Complications of DM

Question 1

What are the Macrovascular complications of DM?

Answer 1

‘Silent MI’ - Due to autonomic neuropathy
Peripheral vascular disease - Claudication, foot ulcers
Stroke

Question 2

How can you manage the risk of Macrovascular complications of DM?

Answer 2

Manage CV risk factors

- BP (aim

Question 3

What can happen in the feet of Diabetics?

Answer 3

Neuropathy

Ischaemia

Question 4

What ischaemic complications can occur in Diabetic feet?

Answer 4

Absent pulses - do ABPI

Ulcers - Can be vascular or neuropathic

Question 5

What are the features of a venous ulcer?

Answer 5

Shallow

Sloped sides

Question 6

What are the features of an arterial ulcer?

Answer 6

Deep

Punched out

Question 7

What are the features of Vascular ulcers?

Answer 7

Painful

Peripheral of foot eg toes

Question 8

What are the features of Neuropathic ulcers?

Answer 8

Painless
Pressure areas
Loss of protective sensation
Usually due to injury or infection in area that doesn’t heal

Question 9

What is Charcot’s /foot? (Neuropathic joints)

Answer 9

Progressive degeneration of a weight bearing joint
Bony destruction, bone resorption, and eventual deformity.
Onset is usually insidious
Can happen in any condition that leads to decreased sensation eg spinal cord injury
Thought to be due to reduced blood flow and repetitive microtraumas

Question 10

What is the management of Diabetic foot?

Answer 10

Regular foot checks
Comfortable shoes
Treat any infection
Surgery if abscess, gangrene or deep infection

Question 11

What is the pathophysiology of Diabetic nephropathy?

Answer 11

Hyperglycaemia → nephron loss and glomerulosclerosis

Question 12

What are the features of Diabetic nephropathy?

Answer 12

Microalbuminaemia

Urine albumin creatinine ratio ≥30mg/mM

Question 13

What is the pathophysiology of Diabetic retinopathy, cataracts and maculopathy?

Answer 13

Microvascular disease → retinal ischaemia → ↑VEGF

↑ VEGF → new vessel formation

Question 14

What are the features of background retinopathy?

Answer 14

• Dots: microaneurysms
• Blot haemorrhages
• Hard exudates: yellow lipid patches

Question 15

What are the features of pre proliferative retinopathy?

Answer 15

• Cotton-wool spots (retinal infarcts)
• Venous beading
• Haemorrhages

Question 16

What are the features of proliferative retinopathy?

Answer 16

• New vessels

- Pre-retinal or vitreous haemorrhage

Question 17

What are the features of Maculopathy?

Answer 17

• ↓ acuity may be only sign

- Hard exudates within the macula

Question 18

What is the pathophysiology of Diabetic neuropathy?

Answer 18

Metabolic - Glycosylation of nerves

Ischaemic - Loss of vasa nervorum (small blood vessels supplying the nerves)

Question 19

What neuopathy occurs in Diabetics?

Answer 19

Symmetric sensory polyneuropathy - Glove + Stocking pattern

Autonomic

Question 20

What is the presentation of Symmetric sensory polyneuropathy in Diabetics?

Answer 20

Glove + Stocking loss of all modalities
Absent ankle jerks
Numbness
Tingling
Pain (Worse at night)

Question 21

What is the management of Glove + Stocking neuropathy in Diabetics?

Answer 21

Paracetamol
SSRI
Amitryptilline
Gabapentin

Question 22

What is the presentation of autonomic neuropathy in diabetics?

Answer 22

Postural hypotension (Fludrocortisone)
GORD/Bloating
Diarrhoea (Codeine phosphate)
Urinary retention
Erectile dysfunction