Diabetes complications

Question 1

how many people are affected by retinopathy?

Answer 1

80% of all patients whove had diabtes for 10+ years

Question 2

what is retinopathy?

Answer 2

macrovascular retinal changes. hyperglycaemia induced pericyte death and thickening of basement membrane lead to incompetance of vascular walls leading to overaccumulation of glucose that damages blood vessels in retina.

Question 3

what is a pericyte?

Answer 3

contractile cell that wraps around endo cells of capills and venules

Question 4

in retinopathy, what can damaged blood vessels do?

Answer 4

leak fluids and lipids onto the macula causing a macula edema because fluids induce inflammation. as this progresses, blood vessels grow bc of lack of O2, these bleed, cloud vision and destroy retina

Question 5

what is the macula?

Answer 5

part of the eye that allows us to see detail

Question 6

what is neuropathy?

Answer 6

microvascular injury involving small bv supplying nerves - advanced glycated end products implicated leading to an increased vascular permeability, arterial stiffening and increased oxidative stress

Question 7

what are symptoms/signs of neuropathy?

Answer 7

pain in legs/feet, ulcers, decreased vibration perception

Question 8

what drugs for neuropathy?

Answer 8

tricyclic antidepressants, anti-epileptics

Question 9

what are tricyclic antidepressants

Answer 9

they block seratonin transporters and increase neurotransmittors

Question 10

what are anti-epileptics?

Answer 10

block sodium/calcium channels and reduce release of excitatory glutamate

Question 11

what is nephropathy?

Answer 11

kidney disease caused by angiopathy of capillaries in kidney glomeruli due to chronic high glucose

Question 12

how is nephropathy diagnosed?

Answer 12

urinary albumin levels equal to or over 300mg/24hr

Question 13

how is retinopathy diagnosed?

Answer 13

visual tests

Question 14

what visual tests? according to NICE guidelines

Answer 14

acuity with an eye chart for distance, pupil dilation and Fundus Fluorescein angiopathy stain shows leaking, non perfusion of the vasculature

Question 15

what is encephelopathy?

Answer 15

brain damage due to long term glucose exposure, diagnosed by mental status

Question 16

how much more likely are diabetics to have a stroke?

Answer 16

2 to 4

Question 17

what has been predicted cost wise and by whom?

Answer 17

new report in ‘diabetic medicine’ 16.9 billion over next 25 years , 17% of entire budget. also says cost of treating complications rise from 7.7 bil to 13.5 bil by 2035

Question 18

what percentage of diabetes budget spent on complications?

Answer 18

79%

Question 19

indirect costs associated with diabetes?

Answer 19

death, illness, work loss, informal care = 13 bil for type 2

Question 20

deaths in working years?

Answer 20

325,000 lost working years

Question 21

what percentage is inpatient care? according to diabetes.co.uk

Answer 21

65.8%