daibetic complication a curt and chronic

Micro and macro vascular complications of diabetes

1. Dr. Aditya Lajmi MBBS MD (Gen .Medicine )
ASSISTANT PROFESSOR
DEPARTMENT OF GENERAL MEDICINE
SNMC MEDICAL COLLEGE BAGALKOT.

38. Lactic acidosis (LA).
DM is one of the major causes of LA, a serious condition
characterized by excessive accumulation of lactic acid and
metabolic acidosis.
The hallmark of LA is the presence of tissue hypoxemia, which
leads to enhanced anaerobic glycolysis and to increased lactic
acid formation.
The normal blood lactic acid concentration is 1mmol/l, and the
pyruvic to lactic ratio is 10:1. An increase in lactic acid without
concomitant rise in pyruvate leads to LA of clinical importance.

39. Causes
Type A (associated with tissue
hypoxia)
reduction of 2,3-diphosphoglycerate,
decreased oxyhemoglobin dissociation,
HbAlc, a violation of the deformation
properties of red blood cells,
deterioration of microcirculation
hypoxia activation of
anaerobic glycolysis increased
lactate
Type B 1:
insulin deficiency decreased activity of
pyruvate dehydrogenase -increased
production of alanine –increase of
lactate
Type B 2 -biguanides
stimulate anaerobic glycolysis
depress gluconeogenesis in the liver
(decreased lactate utilization)

40. Comparison of DCA, HNC and LA.