microvascular complications

Question 1

main thing diabetes affects and where

Answer 1

blood vessels- retinal arteries (eye), glomerular arterioles (kidney), and VASA NERVORUM (nerves)

Question 2

factors affecting microvascular complications

Answer 2

glucose and hypertension- the higher they are, the more likelihood of complications, hence glycaemic/BP control is important genetics as well, and HYPERGLYCAEMIC MEMORY (someone whos naturally controlled their BP well for longer less at risk)

Question 3

general mechanism of glucose damage

Answer 3

hyperglycaemia causes high inflammatory cytokine levels, leading to the complications

Question 4

importance of diabetic retinopathy

Answer 4

main cause of visual loss in diabetes, as well as blindness in working age ppl in general

Question 5

BACKGROUND retinopathy with comparison DIAGRAM

Answer 5

normal- optic disk with vessels coming out, and fovea in middle in diabetics, there are HARD EXDUATES (proteins leaking out of vessels- bright yellow dots), MICROANEURYSMS (bulges of vessels- red dots)- leads to HAEMORRHAGES

Question 6

pre-proliferative diabetic retinopathy DIAGRAM

Answer 6

if background retinopathy not treated, SOFT exudates representing ischaemia of retina- seen as COTTON WOOL areas

Question 7

proliferative retinopathy DIAGRAM

Answer 7

next stage, where visible NEW VESSELS form- may form on optic disk, and vessels are distributed randomly

Question 8

maculopathy DIAGRAM

Answer 8

hard exudates normally background changes, but if occurs at macula, has major effect on vision

Question 9

managing diabetic retinopathy- different stages

Answer 9

background- improve glucose control, and screening pre-proliferative and proliferative- suggests ischaemia, so to prevent new vessels growing (which can bleed and affect vision), PAN RETINAL (whole retina) PHOTOCOAGULATION needed (laser therapy) maculopathy- only macula affected, so only GRID of photocoagulation needed, NOT pan retinal

Question 10

importance of nephropathy

Answer 10

increase morbidity/mortality significantly, and treatment very costly

Question 11

histological features of diabetic nephropathy DIAGRAM

Answer 11

changes in glomerulus- basement membrane THICKENS like on right

Question 12

epi of diabetic nephropathy compared to T1

Answer 12

age of development disease/presentation higher for T2DM (as T1 patients younger), and many die due to heart attack before getting nepropathy- less likely for T1 patients

Question 13

clinical features of nephropathy

Answer 13

increasing proteinuria and BP, and decreasing kidney function (GFR) proteinuria ie microalbumin detected with dipstick, occurs even if GFR normal, so GFR alone not enough

Question 14

managing nephropathy

Answer 14

glucose control (ie diabetic control), BP control, and ACE inhibitors (inhibits renin angiotensin system- VERY IMPORTANT), as well as stopping SMOKING (increases likelihood of heart attack)

Question 15

importance of diabetic neuropathy

Answer 15

most common cause of general neuropathy, often leading to limb amputation

Question 16

peripheral neuropathy- what is it and who most affected

Answer 16

affects nerves supplying hands and feet- leads to sensation loss eg patient won’t notice injury to foot when stepping on nail occurs in patients with poor glucose control, and TALL PEOPLE

Question 17

clinical features of peripheral neuropathy

Answer 17

loss of ankle jerks, as well as vibration sense (using tuning fork) also can lead to CHARCOT’S JOINT- patients walk weirdly, which causeses multiple FRACTURES on an xray of the foot

Question 18

mononeuropathy

Answer 18

another type of neuropathy affecting only one nerve- leads to motor loss causing wrist/foot DROPS can also lead to 3RD NERVE PALSY (paralysis)- prevents eye from going down and out: if pupil still responds to light, PNS fibres not affected, so indicates diabetic neuropathy- if pupil does NOT respond to light, not due to diabetes, often due to aneurysms pressing on 3rd nerve

Question 19

other types of diabetic neuropathy

Answer 19

mononeuritis multiplex- random areas of nerves affected radiculopathy- dermatomes affected ie pain in certain part of abdomen autonomic neuropathy- loss of SNS/PNS fibres to GI/ bladder/CVS= constipation, dysphagia, POSTURAL HYPOTENSION, bladder issues and arrythmias