Microvascular complications

Question 1

What are the 3 main microvascular weaknesses associated with diabetes?

Answer 1

1. Retinopathy
2. Nephropathy
3. Neuropathy

Question 2

Recall the 5 main factors affecting microvascular risk

Answer 2

Severity of hyperglycaemia
Hypertension
Genetic
Hyperglycaemic memory
Tissue damage

Question 3

Recall the site of damage in retinopathy

Answer 3

Retinal arteries

Question 4

Recall the site of damage in nehropathy

Answer 4

Glomerular arterioles

Question 5

Recall the site of damage in neuropathy

Answer 5

Vasa vasorum

Question 6

When looking at an image of the retina, what are the main things to be looking for?

Answer 6

Bright disc in periphery = optic disc

Dark region in centre = macula

Question 7

Name the 4 different types of retinopathy

Answer 7

1. Background
2. Pre-proliferative
3. Proliferative
4. Maculopathy

Question 8

Recall the main identifying characteristics of each type of retinopathy

Answer 8

1. Background = lipid leakage –> hard exudate and microaneurysms
2. Pre-proliferative = soft exudates
3. Proliferative = vessel formation
4. Maculopathy = hard exudates near macula

Question 9

Describe the new vessel formation in retinopathy

Answer 9

1. Pre-proliferative stage
2. Tend to be fragile vessels
3. Response to retinal ischaemia

Question 10

Recall the management strategy for background retinopathy

Answer 10

Screening an improvement of blood glucose control

Question 11

Recall the management strategy for pre-proliferative retinopathy

Answer 11

Pan-retinal photo-coagulation

Question 12

What is pan-retinal phtocoagulation

Answer 12

Laser vessels to prevent rupture or new vessel formation

Question 13

Recall the management strategy for proliferative retinopathy

Answer 13

Pan-retinal photocoagulation

Question 14

Recall the management strategy for maculopathy

Answer 14

GRID of photocoagulation in the affected area

Question 15

Recall the 3 key features of nephropathy

Answer 15

Hypertension
Proteinuria
Deteriorating renal function

Question 16

Describe the glomerular histological changes in nephropathy

Answer 16

Mesangial expansion - due to ECM deposition
BM thickening
Glomerulosclerosis - increases pressure in kidney

Question 17

What are the most important factors to control in diabetes in order to slow renal deterioration?

Answer 17

BP control and RAAS inhibition

Question 18

Recall the 5 types of neuropathy

Answer 18

Peripheral neuropathy
Mononeuropathy
Mononeuritis complex
Radiculopathy
Autonomic neuropathy

Question 19

What is the main clinical feature of peripheral neuropathy and why is it problematic?

Answer 19

Loss of sensation to foot - may not sense injury to foot

Question 20

How does a mononeuropathy present?

Answer 20

Sudden motor loss - wrist/ foot drops suddenly

Question 21

What is mononeuritis complex?

Answer 21

neuropathy with multiple neurons involved

Question 22

What is radiculopathy?

Answer 22

Dermatomal sensational loss

Question 23

Where is there a loss of function in autonomic neuropathy?

Answer 23

GIT, CVS + bladder

Question 24

Recall 5 effects of neuropathy on the GIT

Answer 24

1. Dysphagia
2. Delayed gastric emptying
3. Constipation
4. Nocturnal diarrhoea
5. Bladder dysfunction

Question 25

Recall 2 possible effects of neuropathy on the CNS

Answer 25

1. Postural hypotension

2. Sudden cardiac death

Question 26

What examination should be done to test for autonomic neuropathy?

Answer 26

Measure changes in HR in response to the valsalva manoevre

Question 27

How do you perform a valsalva manoevre?

Answer 27

Make the m blow into a syringe: should see a change in HR - look at ECG and compare RR intervals