Diabetes mellitus Acute and chronic complications - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Diabetes mellitus Acute and chronic complications

Description:

Diabetes mellitus Acute and chronic complications Definition of diabetes mellitus Classification of diabetic syndromes Type 1 diabetes mellitus (10 %) autoimmune and ... – PowerPoint PPT presentation

Number of Views:3794
Avg rating:3.0/5.0
Slides: 30
Provided by: Micro91
Learn more at: http://www.toprecommendedwebsites.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Diabetes mellitus Acute and chronic complications


1
Diabetes mellitus Acute 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 25 of all pregnancies, may improve or
    disappear after delivery
  • about 2050 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
Symptoms of diabetes mellitus
  • 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

7
(No Transcript)
8
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
9
Diagnostic criteria of DM
  • symptoms of DM
  • casual glucose concentration gt 11 mmol/l
  • fasting glycaemia gt 7 mmol/l
  • glycaemia 2h after 75 g of glucose gt 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

10
Acute complications of DM
11
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

12
Hypoglycemia
13
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

14
Diabetic ketoacidosis
  • Symptoms
  • nausea, vomiting, abdominal pain
  • polyuria, polydipsia, hyperglycemia,
    dehydratation
  • hyperventilation (Kussmaul respiration)
  • tachycardia, hypotension
  • acetone smell of breath
  • MAC ?pH, ?AG

15
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

16
Lactate acidosis
  • diabetic pseudohypoxia ? increased lactate
    concentration
  • Symptoms
  • dyspnea
  • abdominal pain
  • MAC (lactate acidosis)
  • unconsciousness

17
Chronic microvascular complications of DM
18
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

19
(No Transcript)
20
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

21
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 protein and lipid exsudates,
  • oedema of macula
  • Other complications
  • cataracta
  • glaucoma
  • disorders of refrakction and motility

22
Diabetic retinopathy
23
Diabetic nefropathy
  • angiopathy of capillaries in the kidney glomeruli
  • ischemia
  • Symptoms
  • microalbuminuria
  • (30 300 mg albumin/day)
  • kidney failure
  • oedema

24
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

25
Diabetic foot
  • ulcer,
  • infection,
  • gangrene...
  • amputation

26
Diabetic footRisk factors
27
prevention
28
Chronic macrovascular complications of DM
29
Atherosclerosis
  • ...one of the previous seminars...
About PowerShow.com