Age is an issue of mind over matter'

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Age is an issue of mind over matter.
If you don't mindit doesn't matter!- Mark
Twain
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Pathology of Diabetes

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Diabetes Mellitus

• Disorder of metabolism (Carb, Prot Fat)
• Due to Absolute or relative deficiency of
  insulin.
• Characterized by hyperglycemia.
• Clinically Polyuria, Polydypsia, Polyphagia.

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Classification

• Primary DM.
• Type I IDDM / Juvenile 10.
• Type II NIDDM /Adult onset 80.
• MODY 5 maturity onset - young - Genetic
• Secondary DM islet destruction.
• Infectious congenital rubella, CMV.
• Pancreatitis/tumors/Hemochromatosis.
• Endocrinopathy, gestational DM, downs.
• Drugs Corticosteroids.

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Normal Pancreatic Islets
ß cells Glucagon cells
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Pathogenesis of Type I DM
Environment ? Viral infe..??
Genetic HLA-DR3/DR4
Autoimmune Insulitis
ß cell Destruction
Severe Insulin deficiency
Type I DM
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Pathogenesis of Type II DM
Environment Obesity ???
ß cell defect Genetic
Insulin resistance
Abnormal Secretion
Relative Insulin Def.
ß cell exhaustion
IDDM
Type II DM
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Insulitis Type I
Insulinitis
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Islets in Type II Diabetes

• Loss of ß cells
• Amyloid deposits
• Hyalinization

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Complications

• Short term Complications (metabolic)
• Hypoglycemia
• Diabetic Ketoacidosis
• Non Ketotic hyperosmolar diabetic coma
• Lactic acidosis
• Long term Complications(microangiopathy)
• Angiopathy, Retinopathy, Nephropathy, Neurophathy

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Long term Complications

• Angiopathy
• Atherosclerosis
• Hyaline arteriolosclerosis
• Diabetic microangiopathy
• Nephropathy
• Nodular glomerulosclerosis
• Retinopathy
• Non Proliferative Proliferative
• Neuropathy
• Peripheral axonal neuropathy

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Pathogenesis of Microangiopathy

• Long standing diabetes
• Glycosylation of BV proteins.
• Protein deposits in the BM.
• Thick and Leaky blood vessels
• Exudation Ischemia
• End Organ damage...

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Diabetic Micro-angiopathy is the primary cause
of diabetic pathies (hyaline
arteriolosclerosis)
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Microangiopathy
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Pathogenesis of Complications
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Neuropathy
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AngiopathyAtherosclerosis
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Atheroma Coronary Artery
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Diabetic Gangrene
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Diabetic Gangrene Amp.
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Candidiasis
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Pathogenesis of Retinopathy
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Normal Retina
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Diabetic Retinopathy
Cotton wool spots
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Proliferative Retinitis

• Neovascularization
• Haemorrhagia
• Fibroplasia
• Retinal detachment
• Laser cauterization

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Cataract
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Pathogenesis of Nephropathy
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Diabetic Glomerulosclerosis
Hyaline nodules
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Diabetic Glomerulosclerosis
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Laboratory Diagnosis

• Urine glucose - dip-stick Screening
• Random or fasting blood glucose (lt11)
• Fasting gt 7mmol, Random gt11mmol
• If Fasting level is between 7-11 then OGTT
• HbA1c - for follow-up, not for diagnosis
• Fructosamine - for long term maintenance.

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Take home points

• Type-I Young, Acute Metabolic complications -
  Ketoacidosis.
• Type-II - Chronic Vascular complications
• Microangiopathy Kidney,Retina,Brain, BV.
• Hypoglycemia is more dangerous.

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Take home points

• Duration level of hyperglycemia are directly
  proportional to Chronic (Vascular) complications.
• Infections are due to microangiopathy and
  ischemia, immuno suppression and lastly
  hyperglycemia.