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Acute Complications Of Diabetes Slideshare

Diabetic Microvascular Complications

Diabetic Microvascular Complications

1. Diabetic MicrovascularDiabetic Microvascular ComplicationsComplications Mathew John MD, DM, DNB Consultant Endocrinologist 2. Microvascular complication MICROVASCULAR COMPLICATIONS Retinopathy Neuropathy Nephropathy Cardiomyopathy Cheiroarthropathy Dermopathy 3. Structure of talk • Screening • Diagnosis • Treatment Retinopathy Nephropathy Neuropathy 4. Therapeutic failures in diabetes • When a patient reaches end stage renal failure • When a patient becomes blind or severely visually impaired • When a patient has a leg or foot amputated • When a patient suffers from MI or stroke 5. Magnitude of the problem • Somewhere in the world a leg is lost to diabetes every thirty seconds • Leading cause of new onset blindness • 10% to 20% of people with diabetes die of renal failure • Diabetes is the leading cause of end stage renal disease requiring dialysis • Every 10 seconds a person dies from diabetes-related causes 6. UKPDS results of Intensive therapy Risk reduction vs. conventional therapy 7. Risk factors for microvascular complications • Degree of glycemic control • Duration of disease • Hypertension • Dyslipidemia • Smoking • Genetic factors 8. Pathophysiology of complications 9. Diabetic Retinopathy 10. Retinopathy • Sight threatening microvascular complication • Changes in retinal microvascular architecture • Leading cause of new onset blindness in the developed world • > 90 % of vision loss resulting from proliferative retinopathy can be prevented 11. How common is retinopathy ? • Type 1 diabetes : 25 % of type 1 diabetes after 5 years : 60-80 % after 10-15 years • Type 2 diabetes : PDR present in 25 % after 15 years 12. Symptoms of diabetic retinopathy NO SYMPTOMS Even stages up to proliferative retinopathy can be asy Continue reading >>

Acute Complications Of Diabetes Mellitus

Acute Complications Of Diabetes Mellitus

1. Acute Complications of Diabetes -Reshma Ann Mathew 2. DIABETES It is a GROUP of metabolic disease characterised by chronic hyperglycemia with DISTURBANCE in the carbohydrate, fat & protein metabolism resulting from DEFECTS in insulin secretion, insulin action or both . 3. Pancreas beta cells Insulin actions Glucose entry and utilization (oxidation, storage) Glucose entry and oxidation TG synthesis Normal glucose and fat metabolism 4. Pancreas beta cells Insulin actions Glucose entry and utilization (oxidation, storage) Glucose entry and oxidation TG synthesis Metabolic consequences of insulin deficiency/resistance 5. Clinical Features of DM due to insulin lack Polyphagia (decr. leptin?) Starvation in the midst of plenty Hyperosmolar hyperglycemic syndrome (HHS) Lactic acidosis Lactic acidosis Muscle protein breakdown Acetoacetate,0H-butyrate, acetone 6. • Insulin level increases when? a) Glucose administered by mouth (food intake) b) Glucose given by IV (glucose infusion) c) No difference 7.  CLASSIFICATION 1) Type 1 2) Type 2 3) Other specific types 4) Gestational diabetes 8. DIABETIC KETOACIDOSIS • It is a MEDICAL emergency • PRINCIPALLY seen in type 1 diabetes • Mortality- • CHILDREN & ADOLESCENTS- cerebral edema • ADULTS- hypokalemia, acute respiratory distress syndrome & co-morbid conditions 9.  PATHOPHYSIOLOGY Insulin Counterregulatory hormones Glucagon, Epinephrine, Cortisol, Growth hormone NORMAL 10. EXCESS counterregulatory hormones Insulin DEFICIENCY DKA 11. Insulin Deficiency Glucose uptake Proteolysis Lipolysis Amino Acids Glycerol Free Fatty Acids Gluconeogenesis Glycogenolysis Hyperglycemia Hepatic Ketogenesis Metabolic Acidosis Osmotic diuresis Dehydration & electrolyte loss Excess counterregulatory hormones Forces H+ ions into cells Continue reading >>

