Macrovascular Complications

Question 1

Macrovascular complications of diabetes refers to… (4)

Answer 1

• Early widespread atherosclerosis
• Ischaemic Heart Disease
• Cerebrovascular disease
• Peripheral vascular disease

Question 2

Sequence of atherosclerosis? start with initial lesion

Answer 2

Initial lesion
Fatty streak
Intermediate lesion
Atheroma
Fibroatheroma
Complicated lesion

Question 3

Things that damage arteries? (9)

Answer 3

Fasting glucose above 6mmol/L
HDL less than 1
Waist circumference 
Hypertension
Insulin resistance
Inflammation
CRP
Adipocytokines
Urine Microalbumin

Question 4

HYPERGLYCAEMIA IS ASSOCIATED WITH SIGNIFICANTLY REDUCED XX

Answer 4

Life expectancy

Question 5

MICROVASCULAR DISEASE CAUSES X; MACROVASCULAR DISEASE CAUSES X AND Y

Answer 5

X - morbidity

Y - mortality

Question 6

MACROVASCULAR DISEASE IS A X DISEASE AND IS COMMONLY PRESENT IN Y ARTERIAL BEDS

Answer 6

X - SYSTEMIC

Y - MULTIPLE

Question 7

The major cause of morbidity and mortality in diabetes are…

Answer 7

• ISCHAEMIC HEART DISEASE

Question 8

Difference between diabetic and normal CEREBROVASCULAR DISEASE

Answer 8

Occurs much earlier in diabetics

Question 9

PERIPHERAL VASCULAR DISEASE contributes to …

Answer 9

diabetic foot problems with neuropathy

Question 10

• RENAL ARTERY STENOSIS may contribute to…

Answer 10

hypertension and renal failure

Question 11

TREATMENT TARGETED TO HYPERGLYCAEMIA ALONE HAS X EFFECT ON INCREASED RISK OF CVD

Answer 11

MINOR

Question 12

What must be managed to prevent diabetic macrovascular disease

Answer 12

MULTIPLE RISK FACTORS

Question 13

what contributes first to diabetic macrovascular disease, insulin resistance or hyperglycaemia

Answer 13

insulin resistance

Question 14

NON-MODIFIABLE RISK FACTORS FOR MACROVASCULAR DISEASE:

Answer 14

Age
sex
birth weight
Family history/Genes

Question 15

MODIFIABLE RISK FACTORS FOR MACROVASCULAR DISEASE:

Answer 15

Dyslipidaemia
High blood pressure
Smoking
Diabetes

Question 16

COMPLICATIONS OF DIABETES PREDISPOSING TO FOOT DISEASE?

Answer 16

1. NEUROPATHY; sensory, motor and autonomic

2. PERIPHERAL VASCULAR DISEASE

Question 17

8 STEPS IN THE PATHWAY TO FOOT ULCERATION: (starting with distal sensory neuropathy)

Answer 17

1. Distal sensory neuropathy
2. Motor neuropathy
3. Limited joint mobility- can’t put hands flat together in prayer position
4. Autonomic neuropathy
5. Peripheral vascular disease
6. Trauma - repeat§ed minor/discrete episode
7. Reduced resistance to infection due to affected white cell function
8. Other diabetic complications e.g. retinopathy

Question 18

Describe THE NEUROPATHIC FOOT: (5)

Answer 18

Numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading

Question 19

Describe THE ISCHAEMIC FOOT: (3)

Answer 19

Cold, pulseless, ulcers at the foot margins

Question 20

Describe THE NEURO-ISCHAEMIC FOOT: (5)

Answer 20

Numb, cold, dry, pulseless, ulcers at points of high pressure loading and foot margins

Question 21

What 4 things do you look for when assessing the neuropathic foot

Answer 21

• Appearance- Deformity, callus
• Feel- Hot/cold, dry
• Foot pulses- dorsalis pedis, posterior tibial pulse
• Neuropathy- vibration sensation, temperature, ankle jerk, fine touch sensation

Question 22

PREVENTATIVE MANAGEMENT FOR NEUROPATHIC FOOT (8)

Answer 22

1. Control diabetes
2. Inspect feet daily
3. Have feet measured when buying shoes
4. Buy shoes with laces and square toe box
5. Inspect inside of shoes for foreign objects
6. Cut nails straight across
7. Care with heat
8. Never walk barefoot

Question 23

MANAGEMENT OF FOOT ULCERATION: (5)

Answer 23

-	Relief of pressure:
Bed rest (risk of DVT, heel ulceration)
Redistribution of pressure Total contact cast
-	Antibiotics, possibly long term Due to osteomyelitis risk
-	Debridement
-	Revascularisation:
Angioplasty
Arterial bypass surgery
-	Amputation