complications of diabetes

Question 1

diabetic comas

Answer 1

• Hypoglycaemia
• Hyperglycaemic, ketotic (DKA)
• Hyperglycaemic, hyperosmolar, non-ketotic
(HHS previously know as HONK)

Question 2

macrovascular complications

Answer 2

• Heart Attacks (MI, ACS, NSTEMI)
• Strokes (CVA,TIA)
• Peripheral Vascular Disease (PVD, PAD)
• Renal artery stenosis
• Heart Failure
• Gut ischaemia

Question 3

microvascular complications

Answer 3

• Neuropathy
• Retinopathy
• Nephropathy
• Autonomic

Question 4

jbs2 guidlesins

Answer 4

• JBS2 guidelines
– LDL<2mmol/l
– TC<4mmol/l

Question 5

ukpds 10 year follow up

Answer 5

• “Metabolic memory” – early intensive glucose
lowering results in future reductions in
macrovascular and microvascular events
• Metformin group showed 33%  in MI, 21%
in any T2DM related endpoint, and 27% in
death from any cause
• No similar “memory” effect with BP lowering

Question 6

skin anifestation of diabetes

Answer 6

• Acanthosis Nigricans
• Necrobiosis Lipoidica Diabeticorum
• Erythema Annulare
• Vitiligo
• Pyoderma Grangrenosum

Question 7

hypoglycaemia

Answer 7

Question 8

diabetic ketoacidosis

Answer 8

• Metabolic acidosis ± hyperglycaemia
• Hyperkalaemia
• Profound hypokalaemia on insulin
treatment/fluid replacement
• Pre-renal renal failure
• Mortality 5% - Cerebral oedema, cardiac
arrhythmia
• 25% of T1D present with DKA

Question 9

HONK coma

Answer 9

• Elderly, confused, hypernatraemia
• May be presenting feature of T2D
• Concurrent infection – Gram negative
• Signs of infection may be masked
• Very high risk of thrombotic events
• Fluids, Heparin, Broad spectrum antibiotic, may
not require insulin
• May be ketotic

Question 10

neuropathy

Answer 10

• Length dependent diabetic polyneuropathy
(LDDP) (80%)
• Proximal diabetic (Motor) neuropathy (PDN)
• Painful symmetrical polyneuropathy
• Diffuse motor neuropathy
• Mononeuritis multiplex
• Pressure neuropathies
• Autonomic neuropathy
• The “Diabetic foot” - Charcots

Question 11

lddp

Answer 11

• Distal, symmetrical, peripheral, ascending
• Loss of small myelinated and unmyelinated
somatosensory fibres
• Once established, irreversible
• Silent; numbness, burning, lightning pains,
paraesthesiae, allodynia, nocturnal
• Loss of thermal (and vibration) and pressure
sensation common
• Cannot be explained on basis of ischaemia alone

Question 12

autonomic neuraphty

Answer 12

Question 13

other causes of polyneuropathy

Answer 13

• Alcoholism
• Vitamin deficiency (B12 deficiency)
• Amyloid
• Drug induced
• Multisystem disorders – SLE, Sarcoid
• Paraneoplastic
• Monoclonal Gammopathy
• POEMS syndrome

Question 14

retinopathy

Answer 14

• Background changes
• Pre-proliferative changes (IRMAs)
• Proliferative changes
• Maculopathy

Question 15

proteinuria

Answer 15

• 50% of patients with diabetes develop
microalbuminuria ~ Approx 30% progress to
proteinuria, 30% remain microalbuminuric, 30%
revert to normal albumin excretion
• Indicator of vascular disease in T2D - 20-40 x 
CV risk
• Reversible – glucose control, antihypertensives
and ACEIs
• CKD – 5 stages; defined by eGFR, stage 1
hyperfiltration. Characteristic changes largely in
glomerular basement membrane