Complications

Question 1

What are the Marco and Microvascular complications

Answer 1

Micro
- retinopathy
-nephropathy
-neuropathy

Macro
- cerebrovascular disease and stroke
- CAD/CVD, MI risk
- PVD, wounds, amputations

Question 2

Mild vs moderate vs severe hypoglycaemia

Answer 2

Mild - autonomic (neurogenic) symptoms present, individual can self treat

Moderate- autonomic and neuroglycopenic symptoms present, individual is able to self treat

Severe - individual cannot self treat (PG usually <2.8mmol/L)

Question 3

Define hypoglycaemia

Answer 3

1.) autonomic and/or neuroglycopenic symptoms
2.) low plasma glucose (<4 for those with diabetes on insulin or taking sulfonylureas or miglitinides
3.) symptoms respond to the administration of carbohydrate.

The severity of hyperglycaemia is defined by clinical manifestations

Question 4

Risk factors for severe hypoglycemia in people treated with sulfonylureas or insulin

Answer 4

-Prior episode of severe hypoglycemia
-Current low AIC (<6.0%)
-Hypoglycemia unawareness
-Long duration of insulin therapy
-Autonomic neuropathy
-Chronic kidney disease
- Low economic status, food insecurity
- Low health literacy
- Preschool-aged children unable to detect and /or treat mild hypoglycemia on their own
- Adolescence
- Pregnancy
- Elderly
- Cognitive impairment

Question 5

DKA treatment

Answer 5

Insulin infusion @ 1 unit/kg/hr
Bicarbonate therapy for extreme acidosis (ph <7)

Question 6

DKA might happen at normal or mildly elevated BG in which cases?

Answer 6

Pregnancy
Those taking SGLT2 inhibitors

Question 7

Screening for CKD in T1DM vs T2DM

Answer 7

T1 - 5 years after Dx
T2 - at time of Dx

Question 8

Risk factors for Neuropathy

Answer 8

Hyperglycaemia
High triglycerides
High BMI
Smoking
HTN

Question 9

Most common form of diabetic neuropathy

Answer 9

Distal symmetric polyneuropathy (DSPN)

gradual loss of integrity of the longest nerve fibers, with symptoms beginning distally and symmetrically in the small muscle fibres in toes and feet.
Small fibres - burning, sharp, shooting pain
Large fibres - numbness, tingling, loss of protective sensation

Question 10

If the 10g stemmes-weinstein monofilament test was used, what is the threshold for neuropathy Dx?

Answer 10

A score of 3/8 = neuropathy is likely present
3.5-5 = risk of new onset neuropathy in the next 4 years is high
5.5 + = risk of new onset neuropathy in the next 4 years is low