Diabetic Complications Lecture Powerpoint

Question 1

What are 3 big microvascular complications of hyperglycemia

Answer 1

• Retinopathy
• Nephropathy
• neuropathy

Question 2

There is a significant reduction in cardiovascular and microvascular disease for every __% drop in A1C

Answer 2

1%

Question 3

Neovascularization of the retina

Answer 3

The body’s response to lack of adequate blood flow due to hypoglycemia to the retina by making new vessels that are very fragile and can leak exudates blocking vision

Question 4

1 leading cause of new blindness and what 2 things is it strongly related to?

Answer 4

Diabetic retinopathy (strongly related to duration of diabetes and presence of hypertension)

Question 5

Diabetic retinopathy screening for type 1 diabetics

Answer 5

Adults and children should have dilated eye exam within 5 years of onset then repeated annually

Question 6

Diabetic retinopathy screening for type 2 diabetics

Answer 6

Patients should have dilated eye exam shortly after diagnosis with subsequent exam repeated annually

Question 7

Diabetic retinopathy screening for women with diabetes planning to become pregnant

Answer 7

Have eye exam first trimester with followup through pregnancy and for first year postpartum

Question 8

3 principles of diabetic retinopathy/nephropathy treatment

Answer 8

• optimize blood sugar control
• optimize blood pressure control
• optimize lipids

Question 9

Metabolic memory/legacy effect

Answer 9

Refers to how patients who have early aggressive management of diabetes have better outcomes and less progression in retinopathy, neuropathy, and nephropathy than those who did not even after returning to less intense therapy later on

Question 10

Diabetic retinopathy treatment (2)

Answer 10

• Panretinal laser photocoagulation decreases loss in patients
• Focal laser photocoagulation in eyes decreases loss in patients

Question 11

Earliest marker of diabetic nephropathy we should test for in at risk groups for diabetes progression

Answer 11

Microalbuminuria (more predictive as can detect lower levels than a dipstick and progression is likelty to result in end stage renal disease)

Question 12

Excess albumin indicates presence of glomerular ____

Answer 12

hypertension

Question 13

Diabetic nephropathy screening for type 1 diabetics

Answer 13

Perform annual urine microalbumin after first 5 years, measure serum creatinine at least annually

Question 14

Diabetic nephropathy screening for type 2 diabetics

Answer 14

Perform annual microalbumin urine test in all type 2 diabetics after diagnosis, measure serum creatinine at least annually

Question 15

Diabetic nephropathy screening for pre-diabetics

Answer 15

Perform annual urine microalbumin

Question 16

Sources of false positives in albumin/creatinine ratio (6)

Answer 16

• blood in urine
• exercise
• infection
• CHF
• hypertension
• hyperglycemia

Question 17

Diabetic nephropathy albuminuria requires ___ abnormal specimens over __ time period to make diagnosis

Answer 17

2-3, 3-6 months

Question 18

Even in the absence of hypertension, if a patient has presence of micro or macroalbumin they should be placed on…

Answer 18

….an ACEI or ARB (never both just FYI)

Question 19

Blood pressure needs to be kept below ___ mmHg systolic

Answer 19

140mmHg

Question 20

Recall, ACEI and ARB’s dilate what vessel of the renal system?

Answer 20

Efferent arteriole

Question 21

SGLT2 inhibitors constrict what vessel of the renal system?

Answer 21

Afferent arterioles

Question 22

Common presentation of diabetic peripheral neuropathy

Answer 22

Chronic, symmetrical**, length dependent (feet before hands) sensation then motor polyneuropathy with nocturnal exacerbation making prickly pain worse

Question 23

Diabetic neuropathy progression

Answer 23

• Begins with pain and tingling
• Eventually becomes painless (and seems to get better) but actually ulcerates because….
• Progression from sensory to motor causing redistribution of weight

Question 24

Charcot foot is brought on by advanced ____ and ___ but not ____

Answer 24

neuropathy, microfractures, lack of circulation

Question 25

Screening for diabetic neuropathy

Answer 25

-Screen anually with pinprick, vibration (increases prediction of foot ulcers), ankle reflexes

Question 26

Treatment of diabetic neuropathy by management of sugars will initially cause the discomfort to….

Answer 26

….worsen before it gets better

Question 27

Diagnosis of diabetic peripheral neurpathy (1)

Answer 27

-clinical

Question 28

Diabetic autonomic neuropathy

Answer 28

Neuropathy with many similar predictors to peripheral and often presents after peripheral but presents with resting tachycardia, exercise intolerance, orthostatic hypotension <20mmHg, or gastroparesis and is associated with signficantly higher overall mortality

Question 29

Sudomotor dysfunction

Answer 29

A sign of diabetic autonomic neuropathy characterized by excess diaphoresis from nipple line upward but not below

Question 30

Women with diabetes are at same risk for heart attack as…

Answer 30

….nondiabetic males

Question 31

Top 3 lab values that are predictive for CAD

Answer 31

1) LDL
2) HDL
3) HbA1C