Long term complications of DM

Question 1

Presentation of complications in type 1 v type 2 DM

Answer 1

can present with complications at time of diagnosis in type 2 whereas with type 1, usually don’t get complications until years later

Question 2

Macrovascular complications of DM include (3)

Answer 2

Coronary vascular disease
Cerebrovascular disease
Peripheral vascular disease

Question 3

Microvascular complications of DM include (3)

Answer 3

Retinopathy
Nephropathy/ diabetic kidney disease
Neuropathy

Question 4

Cardiovascular complications of DM (3)

Answer 4

MI - due to IHD
Heart failure - due to IHD
Stroke - due to ischaemic cerebrovascular disease

Question 5

Main mechanism that leads to cardiovascular disease in DM

Answer 5

Atherosclerosis

-involves macrophages and foam cells

Question 6

Ways to prevent micro/macrovascular complications (6)

Answer 6

Good DM control
Good BP control
Lipid control
Smoking cessation
Exercise
Improve diet

Question 7

Specific management of a severe foot ulcer (3)

General management of foot ulcer (4)

Answer 7

Ulcer debridement
IV antibiotics
Rest/avoid pressure on foot

Improve glycemic control
Lipid control
Review perfusion
Stop smoking

Question 8

What are 2 types of retinopathy you can get from DM

Answer 8

Non-proliferative diabetic retinopathy

Proliferative diabetic retinopathy

Question 9

Non-proliferative diabetic retinopathy v Proliferative diabetic retinopathy

(microvascular complications of DM)

Answer 9

Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease and is less severe
-capillaries in eye may leak fluid into the retina–> blurred vision

Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease
-new blood vessels start to grow in the eye (neovascularisation), which are fragile and can haemorrhage –> vision loss and scarring of the retina

Question 10

Management of non-proliferative diabetic retinopathy (NPDR) (2)

Management of proliferative diabetic retinopathy (PDR) (2)

Answer 10

NPDR:

• If NOT SEVERE but significant macular oedema = intravitreal anti VEGF therapy
• If SEVERE = laser photocoagulation +/- intravitreal anti VEGF therapy

PDR:
-Laser photocoagulation +/- intravitreal anti VEGF therapy

Question 11

Apart from retinopathy, what diseases of the eye does DM increase the risk of (2)

Answer 11

Galucoma

Cataracts

Question 12

Define diabetic kidney disease (diabetic nephropathy)

Answer 12

Macroalbuminuria (severely increased ACR in the urine)
OR
Microalbuminuria (moderately increased ACR) associated with retinopathy

Question 13

What does ACR measure the function of

Answer 13

measures how well your kidneys are working

It compares the amount of albumin in your urine with the amount of creatinine (a waste product from muscles) produced and lost (through urine) at a steady rate

Usually very little albumin is filtered into the urine by kidneys so if high albumin then indicates abnormal permeability for albumin

Question 14

What happens in diabetic kidney disease (diabetic nephropathy)

Answer 14

Abnormal leaking of albumin into urine due to abnormal permeability for albumin in the kidneys

Vessels in kidney begin to fail, loss of control of BP/fluid balance and waste products build in blood as kidney can’t filter it anymore

Question 15

2 key factors contributing to diabetic kidney disease

Answer 15

Hyperglycaemia

Hypertension

Question 16

Symptoms (2)/ signs (4) of diabetic kidney disease

Answer 16

May be asymptomatic until the disease is advanced

fatigue,
anorexia,

hypertension,
oedema in extremities
findings of diabetic retinopathy (impaired vision) and neuropathy (decreased or abnormal sensation in lower extremities)

Question 17

Leading cause of kidney disease

Answer 17

DM

Question 18

How can diabetic nephropathy be screened for

Answer 18

in urinalysis during annual diabetic review

Question 19

Treatment of diabetic nephropathy

• medical (2)
• lifestyle (2)

Answer 19

Improve glycemic control

Anti-hypertensives
-ACEIs or ARBs - to lower BP + protect kidneys from further damage

Low protein/sodium/fat diet

Smoking cessation

Question 20

Diabetic neuropathy may involve what fibre types (3)

Answer 20

Sensory
Motor
Autonomic (sympathetic/parasympathetic)

Question 21

Symptoms/signs of diabetic neuropathy

• sensory symptoms/signs (4)
• motor symptoms/signs (1)
• autonomic symptoms/signs (4)

Answer 21

Sensory:
peripheral pain (in extremities)
peripheral loss of sensation, typically feet and lower legs
peripheral paraesthesia
painless injuries

Motor:
reduced ankle reflexes

Autonomic
resting tachycardia 
urinary frequency increased
urinary/faecal incontinence
erectile dysfunction

Question 22

What has been put into place to allow early management of complications like peripheral vascular disease and retinopathy

Answer 22

Diabetic foot and eye screening

Question 23

Symptoms (2) /signs (2) of diabetic retinopathy

Answer 23

Blurred vision/gradually worsening vision
Floaters
Microaneurysms

Question 24

A self check ‘CPR’ (check, protect, refer) method has been introduced for foot care, describe what each component involves

• check
• protect
• refer

Answer 24

Check

• breaks in skin
• discolouration
• ulcers
• neuropathy (loss of sensation, paraesthesia, pain)

Protect if

• there’s an existing ulcer (by avoiding pressure on it)
• at risk due to neuropathy, previous ulcer, fragile skin

Refer to podiatrist if have foot ulcer/pressure damage

Question 25

What is Charcot foot

Answer 25

Weakening of the bones in the feet in those with diabetic neuropathy

With continued walking, bones can fracture and joints can dislocate –> deforms the foot and becomes an abnormal shape

Question 26

Characteristic triad clinical presentation of diabetic kidney disease

Answer 26

progressive albuminuria,
hypertension,
and decline in GFR

in a long-standing (duration >10 years) diabetic patient

Question 27

Possible complication of a foot ulcer if left untreated

Answer 27

Can get infected and spread to bone –> osteomyelitis