Diabetes Complications

1. ANISH DHAKAL
MBBS 3rd Year
anishdhakal718@gmail.com

2. OBJECTIVES
• To discuss the acute and chronic complications of diabetes

3. ACUTE METABOLIC
COMPLICATIONS
• Diabetic ketoacidosis
• Hyperosmotic hyperosmolar syndrome (HHS)
• Hypoglycemic coma

5. CHRONIC COMPLICATIONS:
PATHOGENESIS
• Persistent hyperglycemia (Glucotoxicity)
1) Formation of Advanced Glycation End Products
2) Activation of Protein Kinase C
3) Oxidative Stress and Disturbances in Polyol Pathways
4) Hexosamine Pathways and Generation of Fructose-6-
Phosphate

7. PANCREATIC LESIONS
• Reduction in the no. and size of islets
• Leukocytic infiltrates in the islets (Insulitis)
• In T2DM , may be a subtle reduction in the islet cell
mass
• Amyloid deposition within islets in long-standing T2DM
• An increase in the number and size of islets (Diabetic
mother)

8. MACROVASCULAR DISEASE
• Hallmark: accelerated atherosclerosis affecting the aorta and
large and medium-sized arteries
• Myocardial infarction

9. GANGRENE OF LOWER LIMBS

10. HYALINE ARTERIOSCLEROSIS
• Vascular lesion associated
with HTN
• Hyaline thickening of the
wall of the arterioles –
Narrowing of the lumen

11. DIABETIC
MICROANGIOPATHY
• Diffuse thickening of BM
(most evident in
capillaries of skin, skeletal
muscle, retina, renal
glomeruli, and renal
medulla)
• Despite increased
thickness, diabetic
capillaries are more leaky
than normal to plasma
proteins

12. DIABETIC NEPHROPATHY
1) Glomerular lesions
2) Renal vascular lesions (arteriosclerosis)
3) Pyelonephritis

13. • Capillary BM
thickening
• Diffuse mesangial
sclerosis
• Nodular
glomerulosclerosis

14. DIFFUSE MESANGIAL
SCLEROSIS
• Diffuse increase in mesangial
matrix
• Typically associated with the
overall thickening of GBM
• Extension of mesangial area can
extend to nodular configuration
• Progressive expansion of the
mesangium (deteriorating renal
function)

15. NODULAR
GLOMERULOSCLEROSIS
Glomerular lesions:
(Kimmelstiel-Wilson
lesion) distinctive by ball-
like deposits of a
laminated matrix situated
in the periphery of the
glomerulus
(nodules: PAS positive &
contain trapped mesangial
cells)

16. PYELONEPHRITIS
- An acute or chronic
inflammation of the kidneys that
usually begins in the interstitial
tissue and then spreads to
involve the tubules.
- Special pattern Necrotizing
papillitis (or Papillary necrosis)
much more prevalent in
diabetics than nondiabetics.

17. OCULAR COMPLICATIONS
• Retinopathy
1) Nonproliferative : hemorrhage, exudate, microaneurysm,
edema
2) Proliferative : Neovascularization, fibrosis, retinal detachment
• Cataract formation
• Glaucoma

18. DIABETIC NEUROPATHY
• Peripheral symmetric neuropathy
(motor and sensory function impairment)
• Autonomous neuropathy
• Diabetic mononeuropathy