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Title: Diabetes and Its Complications
Description: Suitable for medical school students, covers microvascular and macrovascular complications of diabetes
Description: Suitable for medical school students, covers microvascular and macrovascular complications of diabetes
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DIABETES AND ITS COMPLICATIONS
Type 1 Diabetes Mellitus
More common in children
Aetiology:
-‐ Genetic predisposition
-‐ Autoimmune processes – individuals develop antibodies to pancreatic beta cells
or insulin
-‐ Idiopathic process
Type 2 Diabetes Mellitus
T2DM is prevalent within 10% of the population
Aetiology:
-‐ Genetic
-‐ Environmental factors
-‐ Thrifty Genotype Theory
Glycaemic Control
Glycaemic control can be measured by: fasting plasma glucose levels/ post-‐prandial
plasma glucose levels and HbA1c levels; they are all important!
Keeping HbA1c at 7
...
Microvascular vs Macrovascular complications
Microvascular Complications include diabetic nephropathy, diabetic neuropathy and
diabetic retinopathy
...
Diabetes
nephropathy is decreased kidney function with time which occurs as a result of
uncontrolled diabetes or is aggravated by other factors such as uncontrolled
hypertension
Pathogenesis of Diabetes Nephropathy:
-‐ Increased production of matrix in mesangial vessels (around kidneys)
-‐ Nodular lesions in the glomerulus (this can be seen in biopsies from diabetics)
-‐ Formation of microaneurysms: this damages capillary structure in the
glomerulus, resulting in advanced glomerular damage
-‐ Abnormal new vessel formation: these vessels are friable, inefficient at filtering
and exhibit augmented exocytosis
-‐ Diabetes results in a certain degree of oxidative stress, which in turn affects the
polyol pathway, RAA system and glycolysis end products
...
Risk factors:
-‐ Smoking (detrimental to kidneys as well as lungs)
-‐ Anything that increases GFR
-‐ Oral contraception: high doses of oestrogen or progesterone result in insulin
resistance
There are five stages of diabetes nephropathy:
Stage 1
Stage of hyperfunction (very high GFR)
Stage 2
Silent phase: GFR normal
Stage 3
GFR begins to fall
Stage 4
GFR < normal
Stage 5
GFR = 0-‐10; urgent need for dialysis
Diabetic Neuropathy
Diabetic Neuropathy can be peripheral or autonomic
Gastrointestinal effects of DN (all alter quality of life)
-‐ Problems swallowing solids
-‐ Oesophageal dysmotility
-‐ Gastroparesis diabeticorum
-‐ Constipation/ Diarrhea
-‐ Fecal incontinence: innervation of sphincter is affected
Cardiovascular effects of DN
-‐ Heart rate changes
-‐ Orthostatic hypotension
-‐ Silent ischaemia
-‐ Loss of circadian patterns e
...
tosterone patterns
-‐ Exercise intolerance: feels sick when exercises and passes out
GU system
-‐ Urinary incontinence
-‐ Neurogenic bladder
-‐ Erectile dysfunction
Diabetic Retinopathy
Diabetes retinopathy is the most common cause of blindness worldwide
...
Sympathetic overstimulation results in decreased sodium delivery and perfusion of the
kidney; renin increases and the RAA system becomes permanently activated
(consequently causing hypertension)
...
Systemic vasoconstriction as a result of angiotensin II
Cardiac hypertrophy
Aldosterone production à salt and water retention, and stimulates the pituitary to
produce ADH; patient feels bloated due to overloading
Necrobiosis Lipoidica
Atrophic yellow plaques (infiltrations of the skin) associated with
telangiectasia
Hyaline degeneration of collagen; this degeneration is accelerated in DM
patients
Present in 1% of DM patients
Manage with camouflage creams
...
Associated with advanced retinal and renal lesions (thus need to screen
for this if have arthropathy)
Present in up to 35% DM patients
Diabetic Dermopathy
AKA Shin spots
Brown pigmentation: initially red papules which scale over and leave
atrophic brown scars; doesn’t appear as varicose veins as occurs at the
level of capillaries
May affect up to 50% DM patients
Title: Diabetes and Its Complications
Description: Suitable for medical school students, covers microvascular and macrovascular complications of diabetes
Description: Suitable for medical school students, covers microvascular and macrovascular complications of diabetes