Complications of DM
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Chronic Complicationsof
Diabetes Mellitus
By: Ismah Haron
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Classification
DM
Microvascular
- Retinopathy
- Nephropathy
- Neuropathy
Macrovascular
- Coronary heart disease
- Cerebrovascular disease
Both
- Diabetic foot
- Erectile dysfunction
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Mechanisms
1. ↑ formation of advanced glycosylation end products (AGEs)
2. ↑ sorbitol pathway
3. Activation of protein kinase C (PKC)
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↑ intracellular glucose
Interaction of glucose with amino acidsvia nonenzymatic glycosylation Advanced glycosylation end products
↑ AGEs
• cross-link proteins eg.collagen• accelerate atherosclerosis• promote glomerular dysfunction• induce endothelial dysfunction
1. Hyperglycemia ↑ AGEs synthesis
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2. Hyperglycemia ↑ glucose metabolism via