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Year 2 - endocrine > Chronic Complications of Diabetes > Flashcards

Chronic Complications of Diabetes Flashcards

Diabetic Eye Disease, Diabetic Nephropathy, Diabetic Neuropathy

1
Q

What are the microvascular complications of diabetes?

A

Neuropathy, nephropathy, and retinopathy

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2
Q

What are the macrovascular complications of diabetes?

A

Ischaemic heart disease (IHD) and stroke (due to atherosclerosis)

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3
Q

What are the key screenings in a diabetic annual review?

A
  1. Retinal screening
  2. Foot risk assessment
    3, Urine ACR
  3. Serum creatinine
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4
Q

What is diabetic retinopathy?

A

Damage to the retina due to chronic hyperglycaemia

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5
Q

What are the four stages of diabetic retinopathy?

A
  1. Mild non-proliferative (background) 2. Moderate non-proliferative
  2. Severe non-proliferative
  3. Proliferative
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6
Q

What are the key retinal findings in diabetic retinopathy?

A

(1) Dot/blot/flame haemorrhages
(2) Cotton wool spots
(3) Hard exudates
(4) IRMA (intra-retinal microvascular abnormalities)

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7
Q

What happens in non-proliferative diabetic retinopathy (NPDR)?

A

Small vessel damage
→ microaneurysms, haemorrhages, hard exudates, cotton wool spots

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8
Q

What is the key feature of proliferative diabetic retinopathy (PDR)?

A

Neovascularisation due to VEGF release from ischaemic retina

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9
Q

What is IRMA and how is it different from neovascularisation?

A

IRMA (Intra-retinal microvascular abnormalities)

precursor to neovascularisation, but vessels are not leaking

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10
Q

What is the major risk of proliferative diabetic retinopathy?

A

Vitreous haemorrhage → sudden vision loss

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11
Q

What is the primary screening tool for diabetic retinopathy?

A

Fundoscopic examination (digital retinal screening)

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12
Q

What imaging is used for diabetic macular oedema?

A

Optical coherence tomography (OCT)

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13
Q

What is the main treatment for proliferative diabetic retinopathy?

A

Panretinal photocoagulation (laser therapy) – reduces retinal oxygen demand

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14
Q

What is the emergency referral indication in diabetic retinopathy?

A

Vitreous haemorrhage – immediate ophthalmology referral.

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15
Q

What treatment is used for diabetic macular oedema?

A

Intravitreal anti-VEGF (vascular endothelial growth factor) injections

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16
Q

What are two common non-retinal eye complications in diabetes?

A
  1. Cataracts
  2. Glaucoma
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17
Q

How frequently should people with diabetes have routine retinal photography?

A

On an annual (yearly) basis

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18
Q

Other than retina photography assessment, what other eye tests are routinely performed for people with diabetes?

A

Visual acuity test

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19
Q

A 64-year-old woman with a 27-year history of type 1 diabetes attends the retinal screening clinic for her retinopathy screen. This is performed using digital photography following pupil dilatation.

Which features on retinal examination would be a trigger for immediate referral to the ophthalmology service?

A

(1) Proliferative retinopathy - R3 (new blood vessels)
(2) Vitreous haemorrhage
(3) Advanced retinopathy with retinal detachments

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20
Q

A 60-year-old woman with a history of type 2 diabetes presents with a gradual decrease in her vision. She also complains of floaters and difficulty seeing at night.

What is the most appropriate initial test to evaluate her ocular condition?

A

Fundoscopic examination

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21
Q

A 54-year-old woman with a 15-year history of type 2 diabetes mellitus presents for her annual ophthalmology review. She reports no visual symptoms. Her recent HbA1c is 69 mmol/mol. On fundoscopic examination, there is moderate non-proliferative diabetic retinopathy with macular oedema.

What is the most appropriate next step in the management of this patient?

A

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy

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22
Q

A 58-year-old man with a 15-year history of type 2 diabetes mellitus presents for a routine eye examination. He has not experienced any changes in his vision but mentions that he often forgets to take his diabetes medication. His most recent HbA1c level was 9.2%. On fundoscopic examination, the ophthalmologist notes multiple microaneurysms, dot haemorrhages, and hard exudates in both eyes.

What is the most appropriate next step in management? and wy?

A

Strict glycemic control and regular follow-up

= For non-proliferative diabetic retinopathy, the primary management involves achieving and maintaining strict glycemic control to slow the progression of the disease

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23
Q

What is Mild Non-Proliferative Diabetic Retinopathy (NPDR) characterised by?

A

(1) Microaneurysms
(2) Dot haemorrhages on fundoscopy

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24
Q

What is Severe Non-Proliferative Diabetic Retinopathy (NPDR) characterised by?

