Lecture 24: Long Term Complications of Diabetes

Question 1

give examples of macrovascular complications that can occur in diabetes

Answer 1

• coronary vascular disease
• cerebrovascular disease
• peripheral vascular disease

Question 2

give examples of microvascular complications that can occur in diabetes

Answer 2

• retinopathy
• nephropathy
• neuropathy

Question 3

list the effects of atherosclerosis in diabetes

Answer 3

• ischaemic cerebrovascular disease > strokes
• ischaemic heart disease > angina, myocardial infarctions
• heart failure > related to coronary disease and abnormal cardiac myocyte glucose handling
• peripheral vascular disease > causes lower lim ischaemia, leading to ulcers and poor healing of these ulcers, amputations are a potential outcome

Question 4

list prevention measures of macrovascular disease

Answer 4

• good diabetes control
• blood pressure control
• lipid control
• smoking cessation, weight and exercise

Question 5

describe the two types of diabetic retinopathy

Answer 5

Non-Proliferative Diabetic Retinopathy:
- retinal capillary dysfuntion
- platelet dysfunction
- blood viscosity abnormality

Proliferative Diabetic Retinopathy:
- retinal ischaemia
- new blood vessel formation
- vitreous haemorrhage
- retinal tears/detachment
- treat with laser photocoagulation

Question 6

Other eye effects (besides retinopathy) of diabetes include:

Answer 6

50% increase in glaucoma
3-fold increase in cataracts

Question 7

what is the treatment for diabetic retinopathy?

Answer 7

• improve glycaemic control
• laser photocoagulation

Question 8

discuss the prevention and treatment of nephropathy

Answer 8

• screening of urine for albumin is vital
• diabetes control
• renin-angiotensin system blockade: ACE inhibitors, ARBs, renin inhibition
• hypertension control

Question 9

what can autonomic neuropathy cause in diabetic patients?

Answer 9

• GI effects (stomach, intestines)
• CV system effects: tachycardia, blood pressure fluctuations

Question 10

at what stage of diabetic retinopathy is medical treatment initiated?

Answer 10

proliferative stage

Question 11

what are the treatment options for diabetic retinopathy?

Answer 11

• anti-VEGF injections
• argon laser retinal photocoagulation
• macular laser
• vitrectomy: cases with retinal complications