Microvascular Diabetic Complications

Question 1

list three major sites of microvascular complications

Answer 1

retinal arteries
renal glomerular arterioles
vasa nervorum (blood vessels that supply to nerve)

Question 2

what factor is associated with the development of microvascular complications?

Answer 2

high blood pressure

Question 3

relationship of risk of microvascular complications and rising HbA1c

Answer 3

increases exponentially

Question 4

prevention of complications requires?

Answer 4

reduction in HbA1c AND blood pressure control

Question 5

other factors related to the development of microvascular complications

Answer 5

severity of hyperglycaemia
genetic factors > ethnicity
hypertension
hyperglycaemic memory/legacy effect
duration
glucose variability?

Question 6

mechanism of damage

Answer 6

hyperglycaemia/hyperlipidaemia > oxidative stress, AGE-RAGE, hypoxia > inflammatory signalling cascades > local activation of pro-inflammatory cytokines > inflammation > complications

Question 7

why is screening needed to detect retinopathy?

Answer 7

early stages of retinopathy are asymptomatic, need to detect at a stage before it causes visual disturbance/loss

Question 8

mechanism of diabetic retinopathy

Answer 8

hyperglycaemia > activates various pathways > vascular endothelium dysfunction > retinal ischaemia > increases endothelium permeability > macular oedema + neovascularisation

Question 9

list stages of retinopathy

Answer 9

background retinopathy
pre-proliferative retinopathy
proliferative retinopathy
maculopathy (can occur at any stage of retinopathy)

Question 10

characteristics of background retinopathy

Answer 10

hard exudates (cheese colour, lipid)
microaneurysms
blot haemorrhages

Question 11

pre-proliferative retinopathy

Answer 11

cotton wool spots (soft exudates)

represent retinal ischaemia

Question 12

proliferative retinopathy

Answer 12

visible new vessels

on disk or elsewhere in retina

Question 13

characteristics of maculopathy

Answer 13

hard exudates/oedema near the macula
same as background but happens to be at the macula
can threaten direct vision

Question 14

treatment of general retinopathy

Answer 14

improve HbA1c

good blood pressure control

Question 15

treatment of background retinopathy

Answer 15

continued annual surveillance

feedback to person living w/ diabetes

Question 16

treatment of pre-proliferative retinopathy

Answer 16

early panretinal photocoagulation

Question 17

treatment of proliferative retinopathy

Answer 17

panretinal photocoagulation

Question 18

panretinal photocoagulation

Answer 18

burn the new vessel off with a laser

Question 19

treatment of diabetic maculopathy

Answer 19

laser grid retinal photocoagulation

oedema: Anti-VEGF injections

Question 20

diabetic nephropathy is actively screened for and monitored with by measurement of what?

Answer 20

albumin in urine

Question 21

diabetic nephropathy is characterised by?

Answer 21

hypertension
progressively increasing proteinuria
progressively deteriorating kidney fx

Question 22

diabetic nephropathy is associated with what negative consequences?

Answer 22

progression to end stage renal failure requiring haemodialysis
increased risk of cardiovascular events

Question 23

histological features of diabetic nephropathy

Answer 23

glomerular changes: mesangial expansion, basement membrane thickening, sclerosis of the glomeruli

Question 24

diagnosis of diabetic nephropathy

Answer 24

progressive proteinuria (urine ACR - albumin creatinine ratio)
increased BP
deranged renal fx eGFR
advanced: peripheral oedema

Question 25

mechanism of diabetic nephropathy

Answer 25

hyperglycaemia + hypertension > glomerular hypertension > proteinuria > glomerular + interstitial fibrosis > glomerular filtration rate declines > renal failure

Question 26

strategies for intervention for diabetic nephropathy

Answer 26

``` decreasing HbA1c manage blood pressure inhibit renal-angiotensin-aldosterone system (ACEi or A2RB) SGLT-2 inhibition smoking cessation ```

Question 27

diabetic neuropathy

Answer 27

damage to vessels that supply vasa nervorum

Question 28

list diabetic neuropathies

Answer 28

``` peripheral polyneuropathy mononeuropathy mononeuritis multiplex radiculopathy autonomic neuropathy diabetic amyotrophy ```

Question 29

most common diabetic neuropathy

Answer 29

peripheral polyneuropathy

Question 30

how does peripheral polyneuropathy manifest?

Answer 30

``` loss of sensation loss of vibration sense loss of temperature sensation loss of proprioception loss of ankle jerks 'glove and stocking' distribution ```

Question 31

how is peripheral polyneuropathy screened for in people with diabetes?

Answer 31

annual foot check

Question 32

management of peripheral neuropathy

Answer 32

regular inspection of feet by affected individual good footwear avoid walking barefoot

Question 33

management of peripheral neuropathy w/ ulceration

Answer 33

``` multidisciplinary diabetes foot clinic offloading revascularisation if concomitant PVD antibiotics if infected orthotic footwear amputation if all else fails ```

Question 34

characteristics of mononeuropathy

Answer 34

``` usually sudden motor loss wrist drop foot drop cranial nerve palsy double vision due to pressure on 3rd nerve ```

Question 35

mononeuritis mutliplex

Answer 35

random combination of peripheral nerve lesions

Question 36

radiculopathy

Answer 36

pain over spinal nerves usually affected a dermatome on chest wall or abdomen

Question 37

autonomic neuropathy

Answer 37

loss of sympathetic and parasympathetic nerves to GI tract, bladder, CVS

Question 38

gastrointestinal symptoms of autonomic neuropathy

Answer 38

difficulty swallowing, delayed gastric emptying, constipation, nocturnal diarrhoea, bladder dysfunction

Question 39

cardiovascular symptoms of autonomic neuropathy

Answer 39

postural hypotension | disrupted cardiac autonomic supply