Long Term Complications of T1DM

Question 1

Macrovascular complications of T1DM

Answer 1

IHD
CVD
PVD

Question 2

Microvascular complications of T1DM

Answer 2

Retinopathy
Nephropathy
Neuropathy

Question 3

Pathological Findings of Diabetic Retinopathy

Answer 3

-Loss of pericytes
-Basement membrane thickening
-Capillary closure
-Ischaemia
VEGF production
-Increased capillary permeability
-New BV- more susceptible to rupture

Question 4

Cellular mechanism of microvascular complications

Answer 4

High blood glucose
Cells unable to reduce glucose transport

Leads to cell damage of

• Retinal endothelial cells
• Mesangial cells of glomerulus
• Schwann cells and peripheral nerve cells

Question 5

Diabetic Retinopathy

-Treatment

Answer 5

control diabetes and BP

Laser treatment

• Pan retinal
• Focal

Anti VEGF ab
-injected into retina

Question 6

Peripheral neuropathy

Answer 6

Glove and stocking syndrome
-loss of sensation in the feet that rises to the hands

Neuropathic foot ulcers that can present as callus

Charcot’s foot
-deformed foot from inflammation and weakening of bones

Question 7

Mononeuropathy

Answer 7

Loss of function of a single nerve

Includes carpal tunnel (entrapment neuropathy)

Question 8

What can Autonomic Neuropathy lead to?

Answer 8

Gastroparesis
Postural hypotension
Erectile dysfunction
Gustatory sweating
Diarrhoea

Question 9

Pathological Findings of Diabetic Nephropathy

Answer 9

BM thickening 
Loss of podocytes 
Glomerular sclerosis 
Mesangial expansion
Increases CVD  risk

Question 10

Treatment of Diabetic Nephropathy

Answer 10

• Control BP
• ACEi and ARBs
• Glucose control important but less so once overt proteinuria