DM Complications

Question 1

4 mechanisms of hyperglycemia induced damage

Answer 1

1. Increased polyol pathway influx
2. Increased intracellular formation of AGE
3. Activation of protein kinase C
4. Increased hexosamine pathway influx

Question 2

Mononeuropathy of this nerve is the least likely associated with DM

Answer 2

4th cranial nerve

Question 3

CSME definition

Clinically significant macular edema

Answer 3

Retinal thickening within 500 um of the the fovea, hard exudates at or within 500 um of the fovea

Question 4

DCCT results on retinopathy ang glycemic control

Answer 4

Intensive insulin therapy prevented the development of retinopathy by 27%

Question 5

Treshold for treatment of eyes with DME

Answer 5

Presence of thickening of the central 1 mm diameter retinal subfield

Question 6

Severe NPDR bu american academy of ophthalmology

Answer 6

More than 20 intraretinal hemorrhages in each of the four retinal quadrants
Definite venous beading in two or more retinal quadrants
Prominent intraretinal microvascular abnormalities in one or more retinal quardrants
No PDR

Question 7

Definition of PDR by the american college of ophthalmology

Answer 7

1. One or mor retinal neovascularization
2. Vitreous hemorrhage
3. Preretinal hemorrhage

Question 8

% of EOM palsies attributable to DM

Answer 8

4.5-6%

Question 9

Does BP control help reduce diabetic retinopathy?

Answer 9

Yea. UKPDS demonstrated a 34% and 47% reduction in risk of DM retinopathy progression in those assigned to intensive BP control

Question 10

Strong predictor of incipient DM nephropathy, first ever CB event and all cause mortality in patients with T1DM

Answer 10

Serum OPN

Question 11

Single upstream process that links different hyperglycaemia induced pathogenic mechanisms

Answer 11

Overproduction of superoxide by the mitochondrial electron transport chain

Question 12

Explain the hexosamine pathway influx (4th hypothesis)

Answer 12

Fructose 6 phosphate diverted from glycolysis to the hexosamine pathway, it orocudes substrate for reactions that require UDP-GlcNac I

Question 13

What is the rate llimiting step of the conversion of glucose to glucosamine

What mechanism for hyperglycemia induced damaged?

Answer 13

GFAT

hexosamine pathyway

Question 14

Explain increased polyol pathyway flux (mech #1)

Answer 14

Aldose reductose converts glucose to sorbitol

Sorbitol is oxidized to fructose by sorbitol dehydrogenase

Question 15

Accounts for almost all of the hyperglycemia induced increase in reactive AGE precursors

Answer 15

Methylglyoxal

Question 16

Earliest morphologic changes in the diabetic retinal capillaries

Answer 16

1) Pericyte loss

2) Acellular capillary formation

Question 17

Voltage gated sodium channel expressed exclusively in the unmyelinated sensory C fibers, responsible for the painful diabetic neuropathy

Answer 17

Nav 1.8

Question 18

Anti atherogenic enzymes inactivated by ROS

Answer 18

Prostacycline synthase

eNOS

Question 19

Most common cause of vision loss from diabetes

Answer 19

Macular disease/ macular edema

Question 20

Current first line therapy for most etes with center involved DME

Answer 20

Intravitreal injections of VEGF inhibitors

Question 21

Clinical triad of DM nephropathy

Answer 21

Hypertension
Proteinuria
Renal impairment

Question 22

5 stages of diabetic nephropathy in T1 DM patients

Answer 22

1. Hyperfiltration
2. Silent stage
3. Microalbuminuria/ incipient nephropathy
   4: macroalbuminuria
4. Uremia

Question 23

EM abnormalities of diabetic renal disease

Answer 23

Glomerular basement membrane thickening

Mesangial expansion

Question 24

Thiamine derivative that inhibits the downstream effects of mirochondrial ROS production

Answer 24

Benfotiamine

Question 25

The most important single intervention to prevent progressive nephropathy in T1DM and T2DM

Answer 25

Sustained reduction in BP

Question 26

2 landmark studies performed in T2DM patients for DM nephropathy

Answer 26

RENAAL Losartan | IDNT Irbesartan

Question 27

Signs and symptoms of large fiber neuropathy

Answer 27

Impaired vibration perception and position sense Depressed tendon reflexes Sensory ataxia

Question 28

Describe Ao (aloha delta) fiber pain

Answer 28

Deep seated gnawing dull like a toothache in the bones of the feet or even crushing or cramplike pain

Question 29

Tuning fork required to measure vibration perception

Answer 29

128 Hz

Question 30

Pharmacologic therapy of Diabetic neuropathy

Answer 30

1. Aldose reductase inhibitors 2. A-lipoic acid 3. Y-linolenic acid 4. Protein kinase C-B inhibition 5. Benfotiamine 6. Metanx 7. Human intravenous Ig

Question 31

Management of C fiber pain

Answer 31

1. Capcaisin | 2. Clonidine/ phenyolamine

Question 32

The greatest predictor of CVD as well as increased risk of death

Answer 32

Autonomic nerve dysfunction

Question 33

According ti NCEP ATP guidelines DM pxs are candidates for cholesterol lowering therapy if LDL cholesterol is higher than

Answer 33

130 mg/dL | Goal of therapy is less than 100