diabetes complications

Question 1

main cause of hospitalization/mortality in diabetes

Answer 1

cardiovascular disease. Plus, diabetics do worse after MI

Question 2

List macrovascular complications of diabetes

Answer 2

Increased risk of cardiovascular disease ( MI, stroke, peripheral vascular dz), heart failure

Question 3

therapy to decrease cardiovascular complications of diabetes

Answer 3

lipid lowering and intensive blood pressure control

Question 4

hypertension in diabetes

Answer 4

Very common in T2D and uncommon in T1D prior to onset of renal disease, although in T1D there is a loss in normal nocturnal lowering of BP

Question 5

Diabetes and metabolic syndrome

Answer 5

Hyperinsulinemia is associated with the metabolic syndrome. This controversial syndrome is a constellation of: insulin resistance, visceral adiposity, hypertension, dyslipidemia, and type 2 diabetes/glucose intolerance. These factors all increase risk of macrovascular disease

Question 6

lipid abnormalities in diabetes

Answer 6

hypertriglyceridemia, decreased HDL, altered lipoprotein composition, glycation/oxidation, small dense LDL

Question 7

how does diabetes affect vascular wall response

Answer 7

1. Abnormal endothelial cell function. 2. abnormal vascular smooth muscle function. 3. inflammation and decreased fibrinolysis

Question 8

how does diabetes affect endothelial cell function

Answer 8

abnormal clotting (decreased tPA and increased PAI-1), inflammation, decrased vasomotion, increased cytokines/chemokines

Question 9

how does diabetes affect vascular smooth muscle

Answer 9

enhances smooth muscle proliferation, increased production of matrix proteins, cytokines and growth factors, altered contractile function

Question 10

How does diabetes affect inflammation/fibrinolysis

Answer 10

platelet adhesion and activation, monocyte adhesion/activation, foam cel formation

Question 11

Interventions to decrease cardiovascular risk in diabetes

Answer 11

Beta blockers, antihypertensives and lipid lowering agents have great outcome. Aspirin has less of an impact in diabetes, but should be used in high risk subjects and people with diabetes and established CVD. Early intensive glycemic control

Question 12

List mechanisms of microvascular complications in diabetes

Answer 12

Polyol pathways, non-enzymatic glycosylation, elevation of protein kinase C, oxidative/carbonyl stress

Question 13

polyol pathway

Answer 13

Hyperglycemia leads to an influx of glucose into cells, which can be metabolized by aldose reductase to sorbitol and fructose. These molecules can cause osmotic and oxidative stress leading to abnormal cellular function

Question 14

non-enzymatic glycosylation

Answer 14

Glucose binds to proteins and nucleic acids forming advanced glycosylation end products (AGEs)- involved in nephropathy, vasculopathy and retinopathy. Interfere with basement membrane function, impair vasodilation, disrupt DNA function/repair

Question 15

protein kinase C and diabetes

Answer 15

PKC leads to production of extracellular matrix proteins collagen and fibronectin in renal and vascular cells, causing basemnt membrane thickening. In endothelial cells promotes ICAM adhesion molecules, plasminogen inhibitor activator-1, VEGF and defective vasodilating NO

Question 16

oxidative/carbonyl stress in diabetes

Answer 16

generation of intracellular reactive oxygen species leads to blockade of glycolysis

Question 17

pathogenesis of retinopathy in diabetes

Answer 17

pericyte dropout and loss of autoregulation of blood flow to retinal capillary bed > capillary dropout > basement membrane thickening > leakage of intravascular fluids leading to exudates > hypoxic stress >cytokines >neovascularization and retinopathy

Question 18

stages of diabetic retinopathy

Answer 18

1. Early pre-proliferative
2. Mild preproliferative (laser intervention)
3. Severe preproliferative (laser intervention)
4. Early proliferative
5. Neovascularization disc/elsewhere
6. Macular edema

Question 19

prevention of diabetic retinopathy

Answer 19

early intervention with panretinal photocoagulation can prevent or decrease vision loss.

Question 20

other ocular complications of diabetes

Answer 20

macular edema (most common eye complication), corneal ulceraction, glaucoma, cataracts

Question 21

leading cause of renal failure nationwide

Answer 21

diabetes

Question 22

diabetic nephropathy pathogenesis

Answer 22

hyperfiltration (secondary to increased osmotic load of hyperglycemia), intrarenal and peripheral HTN, BM thickening, mesangial proliferation, glomerular obliteration

Question 23

prevention/therapy of diabetic nephropathy

Answer 23

Aggressive control of hyperglycemia (with intensive therapy) and blood pressure (with ACE inhibitors or b blockers)

Question 24

categories of diabetic neuropathy

Answer 24

1. distal symmetric polyneuropathy: stocking glove, painful or painless. 2. autonomic: gastroparesis, sex dysfunction, orthostatic hypotension/ inapproriate heart rate, hypoglycemic unawareness. 3. mononeuritis multiplex: vascular occlusion to single nerve distribution. 4. diabetic amyotrophy: neuromuscular wasting syndrome

Question 25

Most frequent cause of non-traumatic lower limb amputations

Answer 25

diabetes

Question 26

what causes diabetic foot disease

Answer 26

impaired blood flow and sensation to the extremities