Diabetes Flashcards
Type 1 diabetes is also known as ………
IDDM (Insulin dependent)
Type 2 diabetes is also known as ………
NIDDM (Non-insulin dependent)
What pharmacological treatments are available for Type 2 diabetes?
Biguanides
Sulfonylureas
What is a example of a biguanide and what effect does it have?
Metformin
Stops glucose production
What is a example of a sulfonylureas and what effect does it have?
Gliclazide
Stimulates insulin production
What ocular complications can happen as a result of diabetes?
Cataracts
Corneal opacities
Diabetic retinopathy
Refractive changes
Open-angle glaucoma
Tritanopia defect
CN palsies
Recurrent infections
What are the risk factors for diabetic retinopathy?
Length of diabetes
Quality of metabolic control
Smoking
Obesity
Hypertension
Hyperglycaemia
Pregnancy
Renal disease
Anaemia
Cataract surgery
What are the biochemical pathways that contribute to the development of DR?
Polyol pathway
Increased expression of growth factors
Oxidative stress
Inflammation
Genetic factors
What is the polyol pathway?
Sorbitol accumulation due to increased glucose levels (glucose is turned to sorbitol by enzymes)
What type of complication of diabetes is DR?
Microvascular
Why does the increased expression of growth factors contribute to the development of DR?
Neovascularisation is promoted, so vascular permeability increases (due to more blood vessels existing)
What are the stages of DR?
Non-proliferative (mild, moderate and severe)
Proliferative
Diabetic maculopathy
What are the signs of Mild NP DR?
At least one microaneurysm by itself or with:
Dot/blot haem
Hard exudates
CWS
Venous loops
What are the signs of moderate NP DR?
As mild plus:
Increased no of microaneurysms and haem
Larger haem (deeper)
CWS
Venous beading
What are the signs of severe NP DR?
4 quadrants: haem or microaneurysms
2 quadrants: venous beading
1 quadrant: Intraretinal microvascular abnormalities (IRMA)
Which layers of the retina do dot/blot haem occur in?
Nuclear and plexiform layers
Which layer of the retina do hard exudates occur in?
Outer plexiform layer
Which layers of the retina do microaneurysms occur in?
Nuclear layers
Which layer of the retina do CWS occur in?
NFL
What is intraretinal microvascular abnormalities (IRMA)?
Clusters of microaneurysms and tortuous vessels
What are the signs of Proliferative DR?
Neovascularisation
Vitreous detachment
Preretinal or vitreous haem
Retinal detachment
What are the signs of diabetic maculopathy?
Foveal oedema (vascular leakage) - loss of foveal pit
Central vision loss
What is the treatment for DR?
Manage blood sugars
Laser treatment to stop further progression
Vitrectomy
Intravitreal injections (corticosteroids or VEGF inhibitors)
