Diabetes Mellitus

Dr. Ahmad mowafy

Diabetes Mellitus
Diabetes Mellitus lecture
Dr. Ahmad mowafy
!!
diabetes

!!
complications
neurological complications ,,
diabetic coma ,,
Keto-acidosis coma ,,

non-neurological complications
insulin deficiency could be either:

absolute (decreased insulin level)

= type I diabetes

or relative (the insulin level is

normal, but the function is
impaired, because of tissue
resistant) = type II diabetes

.1
pre-diabetes
,,
: pre-diabetes
diabetes

Diabetes Mellitus
( (
: impaired glucose tolerance
,, ,,
,,

.2 ( ):
latent diabetes
,

.3 chemical diabetes
clinical manifestations
.4
clinical diabetes

!!! triad
complications
triad diabetes

triad
polyuria

Diabetes Mellitus
polydipsia
polyphagia

only 40% of patients with diabetes will come to you complaining of
this triad
the other 60% will present to you with complications
this is why you have to know the complications very well
Complications of diabetes:

neuropathy vasculopathy


,,

Diabetes Mellitus
=

:

blood vessels


vasculopathy

Microangiopathy
or Macroangiopathy



sorbitol
neuropathy
very toxicblood vessels
retinopathy
vasculopathyaccumulation of sorbitiol

Diabetes Mellitus
complications diabetes
11

triad
.1 1 :
infection
the patient is liable to have recurrent infection
,,
infection
,,

carbuncles
,,

.2 MCQ

pruritus vulva
,,
.3 Xantholasma

.4

Diabetes Mellitus

delayed healing of wounds
.5 gangrene
( ,, specific)biabetes
Necrobiosis lipoidica diabeticorum

tibia
patches of brown pigment

vasculopathy

Diabetes Mellitus
Respiratiory complications of diabetes
recurrent chest infection is very common in diabetic patients, also TB
is common in them
Gastro-intestinal complications of diabetes
diabetic patient GIT
Cardiovascular complications of Diabetes

cardiovascular complications
heart
vessels
: vessels
Micro-angiopathy
Macroangiopathy
: 3 ,,
Retinopathy
Neuropahty
Nephropathy
: ,,
cerebral blood vessels --> stroke
renal artery stenosis --> hypertension, renal failure
coronary arteries --> ischemic heart disease
blood vessels of muscles --> intermittent claudications

Diabetes Mellitus
coronary
hypertension

:






kidney
hypertension
%01
of type II are obese
& obesity causes hypertension
ry diabetes2
cushing syndrome

salt - water retention
,,

Diabetes Mellitus
complication of diabetes in kidney

pylonephritis .1
increased liability to infection

nephropathy .2
nephropathy

nephron

afferent
glomerulus
efferent

Micro-angiopathy
efferent

Diabetes Mellitus

glomerulus
urine
frothy urine
urine
tubule
:

reabsorption


chronic renal failure
nephropathy
proteinurea
efferent

captopril
ACE inhibitor


!!!!O_o

Diabetes Mellitus
,, nephropathy


,, !!

eye complication of diabetes:

.1
chalazion

recurrent infection

.2
refraction error




,, ,,
,,
refraction error

Diabetes Mellitus
.3 retinopathy
eye complications
:
proliferative retinopathy
non-proliferation retinopathy

non-proliferative
ischemia edema
proliferative
retina new blood vessels formation
ischemia
blood vessels

sudden blindness
blindness

prophylaxis

Diabetes Mellitus
,, photocoagulation

sudden blindness

,,
,,
photocoagulation
,, ,,

Neurological complications of diabetes

diabetes
neurological complications

%01
3:
( ) Macro-angiopathy
strokeneurological manfestations

Diabetes Mellitus
2
diabetic neuropathy
Microangiopathy
3
( )
4:
1. hypoglycemic coma
2. ketoacidosis coma
)3. hyperosmolar hyperglycemic nonketotic coma (HHNC
4. Lactic acidosis coma

: Hypoglycemic coma

ketoacidosis coma
,,


hypoglycemic coma

hypoglycemic coma
!!

Diabetes Mellitus
, ,,
,,



absorption ,,
!!! hypoglycemic coma


" "

hypoglycemia
10
coma
:
5 warning signs
5 CNS symptomes

:

Diabetes Mellitus


= mnemonic

Tachycardia
Swetting
Tremors
Anxiety
Hunger




CNS
:
headach
loss of concentration
blurring of vesion
convulsions
coma

Diabetes Mellitus
sympathatic

sympathatic
sympathatic

1. , sympathteic
neuropathy sympathetic

2. ,, !
!
Beta blockers sympathetic effect
,, ,,

3. ,, sympathetic
!!

