Diabetes

Question 1

How often should diabetics have their eyes screened?

Answer 1

Annually - check for signs of diabetic retinopathy

Question 2

What signs of diabetic retinopathy are seen on retinal screening?

Answer 2

• microaneurysms (dots)
• hard exudates (lipid deposits)
• haemorrhages (blot/flame)
• cotton wool spots (infarcts of retina)
• neovascularisation
• can see retinal detachment secondary to haemorrhages between the retina and choroid

Question 3

What optic disc sign is seen on fundoscopy in glaucoma?

Answer 3

Cupping (optic cup:optic disc ratio smaller - as the cup is bigger)

Due to raised intraoccular pressure

Question 4

What optic disc sign is seen in raised ICP?

Answer 4

Papilloedema - swelling around the optic disc (different to cupping)

Question 5

What are the 2 broad types of diabetic retinopathy?

Answer 5

Non-proliferative

Proliferative

Question 6

What is the difference between Proliferative and non-proliferative diabetic retinopathy?

Answer 6

Proliferative - new BV formation (angiogenesis in response to chronic hypoxia of the retina) - this is the more severe form as more blood vessels increases the oxygen demand of Retina which cannot be met - need to save the Macula (area capable of highest visual acuity) hence treat this by lasering the new vessels

Non-proliferative - no angiogenesis but can still show cotton wool spots, haemorrhages and microaneurysms

Question 7

What Growth Hormone triggers angiogenesis in the ischaemic retina?

Answer 7

VEGF - vascular endothelial GF

Question 8

How can you treat Proliferative Diabetic Retinopathy (with macular oedema)?

Answer 8

• Anti-VEGF injections
• Laser treatment
• Intravitreal steroids
• better diabetic control

Note - if no macular oedema present - cannot get anti-VEGF injections on NHS?)

Question 9

Which cranial nerve palsies are most common in diabetics (as a result of microvascular complications)?

Answer 9

CN III, IV, VI

• oculomotor - pupil sparing as the parasympathetics have a different blood supply - down and out position
• trochlear - extorted, elevated and adducted eyeball (loose superior oblique)
• Abducens - adducted eyeball (loose lateral rectus)

Question 10

What other eye conditions are common in diabetics?

Answer 10

Cataracts
CN palsies (often spontaneously resolve over few months)
Glaucoma (open angled)
Macular oedema secondary to diabetic retinopathy
Rubeosis iridis - may lead to glaucoma

Question 11

What are the other common complications of diabetes?

Answer 11

Vascular disease eg. Vascular dementia, erectile dysfunction, PVD
Nephropathy
Neuropathy
Immunosupression

Question 12

How do you screen for diabetic nephropathy?

Answer 12

Urine ACR - albumin creatinine ratio
Diabetic nephropathy is a NEPHROTIC syndrome
Also monitor blood pressure - this will increase secondary to kidney disease
Get more afferent arterial dilatation here too - hence ACRi’s inhibit this so are protective in Diabetic nephropathy
Screen annually
(Along with:
- Retina
- CVS risk
- feet )