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BRS Y2 > Microvascular Complications of Diabetes > Flashcards

Microvascular Complications of Diabetes Flashcards

1
Q

What are the 3 main sites of microvascular complications in diabetes?

A

Retinal arteries
Renal glomerular arterioles
Vasa nervorum

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2
Q

What are the vasa nervorum?

A

Tiny blood vessels that supply nerves

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3
Q

What is the main factor in increasing risk for developing microvascular complications?

A

High BP

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4
Q

What are the main 2 targets when reducing risk of complications?

A

Reduce HbA1c

Control BP

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5
Q

What is hyperglycaemic memory and how does it affect complications of diabetes?

A

Inadequate glucose control early on which increases risks of complications developing later on

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6
Q

How is HbA1c risked to MI?

A

Higher HbA1c increases risk of MI

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7
Q

What are the main mechanisms of damage in microvascular complications?

A

Oxidative stress
Formation of AGEs
Hypoxia

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8
Q

What are AGEs?

A

Advanced gylcolated end products- other proteins that become glycated eg on the walls of blood vessels

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9
Q

What are the 3 main microvascular complications called?

A

Retinopathy
Nephropathy
Neuropathy

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10
Q

How is retinopathy detected in diabetics?

A

Via screening- diabetics undergo once a year screening

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11
Q

What is mainly damaged in retinopathy?

A

The endothelium

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12
Q

What are the 3 stages of retinopathy?

A

Background
Pre-proliferative
Proliferative

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13
Q

What can occur alongside all stages of retinopathy?

A

Maculopathy

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14
Q

What can be seen during background retinopathy?

A

Hard exudates (cheese colour, made of lipid)
Micro aneurysms
Blot haemorrhages

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15
Q

What can be seen during pre-proliferative retinopathy? What does it indicate

A

Cotton wool spots= soft exudates

Represent retinal ischaemia

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16
Q

What can be seen during proliferative retinopathy?

A

Visible new vessels

On disk or elsewhere in retina

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17
Q

What is maculopathy?

A

Hard exudates near the macula
Same as background retinopathy but happens near the macula
Can threaten direct vision

18
Q

What stage of retinopathy interferes with direct vision?

A

Maculopathy

19
Q

How is background retinopathy treated?

A

Continued annual surveillance

Feedback to person

20
Q

How is pre-proliferative retinopathy treated?

A

Early panretinal photocoagulation

21
Q

How is proliferative retinopathy treated?

A

Panretinal photocoagulation

22
Q

How is diabetic maculopathy treated?

A

Oedema: anti-VGF injections

Grid photocoagulation

23
Q

What is measured when screening for diabetic nephropathy?

A

Urine albumin:creatinine

24
Q

How does diabetic nephropathy present?

A

Hypertension
Increasing proteinuria
Deteriorating kidney function
Histological features

25
Q

What is required if theres renal failure?

A

Haemodialysis

26
Q

What glomerular changes are seen in diabetic nephropathy?

A

Mesangial expansion
Basement membrane thickening
Glomerulosclerosis

27
Q

What constitutes a diagnosis of microalbuminuria?

A

above 2.5 mg.mmol for men

above 3.5 mg/mmol for women

28
Q

What happens to BP and eGFR in diabetic nephropathy?

A

BP increases

eGFR is deranged

29
Q

What type of oedema occurs if diabetic nephropathy is advanced?

A

Peripheral oedema

30
Q

What are the 4 steps of diabetic nephropathy treatment?

A
  1. Aim for tighter glycaemic control
  2. Reduce BP via ACE inhibitors
  3. Stop smoking
  4. Start a SGLT-2 inhibitor if T2DM
31
Q

What happens to the vasa nervorum in diabetic nephropathy?

A

They get blocked

32
Q

What is the main concern in diabetic neuropathy?

A

Damage to the feet- the longest nerves supply the feet so if there is a foot injury they may not notice and complications can arise

33
Q

How often do people living with diabetes have a foot check?

A

Once a year

34
Q

What are clinical features of peripheral neuropathy?

A 
Loss of sensation
Loss of vibration
Loss of temperature sensation
Loss of proprioception
Loss of ankle jerks
Glove and stocking distribution
35
Q

If there is foot ulceration what must be done?

A

Its a medical emergency so admit them to hospital

36
Q

What is mononeuropathy?

A

One nerve is affected so usually there is sudden motor loss, wrist and foot drop, cranial nerve palsy

37
Q

What is mononeuritis multiplex?

A

A random combo of peripheral nerve lesions

38
Q

What is radiculopathy?

A

Pain over spinal nerves affecting dermatome on abdomen or chest wall

39
Q

What is autonomic neuropathy?

A

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

40
Q

When does autonomic neuropathy develop?

A

If diabetes has been very poorly managed

41
Q

What are presentations of autonomic neuropathy?

A 
Difficulty swallowing
Nausea and vomitting
Constipation
Nocturnal diarrhoea
Bladder dysfunction
Postural hypotension
Cardiac autonomic supply

BRS Y2 (85 decks)

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