Long term complications of diabetes

Question 1

What is affected with large vessels and small vessels in diabetes?

Answer 1

large = cardiovascular 
small = kidneys, eyes, nerves

Question 2

Complication risk factors for diabetes

Answer 2

hyperlipidaemia 
metabolic/glycaemic control 
hypertension 
smoking 
duration of diabetes 
genetics

Question 3

What does peripheral arterial disease lead to an increased risk of?

Answer 3

amputation

Question 4

Cardiovascular risk factors - modifiable and non modifiable

Answer 4

modifiable = smoking, glycaemic control, bp control, lipids

non modifiable - age, gender, family, proteinuria

Question 5

Primary prevention of CV risk reduction

Answer 5

smoking cessation 
target HbA1c 
control blood pressure 
lifestyle choices 
statin therapy - simvastatin

Question 6

What is microvascular disease affecting?

Answer 6

arterioles and capillaries

Question 7

3 types of diabetic retinopathy

Answer 7

background retinopathy
proliferative retinopathy
maculopathy

Question 8

Why is visual acuity a poor guide for diabetic retinopathy?

Answer 8

need regular screening for other complications

Question 9

Retinal abnormalities in diabetes

Answer 9

microaneurysms - dot 
hard exudates 
blot haemorrhages 
cotton wool spots 
new vessel formation 
advanced eye disease 
vitreous haemorrhage

Question 10

2 treatments of proliferative retinopathy

Answer 10

laser photocoagulation

vitrectomy

Question 11

How does laser photocoagulation work?

Answer 11

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

Question 12

Describe diabetic maculopathy

Answer 12

macula exudate, blot haemorrhages and ischaemia

oedema behind macula and reduce visual acuity

Question 13

Cataracts

Answer 13

common in elderly, clouding of lens and increased in diabetes with poor glycaemic control
high correction with surgery and visual acuity determines timing

Question 14

3 types of diabetic neuropathy

Answer 14

peripheral neuropathy
mononeuritis
autonomic neuropathy

Question 15

Peripheral neuropathy

Answer 15

glove and stocking - feet
insensitive to trauma, paraesthesia, burning pain and numbness
loss of muscle between toes
risk of diabetic foot ulcer

Question 16

4 ways to help peripheral neuropathy and at risk feet

Answer 16

early detection
protection of feet
self care education
pain relief eg capscain cream, amytriptiline

Question 17

Ways to reduce ulcer prevention

Answer 17

foot screening and risk scoring 
patient education on foot care
regular podiatry for those at risk 
trauma avoidance/fitted footwear 
huge morbidity from ulcers

Question 18

Charcot foot

Answer 18

Condition causing weakening of bones in people with neuropathy

Question 19

Remember feet - signs of at risk feet

Answer 19

impaired circulation 
impaired sensation 
impaired vision 
foot shape changes 
abnormal pressure

Question 20

2 precipitating factors of acute sensory peripheral neuropathy

Answer 20

rapid tightening of control eg planning pregnancy

acute metabolic upset

Question 21

Proximal motor neuropathy

Answer 21

elderly men - type 2 DM

wasting of thigh muscles, weight loss, painful

Question 22

Mononeuritis

Answer 22

mainly affect ocular nerves - CN 3,4,6
acute foot drop - peroneal nerve
vascular event

Question 23

Autonomic neuropathy symptoms

Answer 23

erectile dysfunction 
postural hypotension 
diarrhoea 
gastric stasis and recurrent vomiting 
abnormal sweating, peripheral oedema, urinary retention

Question 24

How is autonomic neuropathy diagnosed?

Answer 24

symptoms and pattern

abnormal ECG

Question 25

What happens in diabetic nephropathy?

Answer 25

damage to structure and function of meshwork of capillaries which make up glomerulus
glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood

Question 26

How to detect kidney disease?

Answer 26

microalbuminuria
screening test - urine sample
definitive test - overnight urine for albumin excretion rate

Question 27

Management of early kidney disease

Answer 27

optimise glycaemic control
tight bp control
ACEI therapy
cardiovascular risk progression