Diabetes chronic complications

Question 1

Microvascular and macrovascular chronic complications with diabetes

Answer 1

Micro (eyes, kidneys, nerves) is specific to diabetes, macro (coronary artery disease etc) is not but is increased risk

Question 2

Risk factors for retinopathy

Answer 2

Glucose (poor control, rapid control**, duration), hormones, lipids, BP

Question 3

Risk factors for nephropathy

Answer 3

Glucose (control, duration), hormones, lipids, BP, Familial factors, gender, metabolic factors, smoking, smoking

Question 4

Pathology of retinopathy

Answer 4

insert chart

Question 5

Classification of retinopathy

Answer 5

Non-Proliferative: mild / moderate / severe. Proliferative: neovascularisation or vitreous hemorrhage. Macular Edema

Question 6

Retinopathy management

Answer 6

tight glycemic and BP control (esp. ACE-i). lipid lowering (triglycerides - using fibrates). laser photocoagulation. intra-vitreal anti-VEGF (avastin/lucentis) for CSME

Question 7

Laser photocoagulation details

Answer 7

Pan retinal photocoagulation (PRP) - promote regression and arrest progression of retinal neovascularisation; and Focal. Pretty intense, would be painful w/o anesthetic

Question 8

Signs and symptoms of nephropathy

Answer 8

Clinical syndrome characterized by: Albuminuria, Hypertension, Progressive decline in renal function. Associated with retinopathy. Proliferative. Severe non-proliferative. DM duration >10 yrs. Typical Biopsy Appearance (rare to do - too obvious)

Question 9

Albuminuria classification

Answer 9

Normal 20, dipstick positive, bad.

Question 10

Natural history of untreated diabetic kidney disease

Answer 10

Intermittent microalbuminuria, GFR slowly drops off, eventually becomes full blown kidney disease. Intervention can prevent this and maintain normal kidney fn.

Question 11

Neuropathy in diabetes

Answer 11

affect peripheral and autonomic senses. 60-70% affected, can lead to ulcers and amputation

Question 12

Aspects of peripheral diabetic neuropathy

Answer 12

Painful peripheral neuropathy. Distal Symmetrical Sensory Neuropathy: reduced sensation / numbness, glove and stocking distribution

Question 13

Aspects of autonomic diabetic neuropathy

Answer 13

Resting tachycardia, Postural hypotension, Erectile dysfunction, Abnormal sweating (with eating), Gastroparesis (stomach doesn’t empty), Constipation / diarrhea

Question 14

2 reasons foot ulcers show up and description

Answer 14

Neuropathic: on bottom; fairly warm feet; no pain, can’t feel pressure, callus builds, more pressure, ulcer develops, then callus falls off and ulcer gets infected. Ischemic: on dorsal/lateral part; painful, cold, pale,

Question 15

What is Charcot foot?

Answer 15

Don’t sense fractures in feet, just notice it’s swollen, but arch collapses and is majorly at risk for ulcers. Consequence of neuropathy. Better to amputate

Question 16

How do you test foot sensitivity?

Answer 16

10g monofilament sensation. If you can’t feel it you’re at risk

Question 17

Macrovascular disease

Answer 17

70-80% of people with DM will die from cardiovascular disease; DM increases risk 2-4 fold; Worse outcomes; other risk factors more common in DM, eg hypertension, obesity, dyslipidemia

Question 18

Ways to prevent or slow complications of diabetes

Answer 18

Control blood glucose; Control blood pressure: ACE inhibitors/ARB; Control lipids: Statins & Fibrates; Control cardiovascular risk factors: Smoking cessation, aspirin