Ppt Pathology And Complications Of Diabetes Mellitus Powerpoint Presentation | Free To Download - Id: 40c94b-yjgyz

Ppt Pathology And Complications Of Diabetes Mellitus Powerpoint Presentation | Free To Download - Id: 40c94b-yjgyz

PPT Pathology and complications of Diabetes Mellitus PowerPoint presentation | free to download - id: 40c94b-YjgyZ The Adobe Flash plugin is needed to view this content Pathology and complications of Diabetes Mellitus Pathology and complications of Diabetes Mellitus * Stage I: This stage is usually not clinically evident Stage II: Renal lesions are found on biopsy Stage III ... PowerPoint PPT presentation Title: Pathology and complications of Diabetes Mellitus Pathology and complications of Diabetes Mellitus 1. Understand why good diabetic control reduces the incidence of long-term complications. 2. Differentiate between micro- and macrovascular 3. Understand the other complications that are 4. Identify some of mechanisms by which glucose can cause long-term complication of diabetes Metabolic disease affecting CHO, protein and fat Two types type I (insulin dependant) and Type May be the 1st presentation of type 1 DM. Result from absolute insulin deficiency or Hypoglycemia is the level of blood glucose at which autonomic and neurological dysfunction In mild cases oral rapidly absorbed carbohydrate In sever cases (comatose patient) iv hypertonic Diabetic patients have a 2 to 6 times higher risk for development of these complications than Accelerated atherosclerosis involving the aorta Myocardial infarction, caused by atherosclerosis of the coronary arteries, is the most common Hypertension due to Hyaline arteriolosclerosis. Activation of the sympathetic nervous system Activation of the Renin angiotensin system A low HDL is the most constant predictor of 1. Examine pulses for cardiovascular diseases. Microvascular complications are specific to Both Type1 DM and Type2 DM are susceptible to The duration of diabetes and the quality of diabetic control are important determina Continue reading >>

Complications Of Diabetes: Acute And Chronic.

Complications Of Diabetes: Acute And Chronic.

Abstract The acute and chronic complications of diabetes account for the morbidity and mortality associated with this disease. Acute complications include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia. Chronic hyperglycemia is central to the pathophysiology of chronic complications such as cardiovascular and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Pathophysiology and assessment of, and interventions for these complications are discussed. Continue reading >>

Microvasular And Macrovascular Complications In Diabetes Mellitus: Distinct Or Continuum?

Microvasular And Macrovascular Complications In Diabetes Mellitus: Distinct Or Continuum?

Source of Support: None, Conflict of Interest: None DOI: 10.4103/2230-8210.183480 Diabetes and related complications are associated with long-term damage and failure of various organ systems. The line of demarcation between the pathogenic mechanisms of microvascular and macrovascular complications of diabetes and differing responses to therapeutic interventions is blurred. Diabetes induces changes in the microvasculature, causing extracellular matrix protein synthesis, and capillary basement membrane thickening which are the pathognomic features of diabetic microangiopathy. These changes in conjunction with advanced glycation end products, oxidative stress, low grade inflammation, and neovascularization of vasa vasorum can lead to macrovascular complications. Hyperglycemia is the principal cause of microvasculopathy but also appears to play an important role in causation of macrovasculopathy. There is thought to be an intersection between micro and macro vascular complications, but the two disorders seem to be strongly interconnected, with micro vascular diseases promoting atherosclerosis through processes such as hypoxia and changes in vasa vasorum. It is thus imperative to understand whether microvascular complications distinctly precede macrovascular complications or do both of them progress simultaneously as a continuum. This will allow re-focusing on the clinical issues with a unifying perspective which can improve type 2 diabetes mellitus outcomes. Keywords: Complications, diabetes, macrovascular, microvascular How to cite this article: Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?. Indian J Endocr Metab 2016;20:546-51 Diabetes mellitus (DM) has routinely been described as a metabolic disorde Continue reading >>

