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Diabetes mellitus Acute and chronic complications

Diabetes mellitus Acute and chronic complications. Definition of diabetes mellitus. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated

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Diabetes mellitus Acute and chronic complications

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  1. Diabetes mellitusAcute and chronic complications

  2. Definition of diabetes mellitus Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

  3. Classification of diabetic syndromes • Type 1 diabetes mellitus (10 %) autoimmune and idiopathic • IDDM, juvenile diabetes • Type 2 diabetes mellitus (90 %) • NIDDM, adult type • Other types of diabetes mellitus (rare, long list) • Gestational diabetes mellitus (temporary dg.) impaired glucose tolerance and impaired fasting glucose are RISK FACTORS And where is LADA and MODY ?

  4. LADA latent autoimmune diabetes of adulthood • late-onset autoimmune diabetes of adulthood • slow onset type 1 diabetes, or • type 1.5 (type one-and-a-half) diabetes • slow-onset Type 1 autoimmune diabetes in adults • age more than 35 years • MODY maturity onset diabetes of the young • several hereditary forms of DM caused by autosomal dominant mutations of genes (MODY 1 – 9) • early manifestation • positive familiar history • various types, most commonly acts like a very mild version of • type 1 DM

  5. Other types of DM • genetic mutations • diseases of exocrine pancreas (chronic pancreatitis) • excessive secretion of insulin-antagonistic hormones • induction of DM by drugs or chemicals (alloxan, streptozotocine) • ... • Gestational DM • DM during pregnancy - resembles type 2 diabetes • about 2%–5% of all pregnancies, may improve or disappear after delivery • about 20%–50% of affected women develop type 2 diabetes later in life • untreated gestational diabetes - damage the health of the fetus - macrosomia, congenital cardiac and central nervous system anomalies, skeletal muscle malformations, respiratory infant syndrome...

  6. Basic Thirst Polyuria Weight loss Fatigue Other Muscle cramps Obstipation Blurred vision Fungal and bacterial infections If you do not begin insulin therapy immediately nausea, vomitus abdominal pain dehydration Kussmaul breathing acetone smell of breath ketones in blood, urine, acidosis COMA DIABETICUM Symptoms of diabetes mellitus

  7. Symptoms of DM NOTHING Type 2 for long time (months, years) Hypertension Myocardial infarction, stroke with very bad prognosis Microangiopathic complications (amputation) Gestational diabetes mellitus Screening! Harmful both for baby and mother

  8. Diagnostic criteria of DM • symptoms of DM • casual glucose concentration > 11 mmol/l • fasting glycaemia > 7 mmol/l • glycaemia 2h after 75 gof glucose > 11 mmol/l • symptoms of DM and 1 abnormal blood glucose • two abnormal BG values on 2 days • fasting glycemia 5,6 – 6,99 = impaired fasting glycaemia, pre-diabetes • glycaemia in oGTT after 2 hod 7,8 – 11,0 = impaired glucose tolerance

  9. Acute complications of DM

  10. Diabetic hypoglycaemia • glycaemia lower than 3,5 mmol/l Cause • higher dose of insulin or PAD (sulfonylurea) • inadequate food intake Symptoms • vegetative – sweating, palpitations, anxiety, shakiness, pallor • neuroglycopenic – confusion, weakness, atypical behaviour, impaired concentration, sleepeness, double vision, incoordination, dificulty speaking • other – hunger, nauzea and vomiting, headache

  11. Hypoglycemia

  12. Diabetic ketoacidosis • acute complication predominantly of type 1 DM • inadequate or no therapy with insulin Mechanism • the absence of insulin  release of free fatty acids from adipose tissue  converted in the liver into ketone bodies (acetoacetate, acetone, b-hydroxybutyrate)  metabolic acidosis  diabetic coma

  13. Diabetic ketoacidosis Symptoms • nausea, vomiting, abdominal pain • polyuria, polydipsia, hyperglycemia, dehydratation • hyperventilation (Kussmaul respiration) • tachycardia, hypotension • acetone smell of breath • MAC – pH, AG

  14. Nonketotic hyperosmolar state • nonketotic hyperglycemic hypeosmolar coma • DM type 2 Mechanism • hyperglycemia  hyperosmolarity  polyuria  dehydratation • the presence of some insulin inhibits lipolysis – no ketoacidosis Symptoms • hyperglycemia, hyperosmolarity • dehydratation – hypotension • renal insuficiency, mental and neurologic signs, trombosis • coma, death

  15. Lactate acidosis • diabetic pseudohypoxia  increased lactate concentration Symptoms • dyspnea • abdominal pain • MAC (lactate acidosis) • unconsciousness

  16. Chronic microvascular complications of DM

  17. The main mechanisms Microangiopathy • an angiopathy of small blood vessels • hyperglycemia  damage of endothelial cells, basement membrane grow thicker and weaker Polyol pathway • sorbitol-aldose reductase pathway • decrease of reduced NADPH and oxidized NAD+  diabetic pseudohypoxia

  18. The main mechanisms Glycation • hyperglycemia  higher non-enzymatic glucation of proteins • Advanced Glycation End products (AGEs) are the result of a chain of chemical reactions after an initial glycation reaction Effect • aging and some age-related chronic diseases • in DM - increasing vascular permeability, inhibition of vascular dilation by interfering with NO, oxidising LDL... • they bind to receptors for AGE (RAGE on endothelial cells, smooth muscle cells, cells of immune system) - contribute to age- and diabetes-related chronic complications

  19. Diabetic retinopathy • damage of the vessels of the retina • the most frequent cause of blindness in developed countries Mechanism • endothelium damage, thickening of basal membrane • changes of osmotic pressure, haemorrhage, microaneurysms, • deposition of proteinand lipid exsudates, • oedema of macula Other complications • cataracta • glaucoma • disorders of refrakction and motility

  20. Diabetic retinopathy

  21. Diabetic nefropathy • angiopathy of capillaries in the kidney glomeruli • ischemia Symptoms • microalbuminuria (30 – 300 mg albumin/day) • kidney failure • oedema

  22. Diabetic neuropathy • angiopathy of vasa nervorum (small blood vessels that supply nerves) sensorimotor neuropathy • sensitivity disorders – pain, heat, cold, pressure vegetative neuropathy • changes in sweating • urogenital dysfunction • gastroparesis, nausea, diarhea, constipation • tachycardia, hypotonia diabetic foot

  23. Diabetic foot • ulcer, • infection, • gangrene... • amputation

  24. Diabetic footRisk factors

  25. prevention

  26. Chronic macrovascular complications of DM

  27. Atherosclerosis • ...one of the previous seminars...

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