Microvascular Complications

Question 1

What are diabetic complications in vasculature

Answer 1

CVD, strokes, diabetic retinopathy, diabetic nephropathy, peripheral vascular disease, Diabetic Peripheral Neuropathy (DPN)

Question 2

Diabetic neuropathy affects 30-__% of patients with diabetes

Answer 2

50

Question 3

What does neuropathy cause?

Answer 3

Pain (burning, tingling, paraesthesia)

Autonomic dysfunction (diarrhoea, constipation, incontinence, erectile dysfunction, gastroparesis, hypotension)

Foot Ulceration (numbness, infection, amputation)

Cannot reverse nerve damage

Question 4

DPN has typical g___ and s___ distributions of sensory loss

Answer 4

glove and stocking

Question 5

Microvascular complications are preventable by rigorous g___ control

Answer 5

glycaemic

Question 6

Treatment of Diabetic Painful neuropathy

Answer 6

Good glycaemic control
Antidepressants
Anticonvulsants
Opioids (less prescribed)
Psychological interventions

Question 7

Diabetic Foot Ulceration (DFU)

Answer 7

Occurs in 15% of people with DM
Hospital bed occupancy
Expensive
2 times mortality in those with DFU

Question 8

Pathway to Diabetic amputation

Answer 8

Neuropathy or vascular disease

Trauma

Ulcer

Failure to heal

Infection

Amputation

Question 9

For annual diabetic check, always check….

Answer 9

the feet by taking off the shoes

Question 10

How can lack of autonomic function contribute to foot amputation?

Answer 10

No sweating, dry skin, cracked skin, Increased risk of infection

Therefore encourage moisturise feet.

Question 11

Diabetic peripheral neuropathy screening tests

Answer 11

Test sensation using 10 gm monofilament neurotips

Vibration perception using tuning fork and biothesiometer

Ankle reflexes

Question 12

Symptoms of peripheral vascular disease

Answer 12

Intermittent claudication (cramps in lower limbs when walking)
Rest pain (at night, decreased perfusion, wake up with pain)

Question 13

Signs of vascular disease

Answer 13

Diminished pedal pulses
Coolness of the feet and toes
Poor skin and nails
Absence of hair on feet and legs

Question 14

Advice/treatment given to those with peripheral vascular disease

Answer 14

Quit smoking
Walk through pain
Surgical intervention

Question 15

Eye screening

Answer 15

Annual scan for diabetics
2 field retinal photography
Reports sent to GP and patients

Question 16

How does retinopathy occurs in diabetic patients?

Answer 16

High blood sugar causes basement membrane thickening
Pericyte loss
Reduces junctional contact with endothelial cells
Leakage of protein and fat into retina

occlusion of retinal arteries causing ischaemia
Growth factors released to make new blood vessels

new vessels are abnormal/weak and be damaged and break causing haemorrhage - bleeding in retina.

Question 17

Treatment for diabetic retinopathy

Answer 17

Laser Therapy
Burn off the new abnormal blood vessels

Can be focal to macula or peripheral scatter

Question 18

Risks of laser therapy

Answer 18

Over 50% notice difficulty with night vision

1/5 lose peripheral vision

Temporary drop in visual acuity

Question 19

Over __% of severe sight loss is prevented by laser

Answer 19

90%

Question 20

Diabetes is the main cause of e___ s____ r____ d___ (ESRD)

Answer 20

End Stage Renal Disease

Question 21

Diabetic nephropathy is characterised by progressive kidney f___ resulting in loss of function

Answer 21

fibrosis

Question 22

DN is hallmarked by p______ followed by decline in renal function.

Answer 22

proteinuria

Question 23

DN is major risk factor for…

Answer 23

CVD

Question 24

Definition of Chronic kidney disease

Answer 24

Decreased eGFR (<60ml/min/m2)
and
Albuminuria A2-A3 (>30 mg/g)

Question 25

Treatment for diabetic CKD

Answer 25

RAS blockers
SGLT2 inhibitors
Finerenone
FLP-1RAs
Cholesterol control
Proteinuria control