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Y2 Endocrinology > Microvascular complications of diabetes mellitus > Flashcards

Microvascular complications of diabetes mellitus Flashcards

1
Q

What are the sites of microvascular complications

A

Retinal arteries
Glomerular arterioles
Vasa nervorum (vessels that supply nerves)

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2
Q

What are the risk factors for microvascular disease

A

Severity of hyperglycaemia
Hypertension
genetic
Hyperglycaemic memory

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3
Q

Are microvascular complications reversible

A

Tissue damage through originally reversible

Later irreversible alterations in proteins

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4
Q

What are the mechanisms of glucose damage

A

Polyol pathway
AGEs
Protein kinase C
Hexosamine

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5
Q

Explain how hyperglycaemia and hyperlipidaemia lead to the complications of diabetes

A
  1. Hypoxia, oxidative stress, age-range
  2. Inflammatory signalling cascades
  3. Local activation of pro-inflammatory cytokines
  4. Inflammation
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6
Q

Describe microvascular complications (key facts)

A

Microvascular -> more likely to get microvascular disease
Increase in morbidity
Increased risk of microvascular if HbA1C is increased

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7
Q

What is hyperglycaemic memory

A

Even if you’ve had poor glycaemic control for a short period of time, it will cause an increased risk of microvascular complications compared to someone who has been well controlled throughout

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8
Q

What are the types of retinopathy

A

Background retinopathy
Pre-proliferative retinopathy
Proliferative retinopathy
Maculopathy

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9
Q

What can be seen in a fundoscopic view

A

Optic disc at the nasal part of the eye

Macula (fovea) laterally

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10
Q

What are the features of background retinopathy

A 
Hard exudates (leakage of lipid)
Microaneurysms (red dots, rupture...)
Blot haemorrhages
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11
Q

What is the management for background retinopathy

A

Improve blood glucose control

Warn patient that warning signs are present

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12
Q

What are the features of pre-proliferative retinopathy

A

Cotton wool spots (soft exudates)

Represent retinal ischaemia

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13
Q

Describe the management for pre-proliferative and proliferative retinopathy

A

Pan-retinal photocoagulation (laser the retina to stop vessels from bleeding + new vessels growing)

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14
Q

What are the features of proliferative retinopathy

A

From untreated pre-proliferative retinopathy
New vessels on optic disc or elsewhere (response to retinal ischaemia, new vessels are more fragile and can bleed anytime, if form in region of macula- can affect acuity and colour vision)

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15
Q

What are the features of maculopathy

A

Hard exudates near the macula
Same disease as background, but is near macula
This can threaten direct vision (+ acuity and colour)

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16
Q

What is the management for maculopathy

A

Grid-photocoagulation

17
Q

What are the clinical features of diabetic nephropathy

A

Hypertension
Progressively increasing proteinuria
Progressively deteriorating kidney function
Classic histological features

18
Q

What are the histological features of glomerular changes in diabetic nephropathy

A

Less flexible and harder:
Mesangial expansion
Basement membrane thickening
Glomerulosclerosis

19
Q

What are the strategies for diabetic nephropathy intervention

A

Diabetic control
Blood pressure control
Inhibition of the activity of RAS system (ACE inhibitors reduce rate of creatinine increase (↑creatinine=↓kidney function)
Stopping Smoking

20
Q

What are the types of diabetic neuropathy

A 
Peripheral polyneuropathy
Mononeuropathy
Mononeuritis multiplex
Radiculopathy
Autonomic neuropathy
Diabetic amyotrophy
21
Q

Describe peripheral neuropathy and its risk factors

A

Sensory loss
Test with monofilament (foot prick)
Danger= patient wont sense an injury on foot- fractures, Charcot foot, ulcer.

Tall patients (Longer nerves to the feet, loss of sensation)
Patients with poor glucose control
22
Q

What are the clinical features of peripheral neuropathy

A

Loss of ankle jerks
loss of vibration sense (using tuning fork)
multiple fractures on foot X-ray (Charcot’s joint)

23
Q

Describe mononeuropathy

A

Usually sudden motor loss
wrist drop, foot drop
Cranial nerve palsy:
double vision due to 3rd nerve palsy

24
Q

Describe the third nerve palsy

A

Eye is down and out
Pupil responds to light
The parasympathetic fibres are on the outside so do not easily lose blood supply
Aneurysm -> press on parasympathetic fibres -> fixed dilated pupil

25
Q

Describe autonomic neuropathy

A

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

26
Q

What are the clinical features of autonomic neuropathy

A 
difficulty swallowing
delayed gastric emptying
constipation / nocturnal diarrhoea
Bladder dysfunction
Postural hypotension 
Impaired cardiac function

Y2 Endocrinology (19 decks)

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