Complications Of Diabetes 2016

Complications Of Diabetes 2016

Journal of Diabetes Research Volume 2016 (2016), Article ID 6989453, 3 pages 1Diabetes Clinic, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece 2Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland 3Diabetic Foot Clinic, King’s College Hospital, London, UK Copyright © 2016 Konstantinos Papatheodorou et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The prevalence of diabetes (DM) is constantly increasing worldwide at an alarming rate. According to the International Diabetes Federation in 2015, an estimated 415 million people globally were suffering from this condition [1]. Complications of DM account for increased morbidity, disability, and mortality and represent a threat for the economies of all countries, especially the developing ones [2]. The present special issue has been devoted to the recent progress in our understanding of diabetic complications, including the underlying molecular mechanisms, new diagnostic tools that facilitate early diagnosis, and novel treatment options. It consists of 20 articles covering 5 thematic areas: (a) epidemiology and pathogenesis of diabetic complications, (b) microvascular complications, (c) macrovascular complications, (d) miscellaneous complications, and (e) treatment options. (a) Epidemiology and Pathogenesis of Diabetic Complications. There is growing evidence that the underlying mechanisms in the pathogenesis of diabetic complications include certain genetic and epigenetic modifications, nutritional factors, and sedentary lifestyle [3]. In a pa Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) A state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone. Can occur in both Type I Diabetes and Type II Diabetes In type II diabetics with insulin deficiency/dependence The presenting symptom for ~ 25% of Type I Diabetics. Hyperosmolar Hyperglycemic State (HHS) An acute metabolic complication of diabetes mellitus characterized by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. Occurs predominately in Type II Diabetics A few reports of cases in type I diabetics. The presenting symptom for 30-40% of Type II diabetics. Diagnostic Criteria for DKA and HHS Mild DKA Moderate DKA Severe DKA HHS Plasma glucose (mg/dL) > 250 > 250 > 250 > 600 Arterial pH 7.25-7.30 7.00-7.24 < 7.00 > 7.30 Sodium Bicarbonate (mEq/L) 15 – 18 10 - <15 < 10 > 15 Urine Ketones Positive Positive Positive Small Serum Ketones Positive Positive Positive Small Serum Osmolality (mOsm/kg) Variable Variable Variable > 320 Anion Gap > 10 > 12 > 12 variable Mental Status Alert Alert/Drowsy Stupor/Coma Stupor/Coma Causes of DKA/HHS Stressful precipitating event that results in increased catecholamines, cortisol, glucagon. Infection (pneumonia, UTI) Alcohol, drugs Stroke Myocardial Infarction Pancreatitis Trauma Medications (steroids, thiazide diuretics) Non-compliance with insulin Diagnostic Studies in DKA/HHS Chemistry ï‚ Glucose  Bicarbonate Anion gap = (Na+) – (Cl- + HCO3-) Frequently seen: ï‚ BUN/creatinine (dehydration) ï‚ potassium  sodium Pseudohyponatremia: to correct, add 1.6 mEq of sodium to every 100mg/dL of glucose above normal Serum acetones Positive in Continue reading >>

Reference

Reference

This purpose of this talk is to overview the 2017 American Diabetes Association Standards of Medical Care in Diabetes. These Standards comprise all of the current and key clinical practice recommendations of the American Diabetes Association. [SLIDE] 2 Reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S1 A few notes on the Standards of Care: The Association funds development of the Standards of Care and all Association position statements out of its general revenues and does not use industry support for these purposes [CLICK] The slides are organized to correspond with sections within the 2017 Standards of Care. As we go through I’ll make note of where we are within the document. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Association’s Board of Directors, which includes health care professionals, scientists, and lay people. [SLIDE] 3 These Standards of Care are revised annually by the ADA’s multidisciplinary Professional Practice Committee (PPC) [CLICK] For the 2017 revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2016. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee Continue reading >>

Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus

Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. See the image below. Simplified scheme for the pathophysiology of type 2 diabetes mellitus. See Clinical Findings in Diabetes Mellitus , a Critical Images slideshow, to help identify various cutaneous, ophthalmologic, vascular, and neurologic manifestations of DM. Many patients with type 2 diabetes are asymptomatic. Clinical manifestations include the following: Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss Diagnostic criteria by the American Diabetes Association (ADA) include the following [ 1 ] : A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy. Indications for diabetes screening in asymptomatic adults includes the following [ 2 , 3 ] : Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP >140/90 mm Hg, and HDL < 35 mg/dL and/or triglyceride level >250 mg/dL) ADA recommends screening at age 45 years in the absence of the above criteria Microvascular (ie, eye and kidney disease) risk reduction through control of glycemia and blood pressure Macrovas Continue reading >>

Diabetes Complications

Diabetes Complications

Mechanisms Hyperglycemia Tissue damage *Repeated acute changes in cellular metabolism **Cumulative long term changes in stable macromolecules Genetic susceptibility Independent accelerating factors * Sorbitol accumulation ï‚ NADH/NAD ratio  Myoinositol early glycation ** Forming advanced glycation end products Independent accelerating factors: - HT - Hyperlipidemia - Smoking Macro-vascular Complications The major cardiovascular risk factors in the non-diabetic population (smoking, hypertension and hyperlipidemia) also operate in diabetes, but the risks are enhanced in the presence of diabetes. Overall life expectancy in diabetic patients is 7 to 10 years shorter than non-diabetic people. Macro-vascular Disease Once clinical macro-vascular disease develops in diabetic patients they have a poorer prognosis for survival than normoglycemic patients with macrovascular disease The protective effect females have for the development of vascular disease are lost in diabetic females CAD Morbidity and Mortality in Type 2 DM Framingham Data: 20 year follow-up:Age 45-74: 2-3 fold increase in clinically evident atherosclerotic disease in diabetics women diabetics=male diabetics in terms of CAD mortality Multiple Risk Factor Intervention Trial (MRFIT) 5000 men with type 2 DM Followed for 12 years Men with type 2 DM had absolute risk of CAD-related death 3 times higher than non-diabetic cohort To further focus on the epidemiology of coronary disease in type 2 diabetes, it is important to understand that diabetics have a significantly increased risk when compared to their non-diabetic cohorts. Framingham data with 20 year follow-up on patients aged 45 to 74 revealed that diabetics had a 2-3 fold increase in clinically evident atherosclerotic disease. Furthermore, women diabeti Continue reading >>

Diabetes And The Older Patient

Diabetes And The Older Patient

Objectives 1. Review treatment options in caring for older patients with diabetes 2. Understand risks of hyperglycemia and hypoglycemia in older patients 3. Appreciate importance of cardiovascular risk reduction in older patients with diabetes by treating hypertension and hyperlipidemia 4. Gain awareness of association: diabetes, HTN, and vascular risk factors with dementia 5. Discuss the Treatment-Risk Paradox and how this applies to medical management in older patients Outline Prevalence Acute complications Treatment options and goals Risks of longstanding diabetes Reducing cardiovascular events: treating hypertension and dyslipidemia Dementia: association with cardiovascular risk factors; ?can we prevent it? The Treatment-Risk Paradox: Paper review Case Study #1 78 y/o nursing home resident presents for evaluation of recurrent severe hypoglycemia. Diagnosed age 65 , treated with sulfonylurea without response, subsequently treated with insulin, currently 70/30 14 u in AM, 10 u QHS. Logs: 4-6 readings/day, ranging from 30’s (usually in afternoon or early AM) to mid 500’s, average 195. PE: 61â€, 98 lbs, 138/66, 82. Exam unremarkable A1c=8.6%; Creatinine=1.3, TC=150, HDL=70, LDL=70, TG=50 This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture. Case study #2 92 year old woman comes to you on glyburide at 10 mg a day. She, after much discusssion, is unable to check her own glucose. She is very afraid of having a hypoglycemic reaction as she lives alone. Her Hgb A1C is currently 9.8%. She is otherwise healthy, on no other medications, and is completely active and independent. Case # 2 What is the goal of treatment in this woman? What are the risks and the benefits Continue reading >>

Diabetes Mellitus (dm)

Diabetes Mellitus (dm)

