Endo 18 - Macrovascular complications of DM

Question 1

What are the common macrovascular complications

Answer 1

Early widespread atherosclerosis, IHD, cerebrovascular disease, PVD

Question 2

Describe the stages of atheroma formation

Answer 2

1. Initial lesion - macrophage
2. Fatty streak - intracellular lipid
3. Intermediate - + extracellular lipid
4. Atheroma - SM hypertrophy
5. Fibroatheroma - + collagen
6. Complicated, thrombosis/haematoma

Question 3

What is insulin resistance associated with

Answer 3

Dyslipidaemia, hypertension - important in growth of atheroma in early stages

Smooth muscle contraction and thrombosis

Question 4

What are the macrovascular complications of T2DM

Answer 4

1. IHD
2. Cerebrovascular
3. Renal artery stenosis
4. Peripheral vascular disease

Question 5

Diabetes increases the risk of all ….

Answer 5

Cardiovascular events

Question 6

Microvascular risk only comes with sugar, but macrovascular risk increases with age

Answer 6

Y

Microvascular = morbidity

Macrovascular = morbidity and mortality

Question 7

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

Answer 7

IHD

Question 8

Cerebrovascular disease occurs earlier in diabetics than non-diabetics. They also have more widespread disease, meaning

Answer 8

Multiple small strokes, maybe some larger strokes too

Question 9

Peripheral vascular disease, alongside neuropathy, can contribute to?

Answer 9

Diabetic foot problems

Question 10

Renal artery stenosis may contribute to?

Answer 10

Hypertension and renal failure

Question 11

What are the risk factors for microvascular disease

Answer 11

Non modifiable:
Age
Sex (M>F)
Birth weight
FH/Genes

Modifiable:
Dyslipidaemia
High blood pressure
Smoking
Diabetes

Question 12

Management of glucose alone doesn’t address vascular risk

Answer 12

T

Question 13

What are the complications of diabetes predisposing to foot disease

Answer 13

1. Neuropathy - sensory, motor and autonomic

2. Peripheral vascular disease

Question 14

In diabetic foot, what is the pathway to foot ulceration?

Answer 14

Sensory neuropathy —> motor neuropathy —> limited joint mobility —> autonomic neuropathy —> PVD —> trauma - repeated minor/discrete episode –> reduced resistance to infection —> other diabetic complications e.g. retinopathy

Question 15

Describe the types of foot ulcerations in diabetic foot

Answer 15

1. Neuropathic foot - numb, dry, warm, palpable foot pulses, ulcers at points of high pressure loading
2. Ischaemic foot - cold, pulseless, ulcers at foot margins
3. Neuroischamic foot - numb, cold, dry, pulseless, ulcers at points of high pressure loading and at foot margins

Question 16

Describe how foot ulcerations are managed

Answer 16

1. Relief of pressure - bedrest?, redistribution of pressure/total contact cast
2. Antibiotics, (maybe Long term)
3. Debridement
4. Revascularisation - angioplasty, arterial bypass surgery
5. Amputation