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Endocrine-Week 3/4 > Complications of Diabetes > Flashcards

Complications of Diabetes Flashcards

1
Q

Examples of CHRONIC complications of Diabetes

A

Microvascular:

  • Retinopathy
  • Nephropathy
  • Neuropathy

Macrovascular:

  • Stroke
  • Heart Disease
  • PVD
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2
Q

The most prevalent microvascular complication of diabetes

A

Diabetic Retinopathy

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3
Q

Compared to conventional insulin therapy, intensive insulin therapy reduced risk of what complications?

A

microvascular complications (retinopathy, nephropathy and neuropathy)

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4
Q

Despite reduced risk of retinopathy, What is a common complication of INTENSIVE insulin therapy?

A

HYPOglycemia

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5
Q

Pathology of Diabetic Retinopathy

A

NPDR:

  • Thickened capillary basement membrane
  • Exudates
  • Aneurysms
  • Hemorrhages

PDR:

  • Stenosis –> Ischemia
  • Neovascularization (inc. VEGF causing angiogenesis)
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6
Q

Clinical features of NPDR

A
  • IRMA (intraretinal microvascular abnormalities)
  • micro-aneurysms
  • intraretinal hemorrhages
  • hard exudates (lipid)
  • Cotton wool spots
  • Venous beading
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7
Q

Clinical features of PDR

A
  • Preretinal neovascularization (hallmark of PDR)
  • vitreous hemorrhage
  • fibrous tissue prolifearation
  • traction retinal detachment
  • can cause blindness due to Macular Edema
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8
Q

Pathology of PDR

A

hyperglycemia causes stenosis of retinal microvasculature –> ischemia –> new FRAGILE blood vessels form

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9
Q

Primary cause of vision loss in DR

A

CSME

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10
Q

Pathology of CSME

A

permeable vascular walls –> leakage and accumulation of intraretinal fluid

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11
Q

(True/False) ME may occur in all stages of NPDR and PDR

A

True

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12
Q

Vision loss/blindness in DR results from what two main causes?

A
  1. Leakage –> hemorrhage, exudate, vascular leakage –> NPDR/CSME
  2. Ischemia –> Neovascularization –> PDR
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13
Q

Treatments for Diabetic Retinopathy

A
  1. Sugar, lipid, and BP management
  2. Injected therapies (VEGF inhibitors)
  3. Laser photocoagulation
  4. Vitrectomy
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14
Q

Pathogenesis of Diabetic Nephropathy

A

Chronic hyperglycemia –> glycation of basement membrane –> Thickened BM and efferent arteriole –> hyperfiltration (increased GFR) –> increase in intraglomerular pressure –> glomerular hypertrophy/scarring –> worsening filtration capacity –> nephrotic syndrome

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15
Q

Three major histological changes of DNephro

A
  1. Mesangial (cell & matrix) expansion
  2. Glomerular BM thickening
  3. Glomerulosclerosis
    - Hyalinization
    - Kimmelstiel-Wilson nodules
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16
Q

UA findings of DNephro

A
  1. Proteinuria (earliest sign of DN)
    - Microalbuminuria (30-299mg) –> macroalbuminuria (>300mg)
  2. Decreased GFR in more advanced DN
17
Q

GFR in ESKD

A

GFR <15

18
Q

Leading cause of End-Stage Kidney Disease

A

Diabetic Nephropathy

19
Q

Average age onset of ESKD due to DNephro

A

60

20
Q

Modifiable contributing factors of DNephro

A

smoking
hypertension
dyslipidemia
high protein diet

21
Q

Treatments for Diabetic Nephropathy

A
  1. ACE inhibitors/ARBs
  2. BP management
  3. low protein diet
22
Q

ACE inhibitors and ARBs should be started in patients with

A
  1. diabetes w/ elevated MA/cr ratio

OR

  1. diabetes w/ elevated urinary 24 hour protein

OR

  1. hypertension
23
Q

Most common form of diabetic neuropathy

A

Symmetric PERIPHERAL neuropathy

24
Q

Which nerves are most prone to Diabetic Neuropathy

A

Longer nerves are most vulnerable (affect feet first –> later on hands)

“stocking-glove” pattern

25
Q

Examples of symptoms of AUTONOMIC Neuropathy

A
  • Orthostatic hypotension
  • Gastroparesis
  • ED
26
Q

What makes diabetics prone to feet/lower extremity problems (ulceration, cellulitis, bony deformity, gangrene, amputation)

A
  • Loss of protective sensation
  • PVD (peripheral vascular disease)
  • HTN
  • Smoking
27
Q

Relatively painless, progressive and degenerative arthropathy of joints in the foot; associated with diabetes, but also syphilis (tabes dorsalis)

A

Charcot Foot

28
Q

Visual inspection of feet, palpation, semmes-weinstein monofilament (poking), and tuning fork can be used to

A

screen diabetic foot

29
Q

Treatments for Diabetic Neuropathy

A
  1. Pain
    - Gabapentin
    - Pregabalin
    - Duloxetine
  2. Autonomic symptoms
    - Anti-emetics for gastroparesis
    - Phosphodiesterase (PDE) inhibitors for ED
  3. Specialized footwear (to off load pressure from feet)
30
Q

Examples of MICROvascular complications of Diabetes (3 total)

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
31
Q

Examples of MACROvascular complications of Diabetes (3 total)

A
  1. Brain (Cerebrovascular Disease)
  2. Heart (Coronary Heart Disease)
  3. Peripheral vessels (Peripheral Artery Disease)
32
Q

Organ or limb complications of atherosclerosis affecting medium and large vessels

A

Macrovascular disease

33
Q

1 cause of mortality in Diabetes

A

Cardiovascular disease

34
Q

Macrovascular disease in diabetes is a result of hyperglycemia +

A

MULTIPLE other risk factors

  • HTN
  • dyslipidemia
  • smoking
  • thrombosis
  • etc.
35
Q

Treatment/Preventatives for MACROvascular disease in Diabetics

A
  • Control HTN
  • Statins
  • Smoking cessation
  • Anti-platelet therapy

*sugar control not proven to affect, as opposed to MICROvascular

36
Q

The relationship between blood sugar control and the reduction for both Macro and Microvascular disease is different (True or False)

A

True: proven effective for MICROvascular disease, but not MACROvascular

37
Q

Although controlling blood glucose has NOT been shown to reduce MACROvascular complications, why is it important to control BG?

A

Early glycemic control resulted reduced LATER MACROvascular events and CV death

38
Q

What non-vascular complications are associated with diabetes?

A
  • GU infections
  • CHF
  • Fatty liver (steatohepatitis)
  • Cataracts
  • Gingivitis
  • Chronic mental illness

Endocrine-Week 3/4 (9 decks)

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