Years of poorly controlled hyperglycemia lead to multiple, primarily vascular complications that affect small vessels (microvascular), large vessels (macrovascular), or both. (For additional detail, see Complications of Diabetes Mellitus.) Microvascular disease underlies 3 common and devastating manifestations of diabetes mellitus: Microvascular disease may also impair skin healing, so that even minor breaks in skin integrity can develop into deeper ulcers and easily become infected, particularly in the lower extremities. Intensive control of plasma glucose can prevent or delay many of these complications but may not reverse them once established. Macrovascular disease involves atherosclerosis of large vessels, which can lead to Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity. Patients with diabetes mellitus are particularly susceptible to bacterial and fungal infections. Continue reading >>

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

University of Gondar, Ethopia *Corresponding Author: Habtamu Wondifraw Baynes Lecturer Clinical Chemistry University of Gondar, Gondar Amhara 196, Ethiopia Tel: +251910818289 E-mail: [email protected] Citation: Baynes HW (2015) Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. J Diabetes Metab 6:541. doi:10.4172/2155-6156.1000541 Copyright: © 2015 Baynes HW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia either immune-mediated (Type 1 diabetes), insulin resistance (Type 2), gestational or others (environment, genetic defects, infections, and certain drugs). According to International Diabetes Federation Report of 2011 an estimated 366 million people had DM, by 2030 this number is estimated to almost around 552 million. There are different approaches to diagnose diabetes among individuals, The 1997 ADA recommendations for diagnosis of DM focus on fasting Plasma Glucose (FPG), while WHO focuses on Oral Glucose Tolerance Test (OGTT). This is importance for regular follow-up of diabetic patients with the health care provider is of great significance in averting any long term complications. Keywords Diabetes mellitus; Epidemiology; Diagnosis; Glycemic management Abbreviations DM: Diabetes Mellitus; FPG: Fasting Plasma Glucose; GAD: Glutamic Acid Decarboxylase; GDM: Gestational Diabetes Mellitus; HDL-cholesterol: High Density Lipoprotein cholesterol; HLA: Human Leucoid Antigen; IDD Continue reading >>

Musculoskeletal Complications In Diabetes Mellitus

Musculoskeletal Complications In Diabetes Mellitus

INTRODUCTION A variety of musculoskeletal conditions have been associated with diabetes mellitus (table 1). These problems are important to recognize because they often respond to treatment, preventing pain and disability and improving quality of life. Specific arthropathies of the hand and shoulder are discussed in this review. The relationships of diabetes with osteoarthritis and gout have become more clear, and the data that bear on the associations are also briefly mentioned. Osteoarthritis and neck and shoulder disorders have a significant impact on the quality of life in people with type 2 diabetes [1]. Estimates of the prevalence of musculoskeletal problems in patients with diabetes mellitus vary depending upon the definitions used for the problems and the study population with diabetes, which can range from diabetics on an insurance database to primary care cohorts and patients with severe diabetes in a specialized referral setting. There are several other musculoskeletal complications of diabetes mellitus which are discussed separately. These include limited joint mobility, neuropathic arthropathy (eg, Charcot joint), bone disease, and diabetic muscle infarction. (See "Limited joint mobility in diabetes mellitus" and "Diabetic neuropathic arthropathy" and "Bone disease in diabetes mellitus" and "Diabetic muscle infarction".) HAND ABNORMALITIES Hand abnormalities are common in diabetic patients, reflecting pathologic changes in the microvasculature, connective tissue, and peripheral nerves. One study, for example, evaluated 100 diabetic patients selected randomly in an outpatient clinic. Hand abnormalities were observed in 50 patients, and more than one abnormality was found in 26 [2]. Furthermore, 25 of the 50 patients with hand syndromes were disabled to such Continue reading >>

Diabetes Mellitus Acute And Chronic Complications.

Diabetes Mellitus Acute And Chronic Complications.

Diabetes mellitus Acute and chronic complications. Published by Griffin Mills Modified over 2 years ago Presentation on theme: "Diabetes mellitus Acute and chronic complications." Presentation transcript: 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.) And where is LADA and MODY ? impaired glucose tolerance and impaired fasting glucose are RISK FACTORS 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 Continue reading >>

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