Long Term Complications of DM

Question 1

What is the main system affected with macrovascular disease in DM?

Answer 1

CVS

Question 2

What are the main areas affected with microvascular disease in DM?

Answer 2

Eyes
Nerves
Kidneys

Question 3

What are the complication risk factors of DM?

Answer 3

Duration of DM
Metabolic control 
Smoking 
Hypertension 
Hyperlipidaemia 
Genetics

Question 4

What is the main cause of death in DM?

Answer 4

MI

Question 5

What is the increased risk of stroke in DM?

Answer 5

3x

Question 6

What is the increased risk of peripheral arterial disease in DM?

Answer 6

x5

Question 7

What is the increased risk of amputation in DM?

Answer 7

40x fold

Question 8

What are cardiovascular risk factors?

Answer 8

Glucose control 
BP 
Smoking
Lipids
Proteinuria 
Family history 
Males

Question 9

What is the primary prevention for CV risk reduction?

Answer 9

Target HbA1-c to 53 mmol/mol 
Control BP 130/80 
Smoking cessation 
Stain therapy - simvostatin 
Lifestyle choices

Question 10

What are the main microvascular diseases in DM?

Answer 10

Retinopathy
Neuropathy
Nephropathy

Question 11

What is the commonest cause of blindness in the working age population?

Answer 11

Diabetic retinopathy

Question 12

How is diabetic retinopathy preventable?

Answer 12

Good glucose control
Tight BP control
Early detection and intervention

Question 13

What are some retinal abnormalities in DM?

Answer 13

Microaneurysms (dots)
Blot haemorrhages
Hard exudates
Cotton wool spots

New vessel formation
Vitreous haemorrhage
Advanced eye disease

Question 14

How is proliferative retinopathy treated?

Answer 14

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

Question 15

Who is cataract common in?

Answer 15

Elderly

Question 16

What is the increased risk of cataract in DM?

Answer 16

2 fold

Question 17

How does poor glycaemic control affect cataract?

Answer 17

Increases the risk

Question 18

What is the treatment for cataract?

Answer 18

Surgery

Question 19

Where does peripheral neuropathy typically affect in DM?

Answer 19

Feet

Question 20

What can the feet be insensitive to in DM with damage?

Answer 20

Trauma

Question 21

What are at a major risk in DM?

Answer 21

Feet

Question 22

How is peripheral neuropathy managed?

Answer 22

Early detection
Self care education
Protection of feet
Pain relief

Question 23

How are ulcer prevented in DM?

Answer 23

Foot screening and risk scoring 
Patient education on foot care
Regular podiatry for those at high risk 
Trauma avoidance
Fitted footwear

Question 24

What are things you need to remember about feet and DM?

Answer 24

Impaired circulation
Impaired sensation
Impaired vision
Foot shape changes
Abnormal pressures

Means at risk feet!

Question 25

Who are mainly affected by proximal motor neuropathy?

Answer 25

Elderly men

Type 2 DM

Question 26

What are some presentations of autonomic neuropathy?

Answer 26

Erectile dysfunction 
Postural hypotension Gastric stasis and recurrent vomiting 
Diarrhoea 
Abnormal sweating 
Peripheral oedema 
Urinary retention

Question 27

Which cranial nerves are mainly affected in mononeuritis?

Answer 27

III
IV
CI

Question 28

How is early kidney disease detected?

Answer 28

Increase in microalbuminuria

Proteinuria

Question 29

What is the screening test for microalbuminuria?

Answer 29

Urine sample

Question 30

What is the definitive test for microalbuminaemia?

Answer 30

Timed over night urine collection for albumin excretion rate

Question 31

What is diabetic nephropathy?

Answer 31

Damage to the structure and function of the meshwork of capillaries which make up the glomerulus

Glomeruli become leaky to larger molecules and eventual reduction in ability to filtrate blood.

Question 32

How is early kidney disease managed?

Answer 32

Optimise glycaemic control
Tight BP control
ACE inhibitor therapy slows progression
CVS risk managed