Addison disease
hypoglycemic coma

Diabetes Mellitus

,, ,,
,,saline glucose 25% or 50%

,, ,, ,,
,,
:! !!
hypoglycemia
varibilty
slow progressive
fast progressive
brain death
,, ,,
,,
,,
slow or fast

Diabetes Mellitus

,,

sympathatic stress ,,
hypoglycemia

hypoglycemic coma
,,
,,
DKA

3:
diabetes
acidosis
ketosis

,,
insulin defficiency
!!!!!!!!O_o
insulin defficiney

Diabetes Mellitus

SEVER insulin defficincey

ketoacidosis coma

ketoacidosis coma
!! !!!
!!!!!!


5:
1. ,, ,, ,, 251 , 311
,, 011 ,, 511 ,, 011

2. ,, ,,
,,
,,Hyperkalemia
manifestation hyperkalemia
nephrology

Diabetes Mellitus
3. ,, : fat ,, fat
,,
Keton body
: Ketosis3
acidosis
4. acidosis
5. ,, () ,,
,
,, diabetic ketoacidosis :
1. Hyperglycemia
2. Hyperkalemia
3. Ketosis
4. acidosis
5. coma
manifestations of ketosis
keton bodies ,,
keton bodies 5:
,, :
:
1. skletal muscles
2. cardiac muscles
)3. smooth muscles (GIT

Diabetes Mellitus

R
,,
4. respiratory
5. renal
!!5
muscles

1. skletal muscles
intermitent claudications
2. "smooth muscles "GI
contractility
nausia & vomitting
abdominal pain
3. cardiac muscles
contractility
low cardiac output
= Hypotention
arrythmeia
respiratory
acidosis
deep gasping breathing
renal:

Diabetes Mellitus
polyurea
hyperglycemia
dehydration
polydepsia !!
!!
DKA SEVER insulin deffiencey
type one or type 2
type one
type 2

DKA
SEVER insulin deficencey

insulin

infusion
5 11
units /hour

!!!!!!!!!!!!!O_o
5 ,, ,,
hypoglycemia

Diabetes Mellitus

251


5
4 - 2
!!251
:2
polyurea
dehydrated
saline
,, dilution
!!
251
saline dextrose
hypoglycemia
:3

Diabetes Mellitus
hyperkalemia




hyperkalemia
diastole
contraction ,, !!

,, !!!
nephrology
calcium gluconate
insulin glucose
hyperkalemia
!!!
3
presipitating factors

Diabetes Mellitus

infection
antiobiotics
:
acidosis
acidosis correction

Na bicarbonate

SEVER insulin deffiecincey
acidosis

Hyperglycemic Hyperosmilar nonketotic coma


insulin defficincey

!!!!!!!!!!!!!!!!!!!!!!!!! SEVER

Diabetes Mellitus
Ketosis
Hyperglycemia
: non-ketotic hyperglycemia

,,
DKA
,,

DKA
Hyperglycemia
Hyperkalemia
Ketosis
,, 011 ,,
,, !!
Hyperglycemic Hyperosmilar nonketotic coma
Hyperglycemia
manifestation
1111

!!!011

Diabetes Mellitus
Hyperglycemiahyperosmilarity





fluids


:
Hyperglycemia
Hyperosimlarity
,, DKA
!!

DKA
modifecation
fluids

Diabetes Mellitus

Hypovoliumeia
coagulation
thrombosis
sever renal failure
anti-coagulant
heparin

:
Lactic acidosis


lactic acid

Hypoxia
anarobic pathway
lactic acid coma

..

Diabetes Mellitus
drug
stimulation of anarobic pathway
tissue hypoxia
lactic acidosis

phenformin and metformin
type 2 diabetes
,
Na bicarbonate

Investigations of diabetes
investigations :

urine
RBCs
1.:
fasting blood glucose level

Diabetes Mellitus
: 111 - 01
121
diabetes
!!!!!!
121 111


pre-diabetes
: impaired glucose tolerance
( )
: postprandial glucose test

141
211
141 211
pre-diabetes
blood sugar count

Diabetes Mellitus


fasting


,,
5
fasting 4
:

maximum 101

101 urine
urine
101
:
,, 111 141

Diabetes Mellitus
141
( )
fasting post-prandial
blood glucose




casual blood glucose
:
randome blood sugar

211
( )211
:!!! criteria criteria
!!!!!!!
:
urine

Diabetes Mellitus
!!!
,,
urine
: urine
!!
!!
!!
!!
urine
::
,,
!!
,,

!!
:
,, 4 , 3

:
!!
: !! !!

Diabetes Mellitus
,, 3 !!

RBC
RBC !!
%0
Hyperglycemia
RBCs %12

3
hemoglobin A1C
,,
hemoglobin A1C !!
!!!
!!
: !

!! !!