This document discusses the pathology of diabetes and its complications. It covers the etiology and pathogenesis of types 1 and 2 diabetes and common complications such as retinopathy, neuropathy, nephropathy and cardiovascular disease. It also discusses acute metabolic complications of diabetes like ketoacidosis and coma. Several case studies are presented examining specific pathologies found in patients with diabetes, such as nodular glomerulosclerosis and renal papillary necrosis.

1. “Climbing to the top demands strength, whether it is to the top of Mount Everest or to the top of your career.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

2. Quick Pathology Review Pathology of Diabetes System : Endocrine Class : Diabetes Topic : Complications of Diabetes. Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia.

3. CPC 24- GIT-PUD: Core Learning Issues(CLI) Major CLI: Etiology and Pathogenesis of Diabetes types. Pathogenesis of Type 1 & 2 DM. Common Complications: retinopathy, neuropathy & peripheral vascular disease. Nephropathy, erectile dysfunction, cardiovascular disease. Minor CLI: Acute metabolic complications of diabetes. Ketoacidosis, coma, Other types of Diabetes. Gestational, MODY, LADA, Secondary, etc. Diabetes insipidus Incretins & incretin pathway.

4. A 61y man with long standing hypertension & diabetes receives heparin after femoral fracture repair. A week later he develops severe thrombocytopenia, hematuria and died a week later due to rapidly developing renal failure. Image shows his right and left kidney’s. What is the most likely diagnosis ? Acute tubular necrosis. Right renal hemorrhage. Right kidney infarction. Benign nephrosclerosis. Endstage kidney disease. Briefly describe gross & Microscopic features of Right and Left Kidneys? Briefly describe pathogenesis of Right & Left kidney pathology? Why heparin was given? What Heparin complication has he developed?

5. A 65y man, BMI 40, peripheral neuropathy, retinopathy and abdominal aortic aneurysm is now developing renal failure. His FBS is 18.3 mmol/L, microscopic examination of his renal biopsy. What is the microscopic feature shown? Renal papillary necrosis. Nodular glomerulosclerosis. Hyaline artereolosclerosis. Atrophy + Amyloid deposition. Diffuse glomerular sclerosis. What is the chemical nature of nodular deposit within glomerulus? Briefly describe steps in the Pathogenesis of nodular glomerulosclerosis? What other renal pathology are commonly seen in diabetic patients?

6. A 47 year old man, Hypertensive & DM2 since 6 years for checkup. Complains of his vision as spectacles recently made does not seem to help. Image shows his fundoscopy. What is the most likely diagnosis ? Normal fundus. Mild Hypertensive retinopathy. Non proliferative retinopathy. Proliferative retinopathy. Retinal detachment. Retinopathy – Differences between Hypertensive & Diabetic retinopathy? Briefly describe steps in the Pathogenesis of diabetic retinopathy? Differentiate soft & hard exudates, dots & blots, proliferative & non-proliferative.?

7. A 65y man, BMI 40, Diabetes since 18 years. His FBS is 18.3 mmol/L, is now developing hypertension since 3 years (BP 186/98 mm of Hg) . Image shows microscopic appearance of his renal biopsy. What microscopic feature shows pathogenesis of high blood pressure? Hyperplasticartereosclerosis Protein cast within tubule. Artereolosclerosis. Nodular glomerulosclerosis. Both A & C. What is the pathogenesis of feature A (hyperplasticarterosclerosis) in the image? Briefly describe feature B and its clinical presentation? What is seen in the interstitium of this kidney? Pathogenesis? Clinical feature?

8. A 52y woman, recently diagnosed diabetic presents with 3 day history of fever, dysuria and flank pain. Examination reveals flank tenderness. Urinalysis shows numerous WBC & WBC casts. Image shows appearance of her kidney biopsy. What is the most likely diagnosis ? Acute glomerulonephritis. Acute tubular necrosis. Renal papillary necrosis. Nodular glomerulosclerosis. Acute interstitial nephritis. Briefly describe 3 microscopic features ? What gross features would be seen? Briefly describe steps in the Pathogenesis of diabetic interstitial nephritis? List common pathologic findings expected in a diabetic kidney?

9. A 72y woman with 22 year history of diabetes, now has creatinine clearance of 20 mL/min (n 75-115mL/min). Image shows appearance of her kidney biopsy. What is the most likely diagnosis ? Diffuse glomerulosclersosis. Acute interstitial nephritis. Hyaline artereolosclerosis. Nodular glomerulosclerosis. Chronic papillary necrosis. Briefly describe pathogenesis of hypertension in diabetes? Briefly describe Pathogenesis of infections in diabetic patients? What other clinical features are more likely in her?

10. A 42 year female presents with recent onset polyuria, polydypsia and decreasing vision. HbA1c was 16.1%. She is chronic alcoholic with past history of jaundice. Image shows her pancreatic biopsy compared with normal. What is the most likely diagnosis ? Secondary diabetes. Late onset Type 2 diabetes. Chronic cholecystitis. Cushing’s syndrome. Type 1 diabetes. Normal Patient Briefly describe features of LADA? What further investigations can be done to confirm the diagnosis? List less common types of Diabetes ?

11. 70y man brought from nursing home with progressive confused & disoriented status since 2 weeks. Not eating or drinking well. On steroid therapy for COPD. What is the most likely diagnosis ? Diabetic ketoacidosis. Non-ketotichyperosmolar coma. Diabetic lactic acidosis. Respiratory acidosis. Diabetic nephropathy. Lab tests: List & briefly discuss common metabolic complications of Diabetes? ? ?

12. “I was willing to accept what I couldn't change.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.