Diabetic Microvascular Complications

Question 1

Which factors surrounding diabetic retinopathy should a providers be conscious of? I.e. what increases PTs risk for blindness?

Answer 1

Chronic hyperglycemia (duration of diabetes)
Presence of nephropathy
HTN

Question 2

Adults and children with TYPE 1 DIABETES should get a fundoscopic / dilated eye exam every ______ years?

Answer 2

5

Question 3

PTs with TYPE 2 DIABETES should get a fundoscopic / dilated eye exam how long after diagnosis and how frequently there after?

Answer 3

Immediately after Dx

ANNUALLY

Question 4

Women with diabetes planning to become pregnant should have an eye exam performed when?

Answer 4

Within the first trimester

Close follow up throughout pregnancy and 1 year postpartum

Question 5

What are the two goals for controlling the risk of diabetic retinopathy?

Answer 5

Control the Sugars

Control the HTN

Question 6

What is the treatment for diabetic retinopathy if it develops in a patient?

Answer 6

Panretinal laser photocoagulation (risk reduction 16-6%)

Focal laser photocoagulation for PTs w/ macular edema

Question 7

What is the earliest marker / stage of diabetic nephropathy?

What does that condition typically result in later in life?

Answer 7

Microalbuminuria

END STAGE RENAL DISEASE

Question 8

In early diabetic microvascular disease; what effect does this have on kidney function?

What are the clinical results / Sx of this?

Answer 8

Afferent arteriole fails to vasoconstrict

Causes glomerular HTN

Results in excess protein spilling into urine

Question 9

What screening procedures should be performed on diabetic patients to determine risk / development of Nephropathy?

Answer 9

Annual urine microalbumin (Type 1 and Type 2) –> immediately after Dx for Type 2

Measure serum creatinine w/ eGFR

Perform annual urine microalbumin –> PRE DIABETICS

Question 10

What false positives should you keep in mind when analyzing a diabetic nephropathy Albuminuria assay?

Answer 10

False positives:
Blood in urine
Infxn
Exercise
CHF
Marked HTN
Hyperglycemia

Question 11

What is considered a true positive result with albuminuria assays to determine diabetic nephropathy?

Answer 11

2 to 3 ABNORMAL SPECIMENS

~~~OVER 3-6 MONTH PERIOD~~~

Question 12

If there is micro- or macro-albuminuria what Tx should you Rx your patient?

Answer 12

ACEi (lisinopril)

ARB (Losartan)

Question 13

Where do SGLT2 inhibitors exert their action within the kidney to alleviate glomerular HTN strain?

Answer 13

Afferent arteriole constriction for renal protection

SGLT-2 Inhibitor

Question 14

Describe some clinical presentation factors of Diabetic Peripheral Neuropathy (DPN).

Answer 14

CHRONIC
SYMMETRICAL
SENSORY (BEFORE MOTOR) POLY-Neuropathy
Length Dependent

Question 15

How do you screen diabetic patients for peripheral neuropathy?

Answer 15

Pinprick
Vibration (128Hz
10p monofilament
Ankle reflexes

Question 16

What is the therapeutic treatment / management for Diabetic Peripheral Neuropathy??

Answer 16

Tricyclics
Anticonvulsants
Serotonin / norepi reuptake inhibitors

Question 17

What is the underlying cause of Diabetic Charcot Foot?

Answer 17

Advanced peripheral neuropathy

w/ Motor involvement

Question 18

What are some signs of Diabetic Autonomic Neuropathy?

Answer 18

Resting Tachy (>100bpm)
Exercise intolerance
Orthostatic HTN (fall in Systolic >20mmHg)
Gastroparesis (Delayed emptying)
ED (THINK MICROVASCULAR COMPLICATIONS)
Sudomotor dysfunction (Anhidrosis)

Question 19

What are microvascular complications predicted by?

Answer 19

Duration of diabetes
A1C
BP

Question 20

What are Macrovascular complications predicted by?

Answer 20

Duration of Diabetes
A1C
BP
LIPIDS (THIS IS THE DIFFERENCE BETWEEN PREDICTING micro and macrovascular complications)

Question 21

What is the LDL goal for a Diabetic patient without risk factors?

Answer 21

HIGH RISK PTs

LDL goal <100mg/dL

Question 22

What is the LDL goal for DM patients with major CVD risk factors?

Answer 22

VERY HIGH RISK PTs

LDL goal <70mg/dL

Other CVD risk factors of HTN, Obesity, Smoking, etc.