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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
Q

What are the clinical features of diabetic nephropathy?

A

Progressive proteinuria
Increased blood pressure
Deranged renal function

26
Q

What is the normal range of protein in urine?

A

<30mg/24hrs

27
Q

What is the nephrotic range of protein in urine?

A

> 3000mg/24hrs

28
Q

How is protein in the urine measured?

A

Urine dipsticks

29
Q

What happens as urinary excretion of albumin increases?

A

Their serum albumin will be low so they will become quite oedematous

30
Q

What are the strategies for intervention of nephropathy?

A

Diabetic control
Blood pressure control
Inhibition of activity of renin-angiotensin system
Stopping smoking

31
Q

What actions of angiotensin make endothelial cells more rigid?

A 
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
Q

What produces renin?

A

Juxtaglomerular apparatus

33
Q

When do renin levels increase?

A

If you have low perfusion (blood pressure)

34
Q

Where is ACE found?

A

Lungs

35
Q

What is diabetes the most common cause of as a result of being the most common cause of neuropathy?

A

Lower limb amputation

36
Q

What are the vasa vasorum?

A

Small blood vessels supplying the nerves

37
Q

What are the 6 types of diabetic neuropathy? (at Parties, Marilyn Manson Regularly Abuses Drugs)

A 
Peripheral polyneuropathy
Mononeuropathy
Mononeuritis multiplex
Radiculopathy
Autonomic neuropathy
Diabetic amyotrophy
38
Q

What does peripheral neuropathy affect?

A

Hands and feet

39
Q

What sort of people is peripheral neuropathy more likely to affect?

A

Tall patients

Patients with poor glucose control

40
Q

How do you test for peripheral neuropathy?

A

Monofilament expansion- prick the patients foot with a filament

41
Q

What does peripheral neuropathy lead to?

A

Loss of sensation
Loss of ankle jerks
Loss of vibrational sense

42
Q

How does mononeuropathy normally present?

A

Sudden motor loss- wrist or foot drop

Cranial nerve palsy

43
Q

What normally happens to the eye in pupil sparing third nerve palsy?

A

The eye is usually down and out because of unopposed action of lateral rectus and superior oblique and the pupil responds to light

44
Q

Where are the parasympathetic fibres in the eye and why is this important?

A

On the outside so they don’t lose blood supply in diabetes

45
Q

What happens when an aneurysm causes third nerve palsy?

A

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
Q

What is mononeuritis multiplex?

A

Random combination of peripheral nerve lesions

47
Q

What is radiculopathy?

A

Pain over spinal nerves usually affecting a dermatome on abdomen or chest wall

48
Q

What is autonomic neuropathy?

A

Loss of sympathetic and parasympathetic nerves to the GI tract, bladder and cardiovascular system

49
Q

What are the effects of autonomic neuropathy on the GI tract?

A

Difficulty swallowing
Delayed gastric emptying
Constipation/nocturnal diarrhoea
Bladder dysfunction

50
Q

What are the effects of autonomic neuropathy on the cardiovascular system?

A

Postural hypotension

Cardiac autonomic supply- sudden cardiac death

51
Q

How do you check for autonomic neuropathy?

A

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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