Chronic Complications of Diabetes Mellitus

Question 1

What are the microvascular complications of DM?

Answer 1

• Nephropathy (microalbuminuria= renal disease if uncontrolled)
• Peripheral neuropathy
• Retinopathy

Question 2

How do we stop/ slow progression of complications?

Answer 2

-Good glycaemic control
=HbA1c
=Blood glucose monitoring

-BP control
=<140/90 with no microvascular disease (clinic)
=<135/85 with target organ damage

Question 3

How do we screen for complications?

Answer 3

-Retinopathy screening
=At least 2 yearly eyes if low risk
=PAEP in some cases for higher risk
-Urinary ACR annually (early indication of protein leakage) 
-Annual foot examination

Question 4

What issues contribute to microvascular issues?

Answer 4

• Lack of insulin (long standing high HbA1c)
• Disordered eating/ anorexia
• Low mood (chronic disease)
• Moving house- lack of engagement, continuity
• HTN? (hypertensive)

Question 5

How can microvascular complications be managed?

Answer 5

• Encourage her to take her insulin regularly? (difficult)
• Accept support from clinic?
• Control BP and bring down HbA1c?
• Technology? (libra sensor= basal bolus/ multiple injection regime)
• Renal input
• DSN (diabetes nurse) input
• Psychological input re eating
• Podiatry (off loading, antibiotics, debridement)

Question 6

What are the risk factors for coronary heart disease?

Answer 6

• Male
• Age
• Smoking status
• Diabetes
• BP
• Lipid profile

Question 7

What is the pathophysiology of CHD in type 1 diabetes?

Answer 7

• Dyslipidaemia is highly correlated with atherosclerosis
• Both insulin deficiency and insulin resistance promote dyslipidaemia
• Endothelial dysfunction is present at an early stage
• Factors combine to promote atherogenicity and thus macrovascular disease

Question 8

How do we modify risk factors for CHD?

Answer 8

• Good glycaemic control
• Statins
• BP control
• Statin therapy
• Watch weight
• Smoking status