Long Term Complications - Micro and Macro

Question 1

What are the macrovascular complications associated with diabetes? (prolonged hyperglycaemia)

Answer 1

• Coronary vascular disease
• Cerebrovascular disease
• Peripheral vascular disease

Question 2

What are the microvascular complications associated with diabetes? (prolonged hyperglycaemia)

Answer 2

• Retinopathy
• Nephropathy
• Neuropathy

Question 3

What conditions are diabetics predisposed to due to macrovascular atherosclerosis?

Answer 3

• Stroke
• Angina / MI
• Heart Failure (due to coronary disease and abnormal cardiac myocyte glucose handling)
• Lower limb ischaemia causing ulceration

Question 4

Why do diabetics often not notice that they are developing foot ulcers?

Answer 4

Due to the peripheral neuropathy that is often associated with it, impaired sensation

Question 5

What is a common complication of diabetic foot ulcers?

Answer 5

Osteomyelitis, infection of the underlying bone

Question 6

Management of a diabetic foot ulcer?

Answer 6

• Podiatry: debridement & dressings
• Antibiotics to prevent infection (depends)
• Special (appropriate) footwear

Question 7

What can be a reason for development of complications in diagnosed diabetics with prescribed medication?

Answer 7

Poor drug compliance

• Smoking / other unhealthy practices

Question 8

What are the two types of diabetic retinopathy? Difference / how are they related?

Answer 8

• Non-proliferative diabetic retinopathy
• Proliferative diabetic retinopathy
• Proliferative is the more advanced form of the disease, occurs after non-proliferative

Question 9

Changes in the eye / complications due to non-proliferative diabetic retinopathy?

Answer 9

• Weakening / dysfunction of retinal capillaries
• Blood viscosity abnormalities
• Platelet dysfunction (may lead to leakage due to microaneurysms)

Question 10

Changes in the eye / complications in proliferative diabetic retinopathy?

Answer 10

• Retinal ischaemia
• Formation of new, fragile capillaries
• Vitreous haemorrhage (bleeding into vitreous space)
• Retinal tears / detachments

Question 11

How is proliferative diabetic neuropathy treated?

Answer 11

Laser photocoagulation

• Cauterization of ocular blood vessels to prevent haemorrhage and further visual issues

Question 12

Sign of diabetic retinopathy on fundoscopy?

Answer 12

• Cotton wool spot: feathery whitish area on the retina, shows focal infarct

Question 13

How common is retinopathy in diabetics?

Answer 13

Within 20 years after diagnosis:

• 100% type 1 diabetics have some retinopathy
• 60% for type 2 diabetics

Question 14

What changes occur in the kidneys during diabetic nephropathy?

Answer 14

• Glomerular basement membrane changes
• Mesangial tissue proliferation
• Glomerular hypertension

Question 15

Effect of diabetic nephropathy on plasma albumin concentration?

Answer 15

Decreases plasma [albumin]: microalbuminuria

• Albumin leaks through the damaged glomerulus into the urine, loss from plasma

Question 16

Investigations for suspected diabetic nephropathy?

Answer 16

• Urine [albumin] (should be screened for in diabetics)

Question 17

Management / prevention of diabetic nephropathy?

Answer 17

• ACE-I or angiotensin receptor blockers (ARBs)

- Hypertension control

Question 18

What divisions of the nervous system can be affected by diabetic neuropathy?

Answer 18

• Sensory
• Motor
• Autonomic

Question 19

Where is most sensory loss incurred as a result of diabetic neuropathy? Symptoms and consequences?

Answer 19

• Mostly in the feet and lower legs
• Paresthesia is the main symptom
• Can result in the development of foot ulcers due to loss of sensation

Question 20

What are some of the possible consequences of autonomic neuropathy as a result of diabetes?

Answer 20

• GI effects (stomach / intestine)

- Tachycardia / BP fluctuations

Question 21

What is charcot foot?

Answer 21

• Foot condition that may occur in individuals with significant neuropathy
• Causes weakening of the bones in the foot, often weakened enough to fracture. With continued walking the foot then eventually changes shape
• Foot appears large (swelling) and with loss of arch

Question 22

What are some other conditions diabetics may be predisposed to?

Answer 22

• Erectile dysfunction
• Sexual dysfunction
• Depression

Question 23

Prognosis for diabetic foot ulcers? Do they tend to heal well?

Answer 23

• Nah pretty bad
• Since patient will most likely continue walking & poorly comply to alternative footwear options a lot of the podiatry treatment focuses on preventing infections / cleaning the wound