Diabetes complications

Diabetes Complications

1. ANISH DHAKAL MBBS 3 rd Year [email protected]

2. objectives To discuss the acute and chronic complications of diabetes

3. Acute metabolic complications Diabetic ketoacidosis Hyperosmotic hyperosmolar syndrome (HHS) Hypoglycemic coma

4. Chronic complications: pathogenesis Persistent hyperglycemia (Glucotoxicity) Formation of Advanced Glycation End Products Activation of Protein Kinase C Oxidative Stress and Disturbances in Polyol Pathways Hexosamine Pathways and Generation of Fructose-6-Phosphate

5. Pancreatic lesions Reduction in the no. and size of islets Leukocytic infiltrates in the islets ( Insulitis ) In T2DM , may be a subtle reduction in the islet cell mass Amyloid deposition within islets in long-standing T2DM An increase in the number and size of islets ( Diabetic mother )

6. Macrovascular disease Hallmark: accelerated atherosclerosis affecting the aorta and large and medium-sized arteries Myocardial infarction

7. Gangrene of lower limbs

8. Hyaline Arteriosclerosis Vascular lesion associated with HTN Hyaline thickening of the wall of the arterioles –Narrowing of the lumen

9. Diabetic microangiopathy Diffuse thickening of BM (most evident in capillaries of skin, skeletal muscle, retina, renal glomeruli, and renal medulla) Despite increased thickness, diabetic capillaries are more leaky than normal to plasma proteins

10. Diabetic Nephropathy Glomerular lesions Renal vascular lesions (arteriosclerosis) Pyelonephritis

11. Capillary BM thickening Diffuse mesangial sclerosis Nodular glomerulosclerosis

12. Diffuse mesangial sclerosis Diffuse increase in mesangial matrix Typically associated with the overall thickening of GBM Extension of mesangial area can extend to nodular configuration Progressive expansion of the mesangium (deteriorating renal function)

13. Nodular glomerulosclerosis Glomerular lesions: ( Kimmelstiel -Wilson lesion ) distinctive by ball-like deposits of a laminated matrix situated in the periphery of the glomerulus ( nodules: PAS positive & contain trapped mesangial cells)

14. Pyelonephritis An acute or chronic inflammation of the kidneys that usually begins in the interstitial tissue and then spreads to involve the tubules. Special pattern Necrotizing papillitis (or Papillary necrosis) much more prevalent in diabetics than nondiabetics.

15. Ocular complications Retinopathy Nonproliferative : hemorrhage, exudate, microaneurysm , edema Proliferative : Neovascularization, fibrosis, retinal detachment Cataract formation Glaucoma

16. Diabetic neuropathy Peripheral symmetric neuropathy (motor and sensory function impairment) Autonomous neuropathy Diabetic mononeuropathy