Macrovascular complications

Question 1

What are examples of macrovascular diseases

Answer 1

Ishcaemic heart disease
Cerebrovascular
Renal artery stenosis
Peripheral vascular disease

Question 2

What are non modifiable risk factors for macrovascular disease

Answer 2

Age
Sex
Birth Weight
FH/Genes

Question 3

What is the difference between what microvascular and macrovascular disease cause?

Answer 3

Microvascular disease cause morbidity, macrovascular disease cause morbidity and mortality

Question 4

Where are macrovascular disease commonly present

Answer 4

In multiple arterial beds as it is systemic

Question 5

What is the major cause of morbidity and mortality in diabetes

Answer 5

Ischaemic heart disease

Question 6

What are modifiable risk factors for macrovascular disease

Answer 6

Dyslipidaemia
High blood pressure
Smoking
Diabetse

Question 7

How should you treat macrovascular conditions caused by diabetes

Answer 7

Treat cholesterol in diabetes using statins to prevent the macrovascular conditions

Question 8

What characteristic of diabetes can contribute to the first 4 stages of atheroma formation

Answer 8

Insulin resistance

Question 9

What are different arteriel beds that macrovascular disease affect?

Answer 9

• Ischaemic heart disease – major cause of morbidity and mortality in diabetes: The mechanisms are similar with and without diabetes.
• Cerebrovascular disease – earlier than without diabetes.: More widespread and uncommon in people younger than 60.
• Peripheral vascular disease – contributes to diabetic foot problems.
• Renal artery stenosis – may contribute to hypertension in some.

Question 10

How does intensive glucose control affect cardiovascular disease risk

Answer 10

It improves the risk but does not change the mortality much. Management of glucose alone does not address vascular risk

Question 11

How are macrovascular diseases prevented in diabetes

Answer 11

By aggressive management of multiple modifiable risk factors eg blood pressure and cholesterol

Question 12

What are treatment goals in order to minimise damage due to macrovascular disease

Answer 12

• Blood-glucose lowering therapy – via metformin, sulphonylurea, insulin, etc.
• Blood pressure management – if damage is to kidneys, eyes or cerebrovascular damage, lower considerably (<130/80mmHg) but other targets and lower less (<140/80mmHg). Constant monitoring.
• Management of blood lipids – review CV risk annually

Question 13

What are complications of diabetes that predispose to foot disease

Answer 13

neuropathy (sensory, motor and autonomic) and peripheral vascular disease.

Question 14

How should foot neuropathy - a test for sensory function be done?

Answer 14

Via a mono filament, and when the filament bends the 10g of pressure has been applied which should be felt by the patient

Question 15

What is sensory neuropathy

Answer 15

cannot feel monofilament – ulcers due to abnormal pressures.

Question 16

What is motor neuropathy in foot neuropathy??

Answer 16

Imbalance of extensors/flexors so the foot is an abnormal shape. Ulcers due to abnormal pressure

Question 17

What is limit joint mobility in diabetic foot neuropathy

Answer 17

It causes joint immobility and cannot put hands flat against each other

Question 18

What is autonomic neuropathy in diabetic foot neuropathy

Answer 18

No sweating so skin dries out and you get ulcers

Question 19

What is peripheral vascular disease in diabetic foot neuropathy

Answer 19

Blood flow is compromised to the lower limbs

Question 20

Describe a neuropathic foot

Answer 20

numb, warm, dry, palpable foot pulses and ulcers at points of pressure.

Question 21

Describe an ischaemic foot

Answer 21

cold, pulseless and ulcers at the foot margins.

Question 22

Describe a neuro-ischaemic foot

Answer 22

numb, cold, dry, pulseless, ulcers at point of pressure AND foot margins.

Question 23

What should you look at when assessing a foot in a patient you think has diabetic foot neuropathy

Answer 23

appearance (callus, deformity), touch/feel (hot, dry), foot pulses (dorsalis pedis, posterior tibial) and neuropathy (vibration, fine touch).

Question 24

What needs to be managed in a diabetes perspective in a patient with diabetic foot neuropathy

Answer 24

o Hyperglycaemia.
o Hypertension.
o Dyslipidaemia.
o Stop smoking.
o Education.

Question 25

What are preventative managements for diabetic foot neuropathy

Answer 25

Controlling diabetes, have feet measured for shoes, attend a chiropodist, take care when feet get hot, inspect feet daily, buying shoes with laces and square toe box, cut nails straight across, never walk barefoot

Question 26

What are management options for foot ulceration

Answer 26

• Relief of pressure – bed rest and redistribution of pressure.
• Antibiotics – possibly long-term.
• Debridement.
• Re-vascularisation – angioplasty or arterial bypass surgery.

§ Amputation.

Question 27

What is a charcot foot?

Answer 27

A ‘rocker bottom’ foot which is orientated in an abnormal way due to distruction of the joints which is painful to non diabetics (but not for diabetics due to sensory neuropathy)

Question 28

What does the charcot foot predispose patients to

Answer 28

Ulcer formation and osteomyelitis

Question 29

What is osteomyelitis

Answer 29

Bone infection