Long Term Complications of Diabetes

Question 1

What do risk of complications worsen with?

Answer 1

Glycaemic state

Question 2

What are some macrovascular compications of diabetes?

Answer 2

Coronary vascular disease

Cerebrovascular disease

Peripheral vascular disease

Question 3

What are some microvascular complications with diabetes?

Answer 3

Retinopathy

Nephropathy

Neuropathy

Question 4

What is atherosclerosis formed from?

Answer 4

• Macrophages and foam cells
• Intracellular lipids
• Extracellular lipid accumulation
• Fibrotic and calcific layers
• Damage to surface, exposure to platelets and clotting

Question 5

What is the broad term describing a number of conditions including hypercholesteraemia and hyperlipidaemia?

Answer 5

Dyslipidaemia

Question 6

What affect does dyslipidaemia have on cholesterol and fatty acids?

Answer 6

HDL cholesterol is lower

Triglycerides are higher

LDL cholesterol is in the form of small dense particles which are worse (oxidation of these particles promotes the feature that leads to plaque formation and glycation of the particles worsens this effect)

Question 7

As well as dyslipidaemia, what else does diabetes cause that leads to CVD?

Answer 7

Endothelial dysfunction

Hypercoagulatibity

Question 8

What does atherosclerosis lead to in diabetes?

Answer 8

• Ischaemic cerebrovascular disease (strokes)
• Ischaemic heart disease
  
  • Angina, myocardial infarctions, heart failure
• Peripheral vascular disease
  
  • Causes lower limb ischaemia leading to ulcers and poor healing, amputations are potential outcome

Question 9

What can be done to prevent macrovascular disease in diabetes?

Answer 9

• Good diabetes control
• Blood pressure control
• Lipid control
• Smoking cessation, weight, exercise

Question 10

What is the general management of diabetes to prevent macrovascular disease?

Answer 10

• Improve glycaemic status
• Optimise lipid levels
• Smoking cessation
• Education, support
• Foot ulcer care
• IV antibiotics

Question 11

What are the different kinds of retinopathy?

Answer 11

• Non-proliferative diabetic retinopathy
  
  • Retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality
• Proliferative diabetic retinopathy
  
  • Retinal ischaemia, new blood vessel formation, vitreous haemorrhage, retinal tears/detachment
  • Treatment with photocoagulation

Question 12

What occurs in non-proliferative diabetic retinopathy?

Answer 12

Retinal capillary dysfunction

Platelet dysfunction

Blood viscocity abnormality

Question 13

What occurs in proliferative diabetic retinopathy?

Answer 13

Retinal ischaemia, new blood vessel formation, vitreous haemorrhage, retinal tearsdetachment

Question 14

What is the treatment for retinopathy?

Answer 14

Improve glycaemic control

Laser photocoagulation

Question 15

What is laser photocoagulation?

Answer 15

Eye surgery using a laser to shrink or destroy abnormal structures in the retina

Question 16

Explain the pathophysiology of diabetes causing nephopathy?

Answer 16

• Microalbuminuria (leak of protein – albumin – starts)
• Glomerular basement membrane changes, mesangial tissue proliferation, glomerular hypertension all contribute to renal dysfunction
• Progressive renal impairment progresses to end stage renal disease if untreated

Question 17

What is done for prevention and treatment of nephropathy?

Answer 17

Screening of urine is vital

Diabetes control

Renin-angiotensin system blockade

Hypertension control

Question 18

How can RAAS blockade be done to treat nephropathy?

Answer 18

ACE inhibition

Angiotensin receptor blockage

Renin inhibition

Question 19

What aspects of the nervous system does neuropathy affect?

Answer 19

Sensory, motor and autonomic

Question 20

What effects does neuropathy have on the sensory aspect of the nervous system?

Answer 20

• Objective loss, particularly in feet and lower legs, subjective symptoms, especially paresthesia
  
  • Lack of sensation can lead to development of neuropathic ulcers which can lead to severe foot infections

Question 21

What does lack of sensation due to neuropathy often lead to?

Answer 21

Development of neuropathic ulcers which can lead to severe foot infectons

Question 22

What effects does neuropathy have on the autonomic nervous system?

Answer 22

Can cause GI effects or CV effects (tachycardia, blood pressure fluctuations)

Question 23

How is footcare achieved?

Answer 23

Check both feet

Protect feet (if pressure damage/ulcer present)

Refer all patients with a foot ulcer/pressure damage

Question 24

What can bad foot care lead to?

Answer 24

Charcot foot (weakening of the bones that can occur in people with neuropathy)

Question 25

What is charcot foot?

Answer 25

Weakning of the bones that can occur in people with neuropathy

Question 26

Other than CVS complications, what other conditions can diabetes cause?

Answer 26

Erectile dysfunction/sexual dysfunction

Depression

Question 27

How is microvascular disease prevented?

Answer 27

Screening and preventative measures

Question 28

How is macrovascular disease prevented?

Answer 28

Controlling risk factors as well as glycaemic status