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Semiology of diabetes mellitus

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Diabetes

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Semiology of diabetes mellitus

  1. 1. Semiology of Diabetes Mellitus Daniel Fernando Isuhuaylas Aguirre
  2. 2. What is Diabetes? • Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
  3. 3. Pathogenic processes involved HYPERGLYCEMIA Autoimmune destruction of the β-cells of the pancreas (resistance to insulin action) Deficient action of insulin on target tissues. Inadequate insulin secretion and/or diminished tissue responses to insulin.
  4. 4. β – Cell dysfunction and IR β – Cell dysfunction INSULIN RESISTANCE  Glucose Uptake  insulin secretion  Glucose Production  Lipolysis  FFA  Blood glucose Factors
  5. 5. Symptoms Weight loss Polyphagia • Acute, life-threatening Polyuria Blurred vision Polydipsia Hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.
  6. 6. Long-term complications Hypertension and abnormalities of lipoprotein metabolism Atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease.
  7. 7. Long-term complications Retinopathy • Loss of vision Nephropathy • Renal Failure Peripheral neuropathy • Risk of foot ulcers, amputations, and Charcot joints Autonomic neuropathy • Gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction
  8. 8. Criteria for the diagnosis of diabetes
  9. 9. Natural progression Normal IGT DM2 Fasting plasma glucose Insulin Sensitivity Insulin Secretion Insulin sensitivity Normal insulin secretion Normoglycemia Hyperglicemia Insulin resistance β-cell failure DM2 + Long-term complications insulin resistance
  10. 10. Long-term complications • Macroangiopathy • Microangiopathy • Neuropathy CVD Cerebrovascular Disease Vascular disease of the lower limbs Retinopathy Nephropathy Symmetric sensory polyneuropathy Mononeuropathy Autonomic neuropathy • Diabetic Foot
  11. 11. Long-term complications • biochemical alterations • functional alterations REVERSIBLE STAGE IRREVERSIBLE • Structural alterations STAGES
  12. 12. Diabetic Nephropathy DIABETES MELLITUS GENETICS HYPERGLYCEMIA Diabetic Nephropathy THICKENING CAPILLARY BASAL GLOMERULAR EXPANSION OF THE MATRIX ↑ PRESSURE MEMBRANE
  13. 13. Stages • Hyperfiltration and renal hypertrophy • Normoalbuminuria • Incipient diabetic nephropathy: microalbuminuria • Clinical Diabetic Nephropathy: Proteinuria • End Stage Renal Disease
  14. 14. Diabetic Retinopathy FUNCTIONAL AND MORPHOLOGICALNS HEMODYNAMIC ALTERATIO HYPERGLYCEMIA LOST PERICYTES VASODILATION OF CAPILLARIES BASAL MEMBRANE ALTERATION LOSS OF ENDOTHELIAL acellular capillaries Hypoxia ↑VPF VEGF Neoformation CAPILLARIES RD NO PROLIFERATIVE RD PRE PROLIFERATIVE RD PROLIFERATIVE
  15. 15. DIABETIC RETINOPATHY NO PROLIFERATIVE LIGHT NO PROLIFERATIVE PROLIFERATIVE NO PROLIFERATIVE
  16. 16. Diabetic Neuropathy
  17. 17. DISTAL AND SYMMETRIC PERIPHERAL NEUROPATHY Symptoms • Asymptomatic • Numbness • Paresthesias • Hyperesthesia • Pain Signs • ↓ Sensitivity • Weakness • Atrophy
  18. 18. Mononeuropathy NERVIO FEMORAL AMIOTROFIA PARES CRANEANOS
  19. 19. Autonomic Neuropathy
  20. 20. Diabetic Foot • In patients with peripheral neuropathy incidence annual foot injuries is 7.2%. • The etiology, 60% of injuries are neuropathic, 30% are neuro-ischemic and ischemic 10%. • Injuries are related to patient age, the glycemic control and age of the disease.
  21. 21. Diabetic FootDiabetic Foot Peripheral neuropathy Loss of sensation Muscle atrophy Change in foot pressure areas Developing new lines of force Micro trauma Ulceration in the foot.
  22. 22. Diabetic Foot
  23. 23. Diabetic Foot • Risk Factors – Decrease or abolition of aquiliano reflex. – Decrease or abolition of vibratory sensation. – Orthopedic disorders: • Hammer toes. • Hallux valgus. • Calluses • Atrophy of foot muscles themselves. • Pes cavus with deformed anterior arch. – Decrease or abolition of tibial and dorsalis pedis pulses. – History of previous ulcer.
  24. 24. Clinical Examinatios • Coloration: – Rubicund in neuropathy, venous engorgement. – Pale in ischemia. • Temperature: – Hot in neuropathy. – Cold in ischemia. • Skin alterations – Dry skin. – Presence of calluses. • Others – Limitation of joint mobility. – Atrophy of intrinsic foot muscles. – Examination of reflexes, pulse, vibration sensitivity.
  25. 25. References • Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care, Volume 33, Supplement 1, January 2014. Care.diabetesjournals.org • Standards of Medical Care in Diabetes. American Diabetes Association. Diabetes Care, Volume 33, Supplement 2, January 2014. Care.diabetesjournals.org • Foot Care. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee Keith Bowering MD, FRCPC, FACP John M. Embil MD, FRCPC, FACP. March 2014.
  26. 26. Instrumentation • Fingerboard 128 mHz • Semmens Weinstein monofilament 10 g • Radiographs of both feet with support, front and profile • Doppler • Arteriography prior to surgery
  27. 27. Thank you for your attention

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