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• Characterized by:
• Enzymatic necrosis and inflammation
• Autodigestion of the pancreas by
inappropriately activated pancreatic
enzymes
• Causes:
–Alcohol: the most common
–Biliary tract disease
–Hypercalcemia
–Hyperlipoproteinemia
–Deficiency in insulin
Type 1A:
– The most common form
– Caused by autoimmune destruction of beta cells
Type 1B:
– Associated with severe insulin deficiency
– No evidence of autoimmunity
Type 1 DM : Clinical features
• Polyuria
• Polydipsia
• Polyphagia
• Weight loss
• Hyperglycemia, hyperlipidemia
• Ketoacidosis
Sequence of metabolic events leading to
diabetic coma in type 1 DM:
• Insulin deficiency leads to a catabolic state, ketoacidosis
and severe volume depletion. These cause CNS
compromise, can lead to coma and eventual death if left
untreated.
Diabetes Mellitus Type 2
• Type 2 diabetes: 80%
• Called non-insulin-dependent DM
• Adult-onset diabetes
• Life style clearly plays a role
• Glomerular lesions
• Diffuse and nodular glomerulosclerosis
• Capillary basement membrane thickening
• 38
• Diabetic Ocular Complications
• Cataract formation
• Glaucoma
• Nonproliferative Retinopathy
• Includes:
1. Hemorrhage: intraretinal or preretinal
2. Microaneurysms
3. Venous dilations and edema
4. Retinal exudates:
• Soft (microinfarcts)
• Hard (deposits of plasma proteins and lipids)
5. Microangiopathy: thickening of the retinal capillaries
• 40
• Proliferative Retinopathy
• Includes:
• Neovascularization
• Fibrosis
• Complications:
–Vitreous hemorrhages
–Retinal detachment
• 41
Non-proliferative (Background) Retinopathy
• Diabetic retinopathy: A view of the fundus shows large areas of preretinal
hemorrhage below the optic disc; pale dots represent exudates in the left side.
Neovascularization is present on the right side of the optic disc
• Glaucoma is caused by high pressure in the eye damaging the optic
nerve, which results in loss of individual nerve cells. This causes a
subsequent increase in the size of the cup, also called cupping.
• Includes:
• Both motor and sensory function
• Peripheral, symmetric neuropathy of lower extremities
• Autonomic neuropathy: produces disturbances in bowel and bladder
function, and sexual impotence
• Diabetic mononeuropathy: e.g. foot-drop, wrist-drop
• Microangiopathy
• Cerebrovascular infarcts and brain hemorrhages
• 48
Diabetic vasculopathy
• A diabetic foot with a previous healed amputation demonstrates an
ulcer in the region of the ankle
• 49
Laboratory Diagnosis of DM:
2. Random glucose level of 200 mg/dL or greater and clinical symptoms of diabetes
3. Oral glucose tolerance test: after ingestion of 75g of glucose, a 2-hour venous plasma
• Protein Glycosylation:
–Measurement of glycosylated hemoglobin (HbA1c)
• Levels in blood (a glucose molecule covalently attached to Hb) It is also a
good way of determining whether the patients are compliant.
• Provides an index of the average blood glucose levels over the 120-day life
span of erythrocytes
•Islet Cell Tumors
• Hyperinsulinism (insulinomas)
• Hypergastrinemia
• Zollinger-Ellison syndrome- gastrinomas (A gastrinoma is a gastrin-
producing tumor usually located in the pancreas or the duodenal wall)
• Multiple endocrine neoplasias (MEN-1)