Long term complications of diabetes

Question 1

When can complications occur in diabetes type 1 and type 2?

Answer 1

Complications can be present at the time of diagnosis in type 2 diabetes

Complications can occur as early as 5 years after a diagnosis of type 1 diabetes.

Question 2

What is the effect of worsening glycaemic state on the risk of complications?

Answer 2

Increase with worsening glycaemic state/control

Question 3

What is the difference between microvascular complications and macrovascular complications?

Answer 3

Macrovascular means it involves large blood vessels meaning the sizeable arteries in the body

Microvascular refers to capillaries n shit

Question 4

What are the different types of macrovascular complications?

Answer 4

Coronary vascular disease

Cerebrovascular disease

Peripheral arterial disease

Question 5

What are the different types of microvascular complications?

Answer 5

Retinopathy

Nephropathy

Neuropathy

Question 6

What is the effect of diabetes on the risk of developing CVS disease?

Answer 6

Increases relative risk of getting CVDs such as MI, heart failure, stroke

Question 7

What specific pathology thing most commonly causes macrovascular complications in diabetes and why?

Answer 7

Atherosclerosis

Diabetes causes dyslipidaemia (which includes stuff like hypercholesterolaemia)

Question 8

Go look at cardio notes for plaque formation n shit

Identify the parts of this atherosclerotic plaque

Answer 8

Question 9

Describe the features (specific levels of stuff) of dyslipidaemia seen in diabetes?

Answer 9

HDL cholesterol is lower

Triglycerides are higher

LDL cholesterol in form of small dense particles which are worse

Question 10

Aside from dyslipidaemia - what other features in diabetes contribute to atherosclerosis

(think Virchow’s triad thing)

Answer 10

Endothelial dysfunction

Hypercoagulability of blood

Question 11

What are the effects of atherosclerosis in diabetes?

Answer 11

Ischaemic cerebrovascular disease - strokes

Ischaemic heart disease - angina, MI

Heart Failure - related to coronary disease and abnormal cardiac myocyte glucose handling

Peripheral vascular disease (formation of ulcers etc)

Question 12

How is macrovascular disease prevented?

Answer 12

Through good diabetes control

Blood pressure control

Lipid control

Smoking cessation, weight loss, exercise

(basically just avoiding risk factors)

Question 13

Diabetic retinopathy is the most commonly diagnosed diabetes-related complication

Describe what happens to the eye as it develops

Answer 13

Initially in Non-proliferative stage:

• Retinal capillary dysfunction
• Platelet dysfunction
• Blood viscosity abnormality

Then moves to proliferative stage:

• Retinal ischaemia
• new blood vessel formation
• vitreous haemorrhage
• retinal tears/detachment

Question 14

How is proliferative diabetic retinopathy treated?

Answer 14

laser photocoagulation

Question 15

Describe the impact of diabetic retinopathy

Answer 15

20 years after diagnosis - 100% of people with Type 1 diabetes and 60% of those with Type 2 diabetes will have some form of retinopathy (mild-to-severe)

Question 16

What other eye conditions does diabetes increase the risk of?

Answer 16

Cataracts

Glaucoma

Question 17

What is nephropathy?

Answer 17

Deterioration of the proper functioning of the kidneys

Many causes - of which diabetes is a big boi

Question 18

Describe how nephropathy in diabetes may develop

Answer 18

Diabetic patient develops Microalbuminuria - leak of protein (albumin) starts

This leads to:

• Glomerular basement membrane changes
• mesangial tissue proliferation
• “glomerular hypertension”

Progressive renal impairment - note kidneys do not shrink when the disease progresses

Question 19

Describe the preventative measures for diabetic nephropathy

Answer 19

Urine albumin screening

Diabetes control

Renin-angiotensin system blockade - ACE inhibition, angiotensin receptor blockade, renin inhibition

Hypertension control

Question 20

How would diabetic neuropathy present?

Answer 20

Diabetic patient with onset of Sensory/motor/autonomic symptoms and signs

Sensory neuropathy:

• Loss of sensation
• Paresthesia
• May lead to ulcers

Autonomic neuropathy:

• GI symptoms
• Cardio symptoms (blood pressure fluctuations in diabetic patient)

Question 21

What is charcot foot?

Answer 21

condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy)