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Metabolic Complications Of Diabetes Mellitus

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 >>

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 >>

Medical Management Of Metabolic Complications Of Liver Transplant Recipients

Medical Management Of Metabolic Complications Of Liver Transplant Recipients

Abstract: Improved short- and long-term survival of liver transplant recipients has led to increased focus on complications of both the early and late posttransplant periods. A variety of metabolic complications have been observed in the postorthotopic liver transplant population, including hypertension, hyperlipidemia, obesity, diabetes mellitus, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis. Although only a small proportion of patients experience metabolic complications prior to transplantation, the prevalence of these complications posttransplantation reaches or exceeds that of the general population. This is of particular concern, as cardiovascular disease is the second leading cause of death in the late transplant period. A number of mechanisms mediate these metabolic complications, including reversal of cirrhosis pathophysiology, patient lifestyle factors, and immunosuppressive medications. Titration and modification of immunosuppression have been demonstrated to improve and sometimes even eliminate these conditions. Therefore, given the multiple etiologies contributing to the metabolic derangements, an effective management approach must incorporate lifestyle modifications, immunosuppression titration, and medical management. Best practices and understanding of the mechanisms underlying these complications allow for discussion of initial therapies and strategies; however, further study is necessary to determine the optimal management of metabolic complications over time. Liver transplantation is the most effective treatment for end-stage liver disease, resulting in increased survival and quality of life for the recipient. Developments and advancements in surgical techniques, as well as the implementation of tolerable and effective immunosuppr Continue reading >>

Type 2 Diabetes And Vascular Complications: A Pathophysiologic View

Type 2 Diabetes And Vascular Complications: A Pathophysiologic View

1Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. 2Faculty of Dentistry, Ibb University, P.O.Box 70627, Ibb, Yemen. 3Department of Medicine, University of Malaya Medical Center, University of Malaya, 50603 Kuala Lumpur, Malaysia. *Corresponding Author: Department of Molecular Medicine Faculty of Medicine, University of Malaya 50603 Kuala Lumpur Malaysia Tel: +603 7697 4717 Fax: +603 7967 4957 E-mail: [email protected] Abstract Diabetes mellitus (DM) represents a range of metabolic disorders characterized by hypergly-cemia resulting from insulin deficiency or insulin resistance or both. Hyperglycemia, the pri-mary clinical manifestation of diabetes, is strongly associated with development of the diabetic complications. Complications caused by hyperglycaemia involve damage to the small vessels such as in neuropathy, nephropathy, and retinopathy, and large blood vessels as in cardiovas-cular diseases. It is well known established that in diabetes, long-term complications ensue from abnormal regulation of glucose metabolism. In fact, all manifestations of cardiovascular disease, coronary heart disease, stroke and peripheral vascular disease are substantially more common in patients with type 2 diabetes than in non-diabetic individuals. For example, pa-tients with type 2 diabetes (T2DM) have a two- to fourfold increased risk of fatal and non-fatal coronary events. Diabetes can lead to microvascular and macrovascular damage through a number of mechanisms, each of which may worsen or accelerate the others. The present re-view summarizes the information on the mechanisms of how vascular complications will de-velop in type 2 diabetes and this might be useful as a direction for further research to provide new strategies for Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

By Erika F. Brutsaert, MD, Assistant Professor, Albert Einstein College of Medicine; Attending Physician, Montefiore Medical Center People with diabetes mellitus have many serious long-term complications that affect many areas of the body. In both types, the amount of sugar (glucose) in the blood is elevated. People with either type 1 or type 2 diabetes are likely to have complications as a result of the elevated glucose level. However, because type 2 diabetes may be present for some time before it is diagnosed, complications in type 2 diabetes may be more serious or more advanced when they are discovered. People with diabetes mellitus may experience many serious, long-term complications. Some of these complications begin within months of the onset of diabetes, although most tend to develop after a few years. Most of the complications gradually worsen. In people with diabetes, strictly controlling the level of glucose in the blood makes these complications less likely to develop or worsen. Most complications of diabetes are the result of problems with blood vessels. Glucose levels that remain high over a long time cause both the small and large blood vessels to narrow. The narrowing reduces blood flow to many parts of the body, leading to problems. There are several causes of blood vessel narrowing. Complex sugar-based substances build up in the walls of small blood vessels, causing them to thicken and leak. Poor control of blood glucose levels also tends to cause the levels of fatty substances in the blood to rise, resulting in atherosclerosis and decreased blood flow in the larger blood vessels. Atherosclerosis leads to heart attacks and strokes . Atherosclerosis is between 2 and 4 times more common and tends to occur at a younger age in people with diabetes than in Continue reading >>

