Chronic Diabetes Complications

Question 1

General organs that can be effected in diabetes

Answer 1

Eyes
Kidneys
Nervous system
Cardiovascular systems
Diabetic foot

Question 2

4 mechanisms of glucose-induced damage

Answer 2

Increased polyol pathway flux
Increased intracellular advanced glycation end product (AGE) formation
Activation of protein kinase C
Increased hexosamine pathway flux

Question 3

3 eye complications of diabetes

Answer 3

Diabetic retinopathy
Cataracts
Glaucoma

Question 4

Nonproliferative retinopathy

Answer 4

The earliest stage of retinal involvement

Changes: microaneurysms, dot hemorrhages, exudates, and retinal edema

Question 5

Proliferative retinopathy

Answer 5

The growth of new capillaries and fibrous tissue within the retina and into the vitreous chamber
Preproliferative phase you get arteriolar ischemia (cotton wool spots)
Vision is usually normal until vitreous hemorrhage or retinal detachment occurs
Leading cause of blindness

Question 6

3 things you can see on an eye exam from diabetic retinopathy

Answer 6

Microaneurysms
Cotton wool spot
Dot-blot hemorrhages

Question 7

How do you treat diabetic retinopathy

Answer 7

Pan retinal photocoagulation (stop vessels from growing and leaking)
Vitrectomy (for severe proliferative with vitreous hemorrhage)
Intravitreal anti-VEGF therapy for patients with clinically significant macular edema
Aspirin

Question 8

3 ways to prevent diabetic retinopathy

Answer 8

Good glycemic control
Good blood pressure control
Smoking cessation

Question 9

When is the first time you should do an eye exam in

1. T1D
2. T2D

Answer 9

1. Within 5 years after diagnosis

2. At the time of diagnosis

Question 10

3 renal complications of diabetes

Answer 10

Diabetic nephropathy
Infection
Renal tubular necrosis

Question 11

Risk factors for diabetic nephropathy

Answer 11

Family history of diabetes
Black race
Certain ethnicities
Higher systemic BP
Evidence of hyperfiltration early in course of disease
Poor glycemic control
Smoking
Obesity, OCP and older age may also be risk factors

Question 12

6 clues suggesting nondiabetic renal disease

Answer 12

Onset of proteinuria less than 5 years from documented onset of T1D
Acute onset of renal disease
Active urine sediment with red cells/cellular casts
In T1D, the absence of diabetic retinopathy or neuropathy
Signs/symptoms of another systemic disease
Reduction in GFR within 2-3 months of ACEIs/ARBs

Question 13

How to treat/prevent diabetic nephropathy (4 ways)

Answer 13

Good glycemic control
Good BP control
Treat hyperlipidemia
If progressed, renal replacement therapy and renal transplantation

Question 14

Causes of transient proteinuria

Answer 14

Febrile illness
UTI
Recent major exercise
Decompensated CHF
Menstruation
Acute severe elevation in blood sugar/pressure

Question 15

What is diabetic neuropathy

Answer 15

Involvement of the peripheral and autonomic NS

Categorized into distinct syndromes

Question 16

Risk factors of diabetic neuropathy

Answer 16

Glucose control
Duration of diabetes
Damage to blood vessels
Mechanical injury to nerves
Autoimmune factors
Genetic susceptibility
Lifestyle factors (smoking, diet)

Question 17

Symmetric sensory polyneuropathy

Answer 17

Most common form of diabetic neuropathy
Sensory involvement usually occurs first (associated with decreased perception of vibration and temperature)
Paresthesia/dysthesia may occur and usually affect distal lower extremities and hands
Pain can range from mild to severe

Question 18

2 ways to screen for peripheral neuropathy

Answer 18

Tuning fork to test for vibrations

Microfilament thing to feel 10 points

Question 19

4 complications of sensory polyneuropathy

Answer 19

Ulcers
Charcot arthropathy
Dislocation and stress fractures
Amputation

Question 20

3 ways to treat symmetric polyneuropathy

Answer 20

Glucose control
Pain control
Foot care

Question 21

CV system complications of diabetes

Answer 21

Heart disease (ischemic heart disease, cardiomyopathy)
Peripheral vascular disease
Cerebrovascular disease

Question 22

ABCDES for vascular protection

Answer 22

A: A1C
B: BP
C: Cholestrol
D: drugs to protect the heart
E: exercise/eating healthy
S: smoking cessation and management of stress

Question 23

How do you get a diabetic foot ulcer

Answer 23

Combo of neuropathy and angiopathy

Question 24

What drug class can be used to reduce CV risk in adults with certain risk factors?

Answer 24

Statins