Diabetics Vascular Complications

Question 1

T or F. The risk of macrovascular disease can be lowered

Answer 1

T.

Question 2

What are the risk factors for retinopathy?

Answer 2

• diabetes
• HTN
• smoking

Question 3

What are the risk factors for lower limb amputation?

Answer 3

peripheral neuropathy, peripheral artery disease, hyperglycemia, HTN, and dislipidemia

Question 4

What interventions are assoicated with a decreased risk of microvascular disease?

Answer 4

Improving glucose control, lowering BP, AND lowering LDL-cholesterol

Question 5

What drug classes have provide renal protection with HTN?

Answer 5

ACEI, ARB

Question 6

How common is HTN is diabetics?

Answer 6

About 80% have elevated MAP

Question 7

What is the most common dyslipidemia in diabetics?

Answer 7

elevated TAGs

Question 8

Rule in treating diabetics

Answer 8

Go ahead and give a statin regardless because it will decrease CV risk by up to 25%

Question 9

T or F. Endothelial cells do not down-regulate glucose transporters and are exposed to high intracellular glucose

Answer 9

T. Muscle, on the other hand, can.

Question 10

Mediators of miscrovascular disease in diabetics?

Answer 10

-increased polyol pathway flux and formation of AGEs

activation of PKC

increased formation of hexosamines and ROS

PARP Poly(ADP-ribose) polymerase

Epigenetic changes- methylation/demethylation

Question 11

Why would lowering cholesterol help reduce CV risk in diabetics?

Answer 11

Because like proteins, cholesterol is glycated and glycated cholesterol is more atherogenic

Question 12

What are the effects of PKC upregulation in diabetes?

Answer 12

The primary effect is upregulation of VEGF which promotes vascular permaeability and angiogenesis, as well as increased fibronectin and collagen synthesis leading to capillary leaking and occlusion.

In addition, PKC also induced NFkB to overexpress pro-inflamamtory genes

Question 13

What are the main (suggested) effects of upregulation of the hexosamine pathway in diabetics?

Answer 13

It is thought that hexosamine pathway leads to increased insulin resistance

Question 14

Why is oxidative stress such a big part of diabetes complication pathogenesis?

Answer 14

Because the large influx of glucose into mitochondria produces vast quantities of ROS

Question 15

What are the stages of diabetic retinopathy in humans?

Answer 15

1) Nonproliferative diabetic retinopathy (NPDR)- pts. may be asymptomatic
2) Preproliferative diabetic retinopathy- laser therapy at this stage may help prevent long-term visual loss
3) Proliferative diabetic retinopathy (PDR)- major cause of severe visual loss

Question 16

How does diabetes cause retinopathy?

Answer 16

When sugar is normal, retinal neurons maintain a healthy barrier and high sugar impairs these neurons (hypothetical model) causing influx of cytokines and inflammation into the retina

Question 17

Question 18

How is diabetic retinopathy treated/managed today?

Answer 18

endothelial growth factor antagonists

Question 19

T or F. Good control with early onset retinopathy may cause it to accelerate slightly but is much better in the long term

Answer 19

T.

Question 20

How long does it usually take to develop diabetic nephropathy in terms of microalbuminuria after a type I diabetes diangosis?

Answer 20

5-15 yrs

1/3 transitions to ESRD

NOTE: The incidence of nephropathy is type II diabetes is higher in type II diabetics and they typically progress to ERSD faster

Question 21

T or F. Lowering BP is beneficial in diabetics

Answer 21

T.

Question 22

What should be the main goal for treating diabetic neuropathy?

Answer 22

get the glucose down