T1 L18 - Long term complications of diabetes

Question 1

what are the main 2 categories and their sub categories of this

Answer 1

Microvascular:

• retinopathy
• nephropathy
• neuropathy

Macrovascular

• IHD
• CVD
• PVD

Question 2

what cells are at risk of hyperglycaemia

Answer 2

Retinal endothelial cells​

Mesangial cells of glomerulus​

Schwann cells and peripheral nerve cells​
​

Question 3

how long do microvascular complications take to form

Answer 3

Microvascular complications take many years to develop​

Rare before 5 years of type 1 diabetes​

May be detected at presentation of type 2 diabetes ​

Question 4

describe what abnormalities can be seen in a retinogram

Answer 4

White dots- protein leaking out into the retina ​
​
Curly stuff- new blood vessels that shouldn’t be there ​

Question 5

describe the prevalence of retinopathy

Answer 5

• Second commonest cause of blindness in those of working age​
• 4000+ in England blind from diabetic retinopathy​

-Risk of blindness increased 10-20 fold by DM​
​
​
(Glaucoma and cataract increased)​

Question 6

what is the normal appearance of retinal microcirculation

Answer 6

Low density of capillaries​
Little functional reserve​
Flow needs to respond to local needs​
Pericytes key to local regulation of flow​

Question 7

what are the pathological findings of diabetic retinopathy

Answer 7

-Loss of pericytes​
-Basement membrane thickening​
-Capillary closure​
-Ischaemia​
—VEGF production​
—Increased capillary permeability​
​

Question 8

look at slides of eyes and descriptions of them

Answer 8

how was it

Question 9

what are the clinical stages of retinopathy

Answer 9

Non-proliferative

• Background​
• Pre-proliferative​

Proliferative​
​
Macular Oedema​
-Sight threatening​
-Nonsight threatening​

Question 10

how do you treat diabetic retinopathy

Answer 10

Diabetic control important​
Blood pressure control important​
​
Laser treatment​
Pan retinal​
Focal​
Intra-vitreal anti VEGF Ab​

Question 11

what is the prevalence of neuropathy

Answer 11

Affects up to 50% of diabetic patients​

15% have painful neuropathy (cf 5% non-diabetic population

Question 12

what are the types of neuropathy

Answer 12

Peripheral
neuropathy​

Mononeuropathy​

Autonomic neuropathy​
​
(Entrapment neuropathy increased)​

Question 13

Look at pictures and give descriptions of what can be found from peripheral neuropathies

Answer 13

• muscle wasting
• neuropathic ulcer
• callus
• Charcot foot

-

Question 14

what is mononeuropathy

Answer 14

Mononeuropathy is damage to a single nerve, which results in loss of movement, sensation, or other function of that nerve.

Mononeuropathy may involve any part of the body. Some common forms of mononeuropathy include:
Axillary nerve dysfunction (loss of movement or sensation in the shoulder)
Common peroneal nerve dysfunction (loss of movement or sensation in the foot and leg)
Carpal tunnel syndrome (median nerve dysfunction – including numbness, tingling,

Question 15

what are the signs of autonomic neuropathy

Answer 15

• Gastroparesis​
• Postural hypotension​
• Erectile dysfunction​
• Gustatory sweating​
• Diarrhoea​

Question 16

what is the prevalence of nephropathy

Answer 16

Commonest cause of ESRD in Western World​
Accounts for deaths of 21% of type 1 and 11% of type 2 patients​

ESRD- end stage renal disease ​
When egfr goes below 3 ​
If kidneys go your eyes are likely to follow and vice-versa- usually due to diabetes – microvascular symptoms ​

Question 17

what is the pathology of the neurons in nephropathy

Answer 17

• Basement membrane thickening​
• –Loss of negative charge ​
• Podocyte loss​
• –Loss of integrity of filtration barrier​

Glomerular sclerosis​

Mesangial expansion​
​

Question 18

what are the Clinical Stages of Diabetic Nephropathy​

Answer 18

dipstick negative
-normoalbuminuria

-Microalbuminuria

Dipstick positive and declining GFR
-Albuminuria >200micrograms

Question 19

what are the secondary chronological effects of nephropathy

Answer 19

• Blood pressure control important​
• Blockers of RAS system preferred​
• Glucose control important but less so once overt proteinuria​
• Associated with increased CVD risk​
• Ultimately renal replacement / transplantation

Question 20

what ultimately kills people

Answer 20

The macrovascular disease

Question 21

what is diabetic foot

Answer 21

Diabetes is the commonest cause of non-traumatic lower limb amputation​

• PVD​
• Neuropathy (neuropathic ulcer, Charcot change)​
• Imapaired leucocyte function​

Question 22

UKPDS- UK prospective diabetes study
&
DCCT-diabetes control and complication trial

Answer 22

look at slide for graphs