Endo 18: Macrovacular complications (NO SLIDES)

Question 1

What are the 4 main macrovascular conditions related to diabetes ?

Answer 1

• Ischaemic Heart Disease
• Cerebrovascular disease
• renal artery stenosis
• peripheral vascular disease

Question 2

Hyperglycemia is associated with significantly increased/ reduced life expectancy

Answer 2

Hyperglycemia is associated with significantly reduced life expectancy

Question 3

Microvascular diseases causes morbidly whereas macrovascular disease causes:

Answer 3

Microvascular diseases causes morbidly whereas macrovascular disease causes:

• morbidity AND
• mortality

Question 4

Macrovascular Disease is a systemic/ local disease and is commonly present in single/ multiple arterial beds

Answer 4

Macrovascular Disease is a systemic disease and is commonly present in multiple arterial beds

Question 5

What is the major cause of morbidity + mortality in diabetes?

Answer 5

• ischemic heart disease

Question 6

What is the effect of renal artery stenosis ?

Answer 6

• contributes to hypertension + renal failure

Question 7

Treatment targeted to hyperglycaemia alone has minor/major effect on increased risk of cardiovascular disease

Answer 7

Treatment targeted to hyperglycaemia alone has minor effect on increased risk of cardiovascular disease

Question 8

What are major risk factors for macrovacular disease?

a) non modifiable:

Answer 8

What are major risk factors for macrovacular disease?

a) non modifiable:
- age
- sex
- birth weight
- Family history / genes

Question 9

What are major risk factors for macrovacular disease?

a) modifiable:

Answer 9

What are major risk factors for macrovacular disease?

a) modifiable:
- dyslipidaemia
- HBP
- smoking
- diabetes

Question 10

What is the link between statin + macrovascular disease?

Answer 10

taking a statin has significant reduction in macrovascular disease risk

Question 11

describe the process of formation of complicated lesion

Answer 11

initial lesion 
fatty streak 
intermediate lesion 
atheroma 
fibroatheroma 
complicated lesion

Question 12

What are features of metabolic syndrome ?

Answer 12

• > 6 fasting glucose level
• increase waist circumference M > 102, W > 88)
• HDL (M <1.0 , W <1.3)
• Hypertension
• Insulin resistance, inflammation CRP, adipocytokines, urine microalbumin

Question 13

What is the effect of metabolic syndrome with reference to insulin?

Answer 13

causes insulin resistance

Question 14

In diabetes, there is an increase/ decrease in cardiovascular events

there is a greater/ lesser risk for women

Answer 14

In diabetes, there is an increase in cardiovascular events

there is a greater risk for women

Question 15

macrovascular diseases are:

Answer 15

• Heart diseases
• stroke
• and peripheral vascular diseases

Question 16

note: controlling ONLY sugar levels contributes to prevention of macrovascular diseases only to a small extent

treating cholesterol with STATIN = very effective in preventing stroke/ MI

treating HBP = very effective
–> reduces risk of ischemic Heart Disease

Answer 16

-

Question 17

new: what is the effect of canakinumab administration

Answer 17

• reduces inflammation, without decrease in lipid conc
• lowered risk of recurrent cardiovascular events
• but increased risk of infection –> so not USED

Question 18

what contributes to diabetic foot disease?

Answer 18

1. neuropathy

2. peripheral vascular disease

Question 19

how would you test fo peripheral neuropathy?

Answer 19

microfilament examination

Question 20

List some pathways to ulceration of the foot

there are 8 potential answers

Answer 20

1. sensory neuropathy
2. motor neuropathy
3. limited join mobility
4. autonomic neuropathy
5. peripheral vascular disease
6. trauma
7. reduced resistance to infection e.g yeast infection / bacterial infection
8. other diabetic complications e.g retinopathy –> e.g can’t see –> more stubbing of foot

Question 21

What are the 2 types of Foot ulceration

Answer 21

1. neuropathic foot
   - -> numb, dry, dry, ulcers at e.g ball of foot (pt of high pressure loading) , absent reflexes
2. ischemic foot
   - -> cold, pulseless, ulcers at foot margins

Question 22

how would you manage the diabetic foot?

Answer 22

• manage hyperglycemia
• manage hypertension
• manage dyslipidaemia
• stop smoking
• education
• relieve pressure –> bed rest, retribution of pressure/ total contact cast
• give antibiotics –> if infected
• debridement –> remove dead tissues
• revascularisation -> angioplasty/ arterial bypass surgery
• amputatation

Question 23

What re some methods of preventative management of diabetic foot disease?

Answer 23

• control diabetes
• inspect feet daily
• buy shoes with laces + square toe box
• inspect inside of shoes for foreign objects
• cut nails straight across (not too short)
• care with heat

Question 24

note: diabetic foot = painless

Answer 24

-

Question 25

compare between osteomyelitis vs diabetic foot (charcot’s)

Answer 25

osteomyelitis:
- hot + red
- has ulcer

charcot

• hot + red
• no ulcer

Question 26

What happens to the feet when sugar binds to Hb ?

Answer 26

• makes tendon less flexible –> limits joint mobility

Question 27

What is Charcot’s foot?

Answer 27

• neuropathy causes joint overuse + misuse
• which causes loss of normal bone articulations
• and abnormal foot shape increases risk of ulceration

Question 28

ulceration of the foot can lead to ….

Answer 28

osteomyelitis