Diabetes Complications: Overview & Retinopathy

Question 1

what chronic complications are associated with diabetes

Answer 1

macrovascular complication, microvascular complication, cognitive dysfunction/dementia, erectile dysfunction, psychiatric complications

Question 2

what is meant by macrovascular complications of diabetes

Answer 2

ischaemic heart disease, stroke etc.

Question 3

what is meant by microvascular complications of diabetes

Answer 3

retinopathy, nephropathy and neuropathy

Question 4

what should be screened for in annual review of diabetes patients to help identify complications/risk of complications

Answer 4

digital retinal screening, foot risk assessment, Urine albumin: Creatinine ratio, creatinine

Question 5

describe how HbA1c is related to the relative risk of developing diabetic complications

Answer 5

as HbA1c increases the relative risk increases, especially when above 9-10% HbA1c

Question 6

microvascular complications not seen in the absence of what

Answer 6

hyperglycaemia

Question 7

what are some of the consequences of hyperglycaemia

Answer 7

Mitochondrial dysfunction, Reactive oxygen species, inflammation, fibrosis, osmotic damage

Question 8

briefly describe why excess glucose results in pathology

Answer 8

when there is too much glucose, the mitochondria cannot keep up with glycolysis, so alternative pathways are used through which reactive oxygen species are formed these cause pathology

Question 9

give some examples of reactive oxygen species that result from hyperglycaemia

Answer 9

sorbitol(osmotic damage), NADPH oxidase, Protein Kinase C(inflammation, fibrosis), RAGE(inflammation)

Question 10

what different eye pathologies do people with diabetes get

Answer 10

diabetic retinopathy, diabetic macular oedema(Maculopathy), cataracts, glaucoma

Question 11

describe what cataracts and glaucoma are

Answer 11

cataracts = clouding of the lens
glaucoma = increase in fluid pressure in eye leading to optic nerve damage

Question 12

what are the different stages of retinopathy

Answer 12

mild non-proliferative(background), moderate non-proliferative, severe non-proliferative, proliferative
(progressive complication)

Question 13

how can haemorrhages be described in retinopathy

Answer 13

as a dot, blot or flame

depends how big

Question 14

what are cotton wool spots and hard exudates seen in retinopathy

Answer 14

cotton wool spots = fluffy white appearance, ischaemic areas

hard exudates = lipid break down products, deposited in retina

Question 15

what does IRMA stand for in retinopathy

Answer 15

intra-retinal microvascular abnormalities

precursor to neovascularisation

Question 16

at what stage of retinopathy do microaneurysms arise

Answer 16

at start, they are not cause for referral or treatment, may go away

Question 17

what maculopathy would be seen as referrable

Answer 17

hard exudates within 1 disc diameter of the fovea

Question 18

what affects can bleeding cause in retinopathy

Answer 18

sudden change in vision(can lose vision), floaters(if small), vitreal haemorrhage is big bleed in retina

Question 19

what is the mainstay of treatment for retinopathy

Answer 19

laser- pan retinal photocoagulation, zaps parts of retina at peripheries killing small parts of retina
(if too much lose some peripheral vision)

Question 20

what are the benefits of pan retinal photocoagulation

Answer 20

reduces oxygen requirement of retina, reduces ischaemia that is driving retinopathy

Question 21

what treatment is used for vitreal haemorrhages

Answer 21

vitrectomy

Question 22

what is the mainstay in treatment for diabetic macular oedema, a common cause of blindness in diabetics

Answer 22

intravitreal anti-VEGF, injected into eye

sometimes need grid laser for macula if doesn’t work