Long Term Complications of Diabetes

Question 1

What are the systems affected by long term diabetes?

Answer 1

Large vessels - cardiovascular system

Small vessels - eyes, nerves, kidneys

Question 2

What are some risk factors for complications in diabetes?

Answer 2

Duration of diabetes
Metabolic control
Smoking
Hypertension
Hyperlipidaemia
Genetics

Question 3

What is the main cause of death in DM patients?

Answer 3

Cardiovascular (microvascular) disease

Question 4

What is peripheral arterial disease?

Answer 4

Atheroma of distant/peripheral arteries that becomes a distal ischaemic causing disease and produces a 40 fold increase of amputation risk

Question 5

What are some cardiovascular risk factors?

Answer 5

Glucose control
Blood pressure
Smoking 
Lipids
Proteinuria
Family history
Gender

Question 6

What is the glycated haemoglobin target for primary prevention of cardiovascular risk problems in diabetes?

Answer 6

53mmols/mol (7%)

Question 7

What is the BP target for primary prevention of cardiovascular complications in diabetes?

Answer 7

=/

Question 8

What drug therapy is given to patients over 40 with diabetes to prevent cardiovascular complications?

Answer 8

Statin therapy

Question 9

What are the three main pathologies of microvascular disease?

Answer 9

Retinopathy
Neuropathy
Nephropathy

Question 10

What so the most common cause of blindness in the working age population?

Answer 10

Diabetic retinopathy

Question 11

Give some examples of retinal abnormalities seen in DM patients

Answer 11

Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cottone wool spots

Question 12

What are two treatments for diabetic retinopathy?

Answer 12

Laser photocoagulation - destruction of peripheral ischaemic retina leads to reduction of endothelial growth factors and regression of new vessels

Vitrectomy

Question 13

What is mononeuritis?

Answer 13

A single nerve palsy

Question 14

What are theres forms of diabetic neuropathy?

Answer 14

Peripheral neuropathy - diffuse nerve disease
Mononeuritis - single nerve palsy
Autonomic neuropathy

Question 15

What are some principles of the management of peripheral neuropathy?

Answer 15

Early detection
Self care education
Protection of the feet
Pain relief 
- capsaisin cream
- amitriptyline, gabapentin, duloxetine

Question 16

What are some principles for the prevention of diabetic foot ulcers?

Answer 16

Foor screening and risk scoring
Patient education on foot care
Trauma avoidance/fitted footwear
Huge morbidity from ulcers

Question 17

What is acute sensory peripheral neuropathy?

Answer 17

A rapi onset of neuropathic symptoms with precipitating factors including a rapid tightening of control and acute metabolic upset
This may be very severe

Question 18

What is proximal motor neuropathy?

Answer 18

Also called diabetic amyotrophy, it affects mostly elderly men with type II, and involves wasting, usually of the thigh muscles which is painful and causes weight loss. Although unpleasant the prognosis is good

Question 19

Which three cranial nerves are most commonly affected by mononeuritis? Which other nerve may also be affected?

Answer 19

III, IV, VI

Peroneal nerve causing acute foot drop

Question 20

What is autonomic neuropathy? Give the common manifestations and treatments

Answer 20

A pathology of the nerves which affect autonomic functions

Erectile dysfunction is common - viagra, cialis may be helpful

Postural hypotension common - NSAIDs, flucocortisone

Gastric stasis and recurrent vomiting - domperidone

Diarrhoea - loperamide, codeine phosphate

Abnormal sweating, peripheral oedema, urinary retention

Question 21

Describe diabetic nephropathy. What proportion of type I patients are likely to develop nephropathy after 30 years?

Answer 21

Damage to the structure and function of the meshwork of capillaries which make up the glomerulus, the glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood
25%

Question 22

What is the basic progression of kidney disease?

Answer 22

Normal function
to
Microalbuminuria
to
Proteinuria
to
Impaired Renal Function

Question 23

Give two ways by which microalbuminuria can be detected

Answer 23

Screening test - first morning urine sample

Definitive test - timed overnight urine collection for albumin excretion rate

Question 24

What are the principles of management for early kidney disease?

Answer 24

Optimise glycaemic control
Tight BP control - aim for 125/75 in type I
Ace inhibitor therapy slows progression
Cardiovascular risk factor management

Question 25

Outline the progression of diabetic neuropathy

Answer 25

Microalbuminuria
to
Proteinuria
to 
Impaired renal function +/- nephrotic syndrome 
to 
End stage renal disease