Diabetes Complications - retinopathy & nephropathy

Question 1

What are the two main categories of diabetic complications

Answer 1

1. Micro-vascular
   Disease ( damage to small blood vessel)
2. Macro-vascular disease - ( damage to large blood vessel)

Question 2

Give examples of Micro - vascular diseases

Answer 2

Retinopathy
Nephropathy
Absent foot pulses
Ischaemic skin changes
Abnormal vibration threshold

Question 3

Give examples of Macrovascular disease in Type 2 diabetics

Answer 3

• Peripheral vascular disease - pain in calf & reduction in blood supply to legs and leads to gangrene , amputation etc
• Abnormal ECG
• Hypertension

Question 4

What are the vital control risk factors?

Answer 4

1. Uncontrollable hypergluycaemia
2. Persistant hypertension

Question 5

What are the three major Micro vascular diseases?

Answer 5

1. Neuropathy
2. REtinopathy
3. nethropathy

Question 6

Why are the eyes, kidneys and nerves vulnerable to damage?

Answer 6

The endotheilial cells of the kidney, retinal and Peripheral nervous system allow glucose into cell even without insulin

Question 7

Describe the various diabetic eye diseases

Answer 7

1. Blurred vision - Diplopia
2. Cataracts
3. Glaucoma

Question 8

What is the incidence of retinopathy in type 1 and type 2 diabtes patients ?

Answer 8

Within 20 years of diagnosis of diabetes
* Present in almost all type 1 patients
* Present in 60% type 2 patients

Question 9

Describe the progression of retinopathy

Answer 9

1. starts with heamoraaghes with spots of leaking fluid
2. Retina infaction
3. fragile new blood vessells formed

Question 10

What are the risk factors of diabetic retinopathy?

Answer 10

1. Hyperglycaemia
   * Hypertension

• Diabetic nephropathy
• Raised blood triglycerides (hyper-triglyceridaemia)
• Pregnancy

Question 11

What is the treatment of diabetic retinopathy ?

Answer 11

1. Management of risk facors including - hyperclycaemia & hypertension
2. Laser eye treatment for blood vessel sealage

Question 12

What is diabetic nephropathy ?

Answer 12

Renal failure in diabetic patiants

Question 13

How is nephropathy tested for ?

Answer 13

1. Proteinuria test - Presence of albumin protein in urine - tested using a dipstick

Repeat positive over 24hr is sign of renal disease

Question 14

What is Microalbuminauria and at wht levels should it be treated for?

Answer 14

• Presence of small amounts of albumin in urine
• To test for it the Albumin:creatine ratio should be checked for

Should be treated for at:

Men : >2.5mg/mmol

Women: >3.5mg/mmol

Question 15

Describe the treatment for for nephropathy in type 1 and type 2 diabetes ?.

Answer 15

1. Type 1 ——> AIm for slow progression of diabetes by keeping HBA1c of <7%

• Intense control of blood pressure < 130/80

2. Type 2 ——> AIm for slow progression of diabetes by keeping HBA1c of <7%

Intense control of blood pressure <140/90

For type 2 control other factors that influence CVD risk increse i.e smoking etc

Question 16

Describe the treatment for diabetic nethropathy?

Answer 16

1. AIm to treat the HIGH BLOOD PRESSURE
2. **Start with ACE INHIBITOR ** —-> RENOPROTECTIVE

If symptom persist then add on CCB or diuretic

If CCB being gusedd - amlodipine / felodipine for renoprotectiveness