Complications Of Diabetes 2017

Complications Of Diabetes 2017

1Outpatient Clinic of Diabetes, University Hospital of Alexandroupolis, Alexandroupolis, Greece 2Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, d, Poland 3Diabetes Center and Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece 4Unit of Diabetes and Cardiovascular Prevention, School of Medicine, University of Palermo, Palermo, Italy 5Diabetic Foot Clinic, Kings College Hospital, London, UK Correspondence should be addressed to Konstantinos Papatheodorou ; [email protected] Received 18 January 2018; Accepted 21 January 2018; Published 11 March 2018 Copyright 2018 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. Diabetes is widely recognized as an emerging epidemic that has a cumulative impact on almost every country, age group, and economy across the world. According to the International Diabetes Federation, in 2015, approximately 415 million people were suffering from diabetes worldwide, and this number is expected to exceed 640 million by the year 2040. It is estimated that half of patients with diabetes are unaware of their disease and are thus more prone to developing diabetic complications. However, the cost of dealing with diabetes can be unaffordable in terms of money spent and lives lost. In 2015, approximately 5.0 million deaths were attributed to diabetes, albeit in the same year, more than 12% of the global health expenditure was dedicated to coping with the disease and its complications [ 1 ]. Diabetes complications are common among patients with type 1 or type 2 diabetes but, at t Continue reading >>

Metabolic Complications Of Diabetes Mellitus

Metabolic Complications Of Diabetes Mellitus

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Metabolic complications of Diabetes Mellitus Presentation on theme: "Metabolic complications of Diabetes Mellitus" Presentation transcript: 1 Metabolic complications of Diabetes Mellitus 2 Introduction - Metabolic complications, particularly diabetic ketoacidosis and hypoglycaemia, are life-threatening and can cause permanent neurological damages. -Diabetic patients present with impaired consciousness may be caused by other conditions -Diabetic ketoacidosis (DKA) was responsible for 70% of diabetic deaths before the advent of insulin therapy and mortality rates are still up to 7%. -It is mainly a recognized complication of IDDM, DKA can also occur in NIDDM. -The clinical features of DKA result from: insulin deficiency increases in counter-regulatory hormones, produce major changes in: fuel, water and electrolyte metabolism glycogenolysis and gluconeogenesis occur. -Tissue uptake of glucose is reduced, contributing to the hyperglycaemia. -As glucose does not enter cells, the extracellular osmotic pressure tends to rise, causing water to transfer from the intracellular to extracellular compartment. - The renal threshold for glucose is exceeded and glycosuria occurs. - The presence of excess non-absorbed solute in the glomerular filtrate causes an osmotic diuresis which interferes with tubular reabsorptive function, leading to: water sodium and potassium depletion - Lipolysis results from insulin deficiency - NEFAs are released and transported to liver(reduced insulin and increased glucagon) leading to: greater amount of fatty acids being metabolized by beta-oxidation Acetyl CoA is exceeded and increased amount of ketone bodies Acetoacetate and -hydroxybutyrate a Continue reading >>

Glutathione Metabolism In Type 2 Diabetes And Its Relationship With Microvascular Complications And Glycemia

Glutathione Metabolism In Type 2 Diabetes And Its Relationship With Microvascular Complications And Glycemia

Glutathione metabolism in type 2 diabetes and its relationship with microvascular complications and glycemia Roles Data curation, Investigation, Methodology, Project administration, Writing original draft, Writing review & editing Affiliation Department of Basic Medical Sciences, The University of the West Indies, Mona, Jamaica Roles Formal analysis, Investigation, Writing review & editing Affiliation Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America Roles Conceptualization, Funding acquisition, Writing review & editing Affiliation Department of Pathology, University Hospital of the West Indies; Mona, Jamaica Roles Investigation, Methodology, Writing review & editing Affiliation Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica Roles Investigation, Methodology, Supervision, Writing review & editing Affiliation Department of Basic Medical Sciences, The University of the West Indies, Mona, Jamaica Roles Formal analysis, Writing review & editing Affiliation Health Research Unit, Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica Roles Project administration, Writing review & editing Affiliation Department of Medicine, The University of the West Indies, Mona, Jamaica Continue reading >>

Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (sn-dreams, Report 14)

Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (sn-dreams, Report 14)

Abstract The Metabolic syndrome (MS) consists of central obesity, glucose intolerance, hyperinsulinemia, low high density lipoproteins, high triglycerides and hypertension. Different studies have observed that MS causes microvascular complications in patients with type 2 diabetes. The aim of the study was to find out the prevalence of MS in the Indian population with type 2 diabetes mellitus in relation to gender, duration of diabetes, and to evaluate the influence of MS and its individual components on microvascular complications such as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. A population-based cross sectional survey was conducted with 1414 patients having type 2 diabetes mellitus. The International Diabetes Federation (IDF) criteria were used to identify the metabolic syndrome. Diabetic retinopathy was graded using the stereoscopic digital fundus photography. Neuropathy was assessed by measuring the vibration perception threshold through a sensitometer. Nephropathy was diagnosed by the presence of microalbuminuria in the first morning urine sample. The age and gender adjusted prevalence of MS, using the IDF criteria, in the South Indian population was 73.3%. The prevalence was higher in women (83.3%), compared to men (65.3%). In subjects with diabetes mellitus, without and with MS, the prevalence of retinopathy was 21.3% and 16.9% (p = 0.057); prevalence of nephropathy was 20.5% and 18.0% (p = 0.296), and prevalence of neuropathy was17.2% and 19.4% (p = 0.353) respectively. Overall and in women, the clustering of MS components led to an increase in the prevalence of diabetic nephropathy. The prevalence of retinopathy and neuropathy in MS subjects, who had diabetes for < 10 years, was more in both men and women; it was more in women but not Continue reading >>

A Review On Diabetes Mellitus: Complications, Management And Treatment Modalities

A Review On Diabetes Mellitus: Complications, Management And Treatment Modalities

Diabetes is a disease chronic disease which affects global population from long time. This review is an update on unknown complications, causes, treatment modalities of this disease. This article also provides a summary on disease management through various strategies. Diabetes, Diabetic retinopathy, Diabetic Complications Diabetes is a lifelong (chronic) disease and is a group of metabolic disorders characterized by high levels of sugar in blood (hyperglycemia) [ 1 ]. More than 230 million people worldwide are affected, and it is expected to reach 350 million by 2025. Globally the affected people are unaware of the disease and only half receive adequate treatment [ 2 ]. It is caused due to deficiency of insulin or resistance to insulin or both. Insulin is secreted by -cells of pancreas to control blood sugar levels [ 1 ]. Blurry visions, excess thirst, fatigue, frequent urination, hunger, weight loss are some of the symptoms commonly seen in diabetic patients [ 3 ]. Diabetes results in the impairment of the bodys ability to use food because either the pancreas does not make insulin or the body cannot use insulin properly. Hypoglycemia (low blood glucose) is most commonly seen in diabetic patients, when the body gets too much insulin, too little food, a delayed meal, or more than the usual amount of exercise. When the body gets too little insulin, too much food, or too little exercise, it results in hyperglycemia (high blood glucose) [ 4 , 5 ]. Stress may contribute to hyperglycemia. Hyperglycemic state (diabetes mellitus) arises when the blood glucose (sugar) levels are higher than 180 mg/dl (10 mmol/l) [ 6 ]. Diabetes is of mainly three types. They are type-1 diabetes (T1D), type-2 diabetes (T2D) and gestational diabetes mellitus. T1D, also called as the insulin-depe Continue reading >>

Late Stage Complications Of Diabetes And Insulin Resistance

Late Stage Complications Of Diabetes And Insulin Resistance

1Department of Microbiology, Chaitanya Postgraduate College, Kakatiya University, Warangal, India 2Department of Biotechnology, Presidency College, Bangalore University, India *Corresponding Author: Department Of Microbiology, Chaitanya Postgraduate College affiliated to Kakatiya University, Warangal, India E-mail: [email protected] Citation: Soumya D, Srilatha B (2011) Late Stage Complications of Diabetes and Insulin Resistance. J Diabetes Metab 2:167. doi:10.4172/2155-6156.1000167 Copyright: © 2011 Soumya D, et al. 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 is considered one of the main threats to human health in the 21st century. Diabetes is a metabolic disorder or a chronic condition where the sugar levels in blood are high. Diabetes is associated with long-term complications that affect almost every part of the body and often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Also it is associated with significantly accelerated rates of several debilitating microvascular complications such as nephropathy, retinopathy, and neuropathy, and macrovascular complications such as atherosclerosis and stroke. In the present article it has been discussed about the resistance of insulin and its consequences in diabetic patients. Insulin resistance results in various disorders. Metabolic syndrome is predicted to become a major public health problem in many developed, as well as developing countries. Keywords Diabetes; Complications Continue reading >>

Metabolic Syndrome And Type-1 Diabetes Mellitus: Prevalence And Associated Factors

Metabolic Syndrome And Type-1 Diabetes Mellitus: Prevalence And Associated Factors

Keywords Diabetes mellitus. Microvascular complications. Metabolic syndrome. Insulin resistance. Article INTRODUCTION Traditionally, persons with type-1 diabetes mellitus (DM1) usually have a normal or low weight and a tendency for the late development of arterial hypertension and dyslipidemia. Until a few years ago, the main causes of death in persons with DM1 were those derived from microvascular complications, particularly kidney disease.1 Although therapeutic advances for the treatment of DM1 and its main associated cardiovascular risk factors have led to significant reductions in the rates of death and microvascular complications,2-5 no similar trend has been seen with cardiovascular disease.6 Though DM1 involves the immune destruction of the pancreatic beta cells and usually presents at an early age, affected persons are not exempt from developing insulin resistance at some earlier stage in the course of the disease,7-9 which is known as "double diabetes." This phenomenon usually appears in patients with a family history of type 2 diabetes mellitus (DM2) and is associated with a greater body mass index, greater insulin requirements and worse metabolic control.10 As well as the insulin resistance, other factors can explain why cardiovascular disease is the leading cause of death in these patients, such as the chronic complications of DM1, like kidney disease,11 and the earlier age of onset of the disease, with the resulting longer period of exposure to the main cardiovascular risk factors, together with a poor control of these risk factors.12,13 As a consequence, the phenotypic characteristics and cardiovascular risk profile of patients with DM1 have become more similar to those of DM2 over recent years. Since the first description of the metabolic syndrome, by Rea Continue reading >>

Complications Of Diabetes | Introduction

Complications Of Diabetes | Introduction

The long term complications of diabetes involve many different systems in the body. These may be found at time of diagnosis of diabetes, or many years after the onset of diabetes. Many of the long term complications of diabetes are thought to be due to persistently elevated levels of blood glucose and it has been shown, that controlling blood glucose levels and blood pressure may minimize or prevent the onset of these complications. It is difficult to predict who is likely to develop chronic complications of diabetes which may sometimes occur regardless of the level of control. Acute Metabolic complications - Diabetic Ketoacidosis and Hypoglycaemia 'Macro-vascular' (involving large blood vessels) complications - Coronary Heart Disease , Strokes, Peripheral Vascular Disease 'Micro-vascular' (involving small blood vessels) complications - Diabetic Retinopathy , Neuropathy , Diabetic Nephropathy What is known about the risk of complications in Type 1 diabetes? It is unusual for people with type 1 diabetes to have complications such as retinopathy and nephropathy within the first five years of their diabetes. Studies have shown that the risk of kidney damage and eye disease are more common in people with poor control. This risk rises steeply above HbA1c values of 9% and is highest if the HbA1c value is above 12%. The Diabetes Control and Complications Trial (DCCT) showed that 12% of people Type 1 diabetes who were intensively treated (tight control) developed new retinopathy changes after nine years, compared to 54% of people who were treated with conventional (less tight control) methods. Progressive retinopathy was uncommon at HbA1c levels below 7%. People with very mild retinopathy were also less likely to progress to severe retinopathy if they were well controlled. Sim Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

Autophagy and Diabetes Complications Complications of diabetes represent the major causes of morbidity and mortality that are associated with this chronic metabolic disorder84. Specifically, cardiovascular disease is the leading cause of mortality in subjects with diabetes, which represents the major cause of end stage renal disease, blindness and limb amputations in developed and many developing societies. Broadly speaking, diabetes complications can be categorized as macrovascular, which are those affecting large and medium size blood vessels and microvascular complications, which involve small blood vessels such as small arterioles. Macrovascular complications include accelerated atherosclerosis, leading to increased coronary artery disease, increased cerebrovascular disease and stroke, and increased peripheral arterial disease that contributes to critical limb ischemia. There is also strong evidence that diabetes leads to direct adverse effects in the heart that leads to diabetic cardiomyopathy85. Microvascular impairment leads to the complications of diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. The pathogenesis of these diverse complications of diabetes is complex, is only partially understood and has been the subject of many reviews. Only recently has attention turned to the potential contribution of changes in autophagy due to the complications of diabetes. As reviewed in other chapters, autophagy may serve a protective role in cells where it promotes cellular survival by removing damaged organelles such as mitochondria. Therefore in these contexts, a decrease in autophagy could contribute to cellular dysfunction that occurs on the basis of accumulation of dysfunctional organelles or irreversibly damaged cellular substructures. Conversely, Continue reading >>

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