01/05/2023

1

welcome

01/05/2023

2

COMPLICATION OF DIABETES MELLITUS

By

AISWARYA

2nd year Pharm.D

01/05/2023

3DIABETES MELLITUS Diabetes mellitus is a group of metabolic disorder

characterized by HYPERGLYCEMIA

Its associated with abnormalities in the carbohydrate, fat , and protein metabolism and it is mainly due to the defect in insulin secretion , insulin action or both

Diabetes mellitus results in chronic complication including

a)Micro vascular diseases b)Macro vascular diseases

01/05/2023

4Micro vascular complication includes

a)Diabetic retinopathy

b)Diabetic nephropathy

c)Diabetic neuropathy

01/05/2023

5DIABETIC RETINOPATHY

Most common microvascular complication .

It eventually leads to BLINDNESS .

It affect 80% of all patient who had diabetes for 10 years or more .

01/05/2023

6

01/05/2023

7

The longer a person had diabetes , the higher his chances of developing retinopathy .

Development of diabetic retinopathy in patients with type 2 diabetes was found to be related to both severity of hyperglycemia and presence of hypertension .

VEGF(Vascular endothelial growth factor) production is increased in diabetic retinopathy .

01/05/2023

8PATHOGENESIS OF DIABETIC RETINOPATHY In the first stage which is called non

proliferated diabetic retinopathy (NPDR)there are no symptom .

Diabetic retinopathy is result of micro vascular retinal change .

Hyperglycemia induced intramural pericyte death and thickness of basement membrane lead to incompetence of the vascular wall .

This damage change the formation of blood retinal barrier and also make the retinal blood vessel more permeable .

01/05/2023

9

Small blood vessels in the eye are vulnerable to poor blood sugar , cause accumulation of glucose and fructose and thus damage the tiny blood vessel in the retina .

Here is a chance of developing MACULAR EDEMA .

When the macula swells with fluid ,macular edema occurs .That causes blurred vision .

No loss of vision.

01/05/2023

10

01/05/2023

11

PROLIFERATIVE DIABETIC RETINOPATHY

New blood vessels grow along the retina and in the vitreous chamber and humorous chamber of the eye.

Damaged blood vessel close off. New blood vessel start growing in retina ;these blood vessel are weak and leaky and thus block vision.

The new blood vessel can also cause scar tissue to grow , later it shrinks and distort the retina out of its place ; a condition called RETINAL DETACHMENT

Thus there is loss of vision

01/05/2023

12DIABETIC NEUROPATHY

Diabetic neuropathy are neuropathic disorder that are associated with diabetes mellitus.

It resulting from injury of small blood vessels that supply nerves.

Diabetic neuropathy affects all peripheral nerves including pain fibers , motor neurons and the autonomic nervous system . It therefore can affect all organ and system as all are innervated.

01/05/2023

13TYPESOF DIABETIC

NEUROPATHY Peripheral neuropathy: it can

cause tingling , pain , numbness , or weakness in feet and hands .

Autonomic neuropathy : affects the nerves in the body that control our body system .

01/05/2023

14

01/05/2023

15SIGNS AND SYMPTOMS

Numbness and tingling of extremities Dysesthesia Diarrhea Erectile dysfunction Dizziness Vision change Muscle weakness Speech impairment Fasciculation Burning or electric pain

01/05/2023

16PATHOGENESIS OF DIABETIC NEUROPATHY

4 Factor involving development of diabetic neuropathy

MACROVASCULAR DISEASES

Micro angiopathy , vascular and neural diseases are closely related and intervened

Blood vessels depend on normal nerve function ,and nerves depend on adequate blood flow.

01/05/2023

17

The first pathologic change include VASOCONSTRICTION

As the diseases progresses , neuronal dysfunction correlates with development of vascular abnormalities like capillary basement membrane thickening and endothelial hyperplasia, which diminished oxygen tension and hypoxia

Neural ischemia is well established characteristic feature of diabetic neuropathy

01/05/2023

18

ADVANCED GLYCATED END PRODUCTS

AGEs are substance that are formed by the process of Glycation (non enzymatic glycosylation; addition of a carbohydrate to protein without involvement of enzyme) .

AGEs can be a factor in the development or worsening of many degenerative diseases such as diabetes, atherosclerosis and chronic renal failure.

01/05/2023

19

Elevated intracellular level of glucose cause non enzymatic covalent bonding with proteins , making cell stiffer ,less pliable and more subjected to damage and premature aging of skin .

20

PROTEIN KINASE C

Increasing levels of glucose cause an increases intracellular diacylglycerol , which activates PKC (PKC inhibitor increases nerve conduction velocity by increasing neuronal blood flow) .

Increased diacyglycerol causes hyperglycemia and thus DIABETES MELLITUS

01/05/2023

01/05/2023

21

POLYOL PATHWAY

Its also called sorbitol / aldose reductase pathway. Especially in microvascular damage to retina , kidney, and nerves .

Sorbitol cannot cross cell membranes , and , when it accumulates , it produces osmotic stresses on the cells by drawing water into the insulin – independed tissues .

01/05/2023

22

DIABETIC NEPHROPATHY Also known as nodular diabetic glomerulosclerosis

and intra capillary glomerulonephritis

It is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomerulii

It is characterized by nephrotic syndrome

Screening of diabetic nephropathy is accomplished by either a 24 hrs urine collection or a spot urine measurement

01/05/2023

23

SIGNS AND SYMPTOMS Fluid retention plus reduced plasma oncotic

pressure causing EDEMA Anorexia Nausea and vomiting Malaise Fatigue Head ache Weight gain Excess glucose in urine

01/05/2023

24

01/05/2023

25PATHOGENESIS OF DIABETIC NEPHROPATHY

Detectable change in the course of diabetic nephropathy is a thickening of the glomerulus , micro aneurysm formation , messaginal nodule formation and other changes .

At this stage kidney may leak more serum

albumin than normal in the urine ( albuminurea ).

As it progresses, increasing number of glomeruli are destroyed by progressive nodular glomerulosclerosis

01/05/2023

26MACROVASCULAR

COMPLICATIONS Macrovascular disease is a diseases of any

large(macro) blood vessels in the body Diseases includes a)Cardiovascular diseases b)Cerebrovascular diseases c)Peripheral vascular diseases

Macrovascular disease (macroangiopathy) refer to ATHEROSCLEROSIS

01/05/2023

27CARDIO VASCULAR

DISEASES CVD is the leading cause(~70%) of death in

people with type 2 diabetes mellitus . They cause myocardial

infarction(MI),congestive heart failure(CHF) . Factors that promote CVD are: Abdominal obesity Hypertension Hyperlipidemia Increased coagulability Even with multiple risk factor for the ischemic

heart disease , stroke ,coronary heart disease and death .

01/05/2023

28PERIFERAL VASCULAR

DISEASES PVD affects the blood vessels outside the

heart .

In persons with diabetes , it often affects the arteries of the legs and may give rise to intermittent CLAUDICATION - a cramping pain experienced on walking , due to reversible muscle ischemia secondary to atherosclerosis .

01/05/2023

29

PVD is responsible for much of the morbidity associated with Diabetic foot problems .

About 20% of people with PVD die from Myocardial infarction within 2 years of symptom onset .

01/05/2023

30CEREBRO VASCULAR

DISEASES

Patients with type 2 diabetes mellitus have a much higher risk of stroke , with an increased 150-400% .

Risk of stroke related dementia and recurrence , as well as mortality is elevated in patients with diabetes.

01/05/2023

31

REFERENCE:

Complications of diabetes mellitus

Source: http://en.wikipedia.org/wiki/Complications_of_diabetes_mellitus?oldid=618313885

Clinical pharmacy and Therapeutics - Roger and Walker , Churchill Livingstone

Pharmacotherapy : A pathophysiological approach - Joseph T . Dipiro et al . Appleton & Lange .

01/05/2023

32

THANK YOU