Microvascular Complications of Diabetes

Question 1

name chronic MACROvascular complications of diabetes?

Answer 1

IHD

stroke

Question 2

name chronic MICROvascular complications?

Answer 2

neuropathy
nephropathy
retinopathy

Question 3

is there a link between dementia and diabetes?

Answer 3

yes

Question 4

what causes the oxidative stress in hyperglycaemia and hyperlipidaemia?

Answer 4

advanced glycaemic end products (AGEs) binding to receptors

Question 5

what happens when an AGE binds to a RAGE?

Answer 5

get hypoxia which causes oxidative stress

then get inflammation causing mitochondrial dysfunction = microvascular complications

Question 6

what type of neuropathy would cause changes in bowel/bladder function?

Answer 6

autonomic

Question 7

what is amyotrophy and what type of neuropathy is it found in?

Answer 7

pain in the thighs, hips and buttocks = proximal

Question 8

what neuropathy would a sudden presentation of carpal tunnel indicate?

Answer 8

focal

Question 9

which of these is not a risk factor for neuropathy:
alcohol 
smoking
type 2 > type 1
increased length of diabetes

Answer 9

type 2>type 1

Question 10

clinical presentation of peripheral neuropathy?

Answer 10

numbness
tingling/burning
sensitive to touch
loss of balance and coordination

Question 11

treatment options for painful neuropathy?

Answer 11

amitryptiline and other complex analgesics

if localised, topical capsaicin cream

Question 12

what nerves are most commonly affected by focal neuropathy?

Answer 12

head
torso
leg

Question 13

where is pain commonly felt in focal neuropathy?

Answer 13

thigh
chest
lower back
pelvis
outside of foot

Question 14

how does the eye present in focal neuropathy?

Answer 14

unable to focus
double vision
aching behind eye

Question 15

what 4 symptomatic groups comprise proximal neuropathy

Answer 15

neuropathy of the lumbosacral plexus, the femur and diabetic amyotrophy, weight loss

Question 16

what type of diabetes is proximal neuropathy more common in?

Answer 16

2

Question 17

what are the roles of the nerves involved in autonomic neuropathy?

Answer 17

controlling:
heart rate
blood pressure
gastric motility
respiratory dunction
sexual function
vision
urination

Question 18

clinical presentation of autonomic neuropathy on GI system?

Answer 18

constipation and diarrhoea due to gastric infrequency
dysphagia from oesophageal nerve damage
gastroparesis = vomiting, bloating

Question 19

what can gastroparesis do to blood glucose levels?

Answer 19

fluctuates them due to abnormal food digestion

Question 20

how can you minimise symptoms of autonomic neuropathy on the GI system pharmacologically?

Answer 20

smaller, more frequent meals
promotility drugs eg metoclopramide
anti nausea drugs
amitryptiline etc and NSAIDs for abdo pain
botox

Question 21

what is it called when you sweat heavily at night or while eating?

Answer 21

gustatory sweating

Question 22

what condition can present with gustatory sweating and why?

Answer 22

autonomic neuropathy of nerves affecting sweat glands so body can’t control temperature

Question 23

treatment for gustatory sweating?

Answer 23

glycopyrrolate
clonidine
botox

Question 24

when would you suspect heart and blood vessel involvement in autonomic neuropathy?

Answer 24

postural hypotension

tachycardia constantly

Question 25

how can you screen for neuropathy?

Answer 25

nerve conduction study electromyography USS/gastric emptying study for GI complications

Question 26

what does a nerve conduction study do?

Answer 26

checks the type and extent of nerve damage

Question 27

what does an electromyography do?

Answer 27

checks how well muscles respond to electrical signals by nearby nerves

Question 28

diabetic nephropathy is made up of which 3 pathologies?

Answer 28

nephrotic sundrome diffuse scarring of glomeruli angiopathy of capillaries

Question 29

consequences of diabetic nephropathy on the patient?

Answer 29

hypertension decline in renal function accelerated vascular disease

Question 30

what test would indicate nephropathy?

Answer 30

urinary albumin creatinine ratio

Question 31

what urine ACR would indicate microalbuminuria in females and males?

Answer 31

2. 5-25 in women | 3. 5-35 in men

Question 32

what urine ACR would indicate macroalbuminuria in females and males?

Answer 32

male >25 | female >35

Question 33

what screenings should be done for a patient with microalbuminuria?

Answer 33

hypertension IHD retinopathy PVD

Question 34

risk factors for nephropathy progression?

Answer 34

``` hypertension cholesterol smoking glycaemic control albuminuria ```

Question 35

what blood pressure should be maintained in all diabetics?

Answer 35

130/80mmHg

Question 36

what drug should patients with microalbuminuria or proteinuria be started on?

Answer 36

ACEi or ARB

Question 37

what HBA1c would indicate good glycaemic control that would prevent nephropathy?

Answer 37

<53mmol/mol

Question 38

most common cause of kidney failure?

Answer 38

diabetes

Question 39

what eye pathologies other than diabetic retinopathy do diabetics get?

Answer 39

cataract glaucoma acute hyperglycaemia

Question 40

where is the retina located?

Answer 40

back of the eye

Question 41

what do cotton wool spots on the eye indicate?

Answer 41

ischaemia

Question 42

what are hard exudates on the eye made of?

Answer 42

lipid breakdown products

Question 43

what does IRMA stand for in terms of the eye?

Answer 43

intra retinal microvascular abnormalities

Question 44

when would you refer a retinopathy compared to just monitoring it?

Answer 44

if there is IRMA AND haemorrhages in both hemi fields of the eye

Question 45

what is maculopathy?

Answer 45

lesions near the centre of the fovea of the eye

Question 46

when would you refer a maculopathy?

Answer 46

if the lesions are smaller than 1 disc diameter of the centre of the fovea

Question 47

what presentation would suggest mild background retinopathy?

Answer 47

haemorrhages and microaneurysms only

Question 48

what symptom is seen in pre proliferative but not in mild retinopathy?

Answer 48

hard exudates

Question 49

what type of retinopathy is IRMA and venous beading seen in?

Answer 49

severe non-proliferative

Question 50

how can bleeding in the eye present?

Answer 50

floaters | sudden change in vision

Question 51

how is retinopathy treated?

Answer 51

laser | vitrectomy

Question 52

cause of erectile dysfunction in diabetic men?

Answer 52

vascular problems | autonomic neuropathy

Question 53

drug causes of erecile dysfunction?

Answer 53

thiazides beta blockers CNS drugs analgesics