Diabetes complications

Question 1

What are the main long-term complications of diabetes?

Answer 1

Microvascular complications = nephropathy, retinopathy, neuropathies (sensory, motor, autonomic neuropathy

Macrovascular = cerebrovascular, coronary artery, peripheral vascular disease

Question 2

How is the risk of macrovascular disease calculated in DM?

Answer 2

Using absolute CV risk guidelines

If existing kidney damage (microalbuminuria or proteinuria) Risk calculator underestimated

Question 3

What is diabetic nephropathy?

Answer 3

Thickening and scarring of the kidney due to changes in small blood vessels within them

Painless, no sx until kidney severely damaged
- proteinuria

Tight BP control, cholesterol, and BG prevent or delay development or retard progression

Question 4

Outline the treatments for diabetic nephropathy

Answer 4

Acei/ARBs = reduce protein sec –> dec progression from microalbuminuria to proteinuria –> dec overt CV events –> slow decline in GFR

If not ACEI/ARBs tolerated –> CCB = titrate to highest dose , thiazide may be added
- monitor K+ and renal function, STOP SMOKING

BP goal <130/80 mmHg

Question 5

What is diabetic retinopathy?

Answer 5

all abnormalities to the eye caused by diabetes = 25% more prone to blindness than non-diabetics

Cataract = clouding of lens –> early diabetes

Glaucoma = inc intraocular pressure

Question 6

How does diabetic retinopathy progress?

Answer 6

1) Progress from mild non proliferative abnormalities = inc vascular perm/microaneurysm

2) Moderate/severe non proliferative abnormalities = vascular closure (e.g. dec blood supply to area of retina)

3) Proliferative disease (growth of abnormal and easily broken vessels on retina)

Question 7

How is diabetic retinopathy treated?

Answer 7

Maintaining ideal/controlled blood glucose levels and management of HTN target

Laser treatment for proliferative disease

Laser tx +/- ranibizumab (antiangiogenic) –> for macularoedema

Fenofibrate

Question 8

What is diabetic neuropathy?

Answer 8

> 50% of diabetics who have had the disease for 20 yrs

Affect sensory and motor nerves, progression related to glycaemic control

Question 9

What are examples of diabetic mononeuropathies?

Answer 9

e.g. sciatic type pain, foot drop

Question 10

What are the types of symmetrical peripheral polyneuropathies?

Answer 10

Autonomic = HR, BP, sweating, GI tract, genitourinary tract

Sensory = warmth perception, pain
= cold perception, pain
= touch, vibration, position perception

Motor = muscle control

Question 11

What are some examples of autonomic neuropathy of GI tract in diabetes?

Answer 11

constipation, faecal incontinence, oesophageal dysfunction, gastroparesis

Question 12

What are some examples of autonomic neuropathy of CV system in diabetes?

Answer 12

heat intolerance (inc skin blood flow), postural hypotension, syncope, tachycardia, ‘silent’ MI

Question 13

What are some examples of autonomic neuropathy of Urinary tract in diabetes?

Answer 13

Urinary hesitancy

Overflow incontinence

Question 14

What are some examples of autonomic neuropathy of sexual dysfunction in diabetes?

Answer 14

impotence, ejaculatory disorders, vaginal dryness, anorgasmia

Question 15

What are some examples of autonomic neuropathy of sweating disturbances in diabetes?

Answer 15

gustatory sweating

Anhidrosis

Question 16

What are the tx for diabetic peripheral neuropathies?

Answer 16

TCA - lower dose than for depression
- amitriptyline

SNRis = duloxetine

Antiepileptics - gabapentin, pregabalin

Question 17

What factors precipitate foot problems in diabetics?

Answer 17

Small cracks & minor traumatic lesions –> form ulcers

Destruction of protective epithelium can occur via heat –> foot problems

Ill-fitting shoes and walking barefoot

Main elements responsible = vascular disease, neuropathy, infection

Question 18

How do motor neuropathies in diabetics affect the feet?

Answer 18

weakness of small muscles in foot

Result = toe clawing and/or uneven dist of weight

Calluses, corns

Question 19

How do autonomic neuropathies in diabetics affect the feet?

Answer 19

Foot can’t sweat

hard, dry skin which cracks –> entry portal for infection

Question 20

How do sensory neuropathies in diabetics affect the feet?

Answer 20

Loss of pain perception

May walk on ulcer or wound without knowing

Tissue damage and infection may go unnoticed

gangrene in extreme cases

Question 21

How do vascular disease in diabetics affect the feet?

Answer 21

ischaemic foot lesions

Minor wounds may not heal due to lack of blood