Diabetic Complications

Question 1

What are microvascular and microvascular complications of DM?

Answer 1

Microvsacular:
Neuropathy
Nephropathy
Retinopathy

Macrovascular:
Stroke
MI
Renovascular disease
Limb ischaemia

Question 2

What is diabetic nephropathy?

Answer 2

Hyperglycaemia leads to increased growth factors, rAAS activation, production of advanced glycosylation end-products and oxidative stress.
This causes increase glomerular capillary pressure, podocyte damage due endothelial dysfunction.

Question 3

What is the first clinical sign of diabetic nephropathy? What are later signs?

Answer 3

Albuminuria

Scarring (glomerulosclerosis) nodule formation and fibrosis with progressive loss or renal function

Question 4

How is diabetic nephroapthy diagnosed?

Answer 4

Microalbuminuria (moderately increased albuminuria) = A:CR 3-30mmol
Regression at this level is not possible.
Not on dipstick msg send MCU for ACR
Annual screen

Question 5

How is diabetic nephropathy treated?

Answer 5

Intensive DM control prevents microalbuminuria and reduces progression to macroalbuminuria.

BP<130/80 - use ACEi or ARB for CV and renal protection above BP control.
Sodim restriction to <2g/day
Statins to reduce CVS risk.

Question 6

What HbA1c value reduces development of all microvascular complications

Answer 6

53mmol/L 7%

Question 7

What is the aim of retinal screening?

Answer 7

Pre-symptomatic screening enables laser photocoagulation to be used, aimed to stop production of angiogenic factors from the ischaemic retina.

Question 8

What is background reinopathy?

Answer 8

Microaneurysms (dots on ophthalmoscopy) haemorrhages (blots) and hard exudates (lipid deposits)
Refer if near the macula (dark spot at back of eye used for high acuity vision)

Question 9

What is pre-proliferative retinopathy?

Answer 9

Cotton wool spots (infarcts) haemorrhages, venous bleeding

Signs of retinal ischaemia – refer

Question 10

What is proliferative retinoapthy

Answer 10

New vessel formation and haemorrhages – urgent referral

Question 11

What is maculopathy?

Answer 11

Suspect if reduced acuity

Prompt laser, intravitreal steroids or anti-angiogenic agents may be needed in macular oedema.

Question 12

What is the pathogenesis in maculopathy?

Answer 12

Capillary endothelial change
Vascular leak
Microaneurysms
Cpaillary occlusion
Local hypoxia + ischaemia
New vessel formation

High retinal blood flow caused by hyperglycaemia triggers this causing capillary pericyte damage

Question 13

What is rubeosis iris?

Answer 13

New vessels on iris: occurs late and may lead to galucoma