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LCRS Endocrinology > Microvascular complications of diabetes > Flashcards

Microvascular complications of diabetes Flashcards

1
Q

What is the relationship between diabetes and blood vessels?

A

Diabetes damages blod vessels

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2
Q

What are the sites of microvascular complications?

A 
Retinal arteries (diabetic retinopathy)
Glomerular arteries (nephropathy)
Vasa vasorum (tiny blood vessels that supply the nerves- neuropathy)
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3
Q

What factors affect the risk of microvascular complication?

A 
Severity of hyperglycaemia
Hypertension
Genetic
Hyperglycaemic memory- poor diabetes control
Tissue damage
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4
Q

What is the main cause of blindness in people of working age?

A

Diabetic retinopathy

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5
Q

What do you look at an eye with?

A

Fundoscope

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6
Q

Where is the optic disc when you look at an eye?

A

Yellow ring in the nasal part of the eye

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7
Q

Where is the macula?

A

Dark ring more lateral to fovea (middle of image)

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8
Q

What are the 4 types of retinopathy?

A

Background
Pre-proliferative
Proliferative
Maculopathy

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9
Q

How does background diabetic retinopathy present?

A

You get hard exudates which appear as cheesy yellow spaces in the retina
Microaneurysms which can rupture causing blot haemorrhages

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10
Q

What causes the hard exudates in background diabetic retinopathy?

A

Leakage of lipid contents

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11
Q

How does pre-proliferative diabetic retinopathy present?

A

Cotton wool spots called soft exudates which show retinal ischaemia

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12
Q

How does proliferative diabetic retinopathy present?

A

It involves formation of new vessels which can be in optic disc or elsewhere, they form as a response to retinal ischaemia, they are fragile and can bleed easily

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13
Q

How does maculopathy present?

A

Hard exudates near the macula (same disease as background just exudates are at macula)
This can threaten direct vision

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14
Q

How do you treat background retinopathy?

A

Improve control of blood glucose and warn patient

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15
Q

How do you treat pre-proliferative and proliferative?

A

Pan-retinal photocoagulation

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16
Q

What is pan-retinal photocoagulation?

A

Laser the retinal and stop the vessels from bleeding

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17
Q

Why do you not use pan-retinal photocoagulation for maculopathy?

A

Only a problem at macula so you only need a grid in affected area

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18
Q

What are the features of diabetic nephropathy?

A

Hypertension
Progressively increasing proteinuria
Progressively deteriorating kidney function

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19
Q

Which histological sites are affected by nephropathy?

A

Glomerular
Vascular
Tubulointerstitial

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20
Q

What glomerular changes occur?

A

Mesangial expansion
Basement membrane thickening
Glomerulosclerosis

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21
Q

What do the changes in the glomerulus cause?

A

Glomerulus becomes less flexible and harder- absorption of nutrients can change so you can get more pressure going through kidneys which can lead to changes in blood pressure

22
Q

What are the stimuli for glomerusclerosis and secondary effects on tubulointerstitium?

A

Prolonged exposure to high glucose or glycosylated proteins in at risk patients

23
Q

How common is diabetic nephropathy in both types of diabetes?

A

20-40% after 30-40 years in both

24
Q

What affects the epidemiology of diabetic nephropathy in T2DM?

A

Age at development of disease
Racial factors
Cardiovascular morbidity

25
What are the clinical features of diabetic nephropathy?
Progressive proteinuria Increased blood pressure Deranged renal function
26
What is the normal range of protein in urine?
<30mg/24hrs
27
What is the nephrotic range of protein in urine?
>3000mg/24hrs
28
How is protein in the urine measured?
Urine dipsticks
29
What happens as urinary excretion of albumin increases?
Their serum albumin will be low so they will become quite oedematous
30
What are the strategies for intervention of nephropathy?
Diabetic control Blood pressure control Inhibition of activity of renin-angiotensin system Stopping smoking
31
What actions of angiotensin make endothelial cells more rigid?
``` Vasoactive effects Mediation of glomerular hyper filtration Increased tubular uptake of proteins Induction of profibrotic cytokines Stimulation of glomerular and tubular growth Podocyte effects Induction of pro-inflammatory cytokines etc ```
32
What produces renin?
Juxtaglomerular apparatus
33
When do renin levels increase?
If you have low perfusion (blood pressure)
34
Where is ACE found?
Lungs
35
What is diabetes the most common cause of as a result of being the most common cause of neuropathy?
Lower limb amputation
36
What are the vasa vasorum?
Small blood vessels supplying the nerves
37
What are the 6 types of diabetic neuropathy? (at Parties, Marilyn Manson Regularly Abuses Drugs)
``` Peripheral polyneuropathy Mononeuropathy Mononeuritis multiplex Radiculopathy Autonomic neuropathy Diabetic amyotrophy ```
38
What does peripheral neuropathy affect?
Hands and feet
39
What sort of people is peripheral neuropathy more likely to affect?
Tall patients | Patients with poor glucose control
40
How do you test for peripheral neuropathy?
Monofilament expansion- prick the patients foot with a filament
41
What does peripheral neuropathy lead to?
Loss of sensation Loss of ankle jerks Loss of vibrational sense
42
How does mononeuropathy normally present?
Sudden motor loss- wrist or foot drop | Cranial nerve palsy
43
What normally happens to the eye in pupil sparing third nerve palsy?
The eye is usually down and out because of unopposed action of lateral rectus and superior oblique and the pupil responds to light
44
Where are the parasympathetic fibres in the eye and why is this important?
On the outside so they don't lose blood supply in diabetes
45
What happens when an aneurysm causes third nerve palsy?
It will press on the parasympathetic fibres first causing a fixed dilated pupil which is how you know that it's not due to diabetes
46
What is mononeuritis multiplex?
Random combination of peripheral nerve lesions
47
What is radiculopathy?
Pain over spinal nerves usually affecting a dermatome on abdomen or chest wall
48
What is autonomic neuropathy?
Loss of sympathetic and parasympathetic nerves to the GI tract, bladder and cardiovascular system
49
What are the effects of autonomic neuropathy on the GI tract?
Difficulty swallowing Delayed gastric emptying Constipation/nocturnal diarrhoea Bladder dysfunction
50
What are the effects of autonomic neuropathy on the cardiovascular system?
Postural hypotension | Cardiac autonomic supply- sudden cardiac death
51
How do you check for autonomic neuropathy?
Measure changes in heart rate in response to valsalva manoeuvre (make them blow into a tube which normally causes a change in heart rate)

LCRS Endocrinology (18 decks)

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