CM: Diabetes Complications

Question 1

What are the findings of non-proliferative diabetic retinopathy?

Answer 1

microaneurysms
capillary non-perfusion
leakage –> blood andv (hard) exudates (macular edema can lead to loss of visual acuity)

Question 2

What are the findings of pre-proliferative diabetic retinopathy?

Answer 2

intra-retinal microvascular abnormalities (IRMA)
intra-retinal hemorrhages
cottons wool spots = soft exudates
venous bleeding

Question 3

What are the findings of proliferative diabetic retinopathy?

Answer 3

new vessels = neovascularization (fine tufts)
fibrous tissue
vitreous hemorrhage
traction retinal detachment

Question 4

When should follow up visits for pts w diabetes be conducted?

Answer 4

annually - children, adolescents, adults w/o retinopathy
semi-annually: non-proliferative retinopathy
quarterly: pre-proliferative
individualized: proliferative, pregnant

Question 5

What are important early findings in diabetic nephropathy?

Answer 5

BP elevation
microalbuminuria
hyperfiltration (CCr above normal)
alterations in glomerular structure (BM thickening and mesangial expansion)

Question 6

How can microalbuminuria be detected?

Answer 6

dipstick negative, albumin excretion 30-300 mg/24 hrs (30-300 microg/min), found in 2 of 3 urine samples w/i 6 mos
should look for 5 yrs after diagnosis of type 1 and at diagnosis of type 2

Question 7

What can cause transient microalbuminuria?

Answer 7

poor glycemic control, UTI, physical exercise, high protein intake, cardiac insufficiency

Question 8

What are the features of distal symmetrical polyneuropathy?

Answer 8

paresthesias (tingling, numbness), pain, impaired sensation (vibratory, pain), nocturnal exacerbation, absent knee and ankle reflexes
motor involvement variable

Question 9

What are the features of neuropathic ulcers?

Answer 9

caused by loss of protective sensation and repetitive trauma
over areas w increased pressure
hammer-claw toe deformity of foot –> increased pressure on metatarsal heads

Question 10

What are the risk factors for the dev of diabetic neuropathy?

Answer 10

genetic predispostion, male gender, height, alcohol, hyperglycemia

Question 11

How can one examine a pt for subclinical diabetic neuropathy?

Answer 11

quantitative sensory tests:
vibratory perception threshold - measures large nerve fiber integrity, better in upper limbs
thermal perception threshold - measures small nerve fiber integrity
also tactile perception threshold and electrical threshold