Complications of diabetes

Question 1

Hba1c and fasting glucose for diabetes

Answer 1

> 48 mol/dL and >7mmol/dL

Question 2

Polyol pathway

Answer 2

Excess glucose phosphorylated by hexokinase
Sorbitol converted to fructose via sorbitol dehydrogenase
NADH depletion protects against oxidative stress

Question 3

Microvascular complications

Answer 3

Heart disease
cerebrovascular disease
Peripheral vascular disease

Question 4

Microvascular complications

Answer 4

Retinopathy
Neuropathy
Nephropathy
Cardiomyopathy

Question 5

Risk factors for retinopathy

Answer 5

Long duration of diabetes
Poor control
Hypertension
genetic factors

Question 6

Retinopathy screening

Answer 6

High resolution images of macula and disc

Dilated pupils

Question 7

Preventing diabetes complications

Answer 7

Glucose control
BP control
Lipid control

Question 8

Treatment for diabetic retinopathy

Answer 8

Laser photocoagulation

Anti-VEGF

Question 9

Risk factors for nephropathy

Answer 9

• Duration of diabetes - plateau of prevalence 16-21 years
• Glycaemic control
• Hypertension
• Ethnicity
• Genetics

Question 10

Screening for nephropathy

Answer 10

Annual review of serum creatinine and eGFR
Urine albumin (early detection )
ACR >3mg/mmol

Question 11

How do we use ACR?

Answer 11

Albumin:creatinine ration
Predicts cardiovascular risk
Prescribe statins

Question 12

Statin dosage eGFR <60

Answer 12

Atorvastatin 20mg daily

Question 13

preventing nephropathy

Answer 13

BP and glucose control

RAS blockade - ACEi or ARB is first line for hypertension in diabetes

Question 14

Bilateral motor-sensory peripheral neuropathy

Answer 14

Tingling toes
Claw toes
Foot drop

Question 15

Isolated neuropathy

Answer 15

Diabetic amyotrophy
CN palsies
Carpal tunnel syndrome

Question 16

Autonomic neuropathy

Answer 16

Gastroparesis, diarrhoea/constipation
Atonic bladder
Gustatory sweating
Death

Question 17

Motor neuropathy sx

Answer 17

High arch and claw toes

Question 18

Sx neuropathic foot

Answer 18

Ulcers
Charcot joint
Pain

Question 19

Foot disease

Answer 19

Ischaemic foot - prone to ulceration at toes and MTP 1 and 5
Screening - inspection, pulses and sensation
Tx: debridement of callus, orthotic footwear, podiatry

Question 20

Ulceration tx

Answer 20

Debridement
Dressings
Offloading
ABs

Question 21

Ischaemia tx

Answer 21

Antiplatelets
BP control
Cholesterol control
Blood glucose control
Angioplasty
Bypass grafting

Question 22

Neuropathy tx

Answer 22

Amitriptyline 
gabapentin 
Pregabalin 
Duloxetine 
Opioids

Question 23

Macrovascular complications

Answer 23

• Stroke
• Ischaemic heart disease
• Peripheral vascular disease - claudication, gangrene, amputation
• Screening - annual review of pulses etc
• Screening for heart disease - enquire about angina, SOB etc
• Cerebrovascular disease sx - enquire about sx (loss of power or sensation, dysphagia