

eye looks down and out

Question 25

How do manage macrovascular complications of diabetes?

Answer 25

not just glycaemic control must be multiple factors:

• dyslipidaemia
• hypertension
• smoking
• central obesity
• weight
• urine screening