Long term complications of diabetes

Question 1

Question 1 of 8

George has been managing his diabetes for 20 years. His recent checkup revealed the following: He has had bouts of alternating constipation and diarrhea. He complains of being too hot when he goes outdoors in the summer and admits he is sweating less. He has been treated for urinary tract infections twice in the past year.

Drag and drop the complication related to George’s symptoms and illnesses.

atherosclerosis

autonomic neuropathy
insulin purging

lipoatrophy
nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 1

autonomic neuropathy

Autonomic neuropathy involves dysfunction of the sympathetic and parasympathetic nervous systems. This dysfunction has system-wide effects. Effects include tachycardia, postural hypotension, gastroparesis (which may cause anorexia, bloating, diarrhea or constipation), bladder and bowel dysfunction, and blunted ability to perspire (which affects heat regulation). In addition, autonomic neuropathy can mask the signals of hypoglycemia.

Question 2

Question 2 of 8

Mark was diagnosed with type 2 diabetes 15 years ago. Recently, a fundoscopic examination showed macular edema and “cotton wool spots” indicating damaged areas.

Drag and drop the complication that causes these changes.

atherosclerosis

autonomic neuropathy
insulin purging

lipoatrophy
nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 2

retinopathy

In diabetic retinopathy, damage to the retinal artery endothelium leads to inflammation which eventually causes occlusion of the arterioles, leading to ischemia. Signs of retinopathy include microaneurysms, hemorrhages, edema, exudates, and “cotton wool spots.”

Question 3

Question 3 of 8

Sarah has made an appointment with her primary care provider because she has been experiencing some burning in her feet. She also has pain that spreads up her legs. Sarah has been on an insulin regimen for diabetes for 10 years.

Drag and drop the complication related to Sarah’s symptoms.
atherosclerosis

autonomic neuropathy
insulin purging

lipoatrophy
nephropathy

retinopathy
immunosuppression
peripheral neuropathy

Answer 3

peripheral neuropathy

In peripheral neuropathy, the arterioles that supply the nerves are damaged, resulting in reduced blood flow and neuron demyelination. Symptoms include burning, pain, and sensory loss in the feet and lower extremities. Peripheral neuropathy can also blunt pain, masking symptoms of more serious conditions, such as myocardial infarction.

Question 4

Question 4 of 8

In the past few months, Joan’s preprandial blood glucose values have averaged 140 to 155 mg/dL. She has been to her primary care provider several times and has been treated for pneumonia and Candida vaginitis.

Drag and drop the complication that Joan may be experiencing.
atherosclerosis

insulin purging
autonomic neuropathy

lipoatrophy
nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 4

immunosuppression

Hyperglycemia negatively affects white blood cell function, making the body less effective at fighting infection. Several infections are more common in the diabetic population, including pneumonia, urinary tract infection, and skin and soft tissue infections.

Question 5

Question 5 of 8

Bill was diagnosed with diabetes 12 years ago. Three months ago, he was diagnosed with hypertension.

Drag and drop the long-term complication that could both contribute to and also be made worse by hypertension.
atherosclerosis

autonomic neuropathy
insulin purging

lipoatrophy
nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 5

nephropathy

Hyperglycemia can injure the capillaries of the glomeruli of the kidneys. One of the initial signs of this damage is the presence of albumin in the urine. Eventually, so much damage occurs to the glomeruli that proteins may also begin to appear in the urine. The damage and resulting changes to the glomerulus lead to renal dysfunction.

Renal dysfunction is a source of hypertension, which further damages the glomeruli. This damage then continues in a cyclical manner.

Question 6

Question 6 of 8

Tina is an 18-year-old college student who was diagnosed with type 1 diabetes mellitus (T1DM) 8 years ago. Up until college, Tina demonstrated excellent glucose regulation through diet, exercise, and insulin usage. Lately, however, Tina has exhibited much poorer glucose regulation and has been losing weight. She attributes her weight loss to using less insulin. She states she feels great and is happy to be avoiding the “freshmen fifteen,” the common weight gain of college freshmen.

Drag and drop the term that best describes the reason for Tina’s current situation of poor glucose regulation and weight loss.

Insulin purging

atherosclerosis

autonomic neuropathy

lipoatrophy

nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 6

Insulin purging

Some patients with T1DM will attempt to regulate weight by reducing insulin usage. This process is known as “insulin purging.” By reducing insulin usage, or skipping insulin doses altogether, weight loss is stimulated by inducing lipolysis and less utilization and storage of glucose. Insulin purging can be very dangerous because it leads to poor glycemic control and increased risk for diabetic ketoacidosis.

Question 7

Question 7 of 8

Mike has T1DM and has used insulin injections since his diagnosis 6 years ago. He uses an insulin analogue and a large indented area has developed around his preferred injection site.

Drag and drop the term that best describes Mike’s experience.
atherosclerosis

autonomic neuropathy
insulin purging

lipoatrophy
nephropathy

retinopathy
immunosuppression

peripheral neuropathy

Answer 7

lipoatrophy

Loss of subcutaneous fat near insulin injection sites can occur, especially with the usage of insulin analogues. Mike should be counseled to make certain he rotates his injection site to reduce the likelihood of developing lipoatrophy.

Question 8

Question 8 of 8

Harold’s primary care physician is very concerned about Harold’s poor glycemic control. All blood glucose values were elevated during a recent checkup, including fasting blood glucose and A1c. The clinician is worried that hyperglycemia may result in disease development such as myocardial ischemia or stroke, both of which are present in Harold’s family history. The physician talks to Harold about how glucose can lead to damage and blockage of blood vessels, which may reduce blood flow to key areas such as the heart and brain.

Drag and drop the term that best describes the damage high glucose levels may cause in blood vessels.
autonomic neuropathy

insulin purging
lipoatrophy

nephropathy

retinopathy
peripheral neuropathy
immunosuppression

Atherosclerosis

Answer 8

Atherosclerosis

High blood glucose levels may damage the endothelium of blood vessels. The damage to the blood vessel initiates an inflammatory response, which may eventually develop into plaque formation. This process leads to atherosclerosis and subsequent decreased flow through the vessel. Glucose regulation helps reduce the risk of atherosclerosis.

Question 9

Question 1 of 5

Chronic hyperglycemia may cause ____________________. Select all that apply.

macrovascular angiopathy only
both microvascular and macrovascular angiopathy
damage to peripheral, but not autonomic nervous system
damage to both peripheral and autonomic nervous systems
microvascular angiopathy only

Answer 9

both microvascular and macrovascular angiopathy

damage to both peripheral and autonomic nervous systems

Question 10

Question 2 of 5

Which conditions may be caused by chronic hyperglycemia? Select all that apply.

Retinopathy
Nephropathy
Neuropathy
Poor wound healing
Increased infection

Answer 10

Retinopathy
Nephropathy
Neuropathy
Poor wound healing
Increased infection

Question 11

Question 3 of 5

What is an initial sign of diabetic nephropathy?

Glucose in urine
Ketones in urine
Albumin in the urine
Acidic urine

Answer 11

Albumin in the urine

Question 12

Question 4 of 5

Which of the following conditions is not a long-term complication associated with diabetes mellitus?

Joint and muscle pain
Cardiovascular disease
Peripheral vascular disease
Blindness

Answer 12

Joint and muscle pain

Question 13

Question 5 of 5

Gastrointestinal problems, bladder control issues, and sweating dysregulation may occur in individuals with diabetes as a result of _____________________.

suppression of T cell function
peripheral neuropathy
autonomic neuropathy
poor wound healing

Answer 13

autonomic neuropathy