A

(1) Beaded veins
(2) Intraretinal microvascular abnormalities (IRMA)
(3) Extensive retinal haemorrhages

25
What is Moderate Non-Proliferative Diabetic Retinopathy (NPDR) characterised by?
(1) Presence of microaneurysms (2) Dot and blot haemorrhages cotton-wool spots (3) Hard exudates on fundoscopy
26
What is diabetic nephropathy?
Progressive kidney disease caused by damage to the capillaries in the glomeruli
27
What is another name for diabetic nephropathy?
1. Kimmelstiel-Wilson Syndrome 2. or Nodular Glomerulosclerosis
28
What are the key pathological features of diabetic nephropathy?
Proteinuria and diffuse scarring of the glomeruli
29
How is microalbuminuria defined?
ACR <30 mg/mmol or PCR <50 mg/mmol
30
How is microalbuminuria confirmed?
Repeat test twice (2 out of 3 positive tests confirm diagnosis)
31
Does microalbuminuria show up on a urine dipstick?
No, it does not show as protein++
32
How is overt proteinuria (nephropathy) defined?
ACR >30 mg/mmol or PCR >50 mg/mmol
33
What should be done if overt proteinuria is detected?
Repeat on early morning urine (EMU) to confirm
34
Does proteinuria show up on a urine dipstick?
Yes, it will be positive for protein
34
What is the first-line treatment for microalbuminuria?
ACE inhibitors (ACEi) or ARBs
35
Why do ACEi/ARBs cause a slight GFR decline?
They dilate renal arterioles, reducing filtration pressure
36
Which medication should all diabetic patients with microalbuminuria be started on?
SGLT2 inhibitors (SGLT2i) regardless of HbA1c
37
What is the target blood pressure for diabetics?
<140/80 mmHg
38
How can diabetic nephropathy be prevented?
(1) Strict glycaemic control (HbA1c ~53 mmol/mol) (2) Aggressive BP control
39
What are the key complications of diabetic nephropathy?
(1) Hypertension (2) Decline in renal function (3) Vascular disease
40
What is the typical rate of renal function decline if untreated?
GFR decreases by ~1 ml/min/month
41
A 58-year old woman with long-standing type 2 diabetes and CKD is reviewed in the nephrology clinic. She is currently taking metformin, gliclazide, ramipril, empagliflozin and rosuvastatin at optimised doses. She was referred to the clinic because her urine albumin-to-creatinine ratio (ACR) was 90 mg/mmol. What should her target blood pressure be?
generally be <140/90 mmHg however if there is significant albuminuria (ACR >30 mg/mmol), aiming for a lower target of <130/80 mmHg is beneficial to reduce the risk of further kidney damage
42
What is diabetic neuropathy?
Damage to the peripheral nervous tissue due to prolonged hyperglycaemia
42
What is the pattern of diabetic peripheral neuropathy?
'Glove and stocking' distribution'
43
What are the symptoms of peripheral neuropathy?
(1) Numbness, tingling (2) Burning, sharp pains (3) Sensitivity to touch (4) Loss of balance/coordination
44
How is Charcot's foot managed?
Non-weight bearing, total contact cast, or air cast boot to prevent further damage
45
What are the 1st-line treatments for neuropathic pain?
1. Amitriptyline 2. Duloxetine 3. Gabapentin 4. Pregabalin
46
What is the 2nd-line treatment for localised pain?
Topical capsaicin cream
47
Which focal neuropathy is most common?
Carpal tunnel syndrome
48
A 65-year-old male with long-standing type 1 diabetes mellitus presents to the GP with burning in his feet which is keeping him awake at night. The GP diagnoses diabetic neuropathy and decides to start medical management for it. What treatment is the first-line treatment of diabetic neuropathy?
1. Duloxetine 2. Gabapentin 3. Pregabalin
49
Radial nerve → C5–T1 → Posterior cord Median nerve → C5–T1 → Lateral and medial cords Ulnar nerve → C8–T1 → Medial cord Musculocutaneous nerve → C5–C7 → Lateral cord Axillary nerve → C5–C6 → Posterior cord
50
Explain the Treatment for diabetic foot
1. Diabetes can also reduce blood flow, slowing healing and making the skin more vulnerable. 2. The good news is that managing your blood sugar, checking your feet daily, and wearing comfortable, well-fitted shoes can help prevent problems . 3. We’ll also arrange regular foot checks to catch any issues early and keep your feet healthy
51
A 55-year-old woman attends the clinic with worsening vision. She has a past medical history of poorly controlled diabetes mellitus. A slit lamp examination confirms proliferative diabetic retinopathy. You counsel the patient for panretinal laser photocoagulation. What complication is this patient most at risk of?
Reduction of the visual field
52
A 51-year-old woman who is known to have poorly controlled type 1 diabetes mellitus is reviewed. Her main presenting complaint is bloating and vomiting after eating. She also notes that her blood glucose readings have become more erratic recently. Which one of the following medications is most likely to be beneficial?
Metoclopramide
53
Where is Retinal neovascularisation seen? What stage.
proliferative retinopathy
54
A 32-year-old man with type 1 diabetes presents to the GP with bloating and vomiting. This has been gradually worsening for the last 6 weeks. He attended his diabetic review last week and his control is much worse than it was this time last year even though he is taking his insulin properly. Given the above, which of the following may explain all of his symptoms?
Erratic blood glucose control, bloating and vomiting think gastroparesis
55
A 72-year-old man presents to his GP as he is having pains in his legs. He has lived with diabetic neuropathy affecting both his legs for the past 5-years and has tried a multitude of drug regimens including amitriptyline, duloxetine and gabapentin. He asks if there is anything extra that can be done to aid his pain long term. What is the most appropriate response?
Consider the use of pain management clinics in resistant diabetic neuropathy
56
A 53-year-old man attends his optician for a review as he was recently diagnosed with type 2 diabetes mellitus. As part of the assessment, the doctor looked at the back of his eye with a slit lamp and this showed cotton wool spots. What is the likely underlying pathology causing these?
Retinal infarction

Year 2 - endocrine (37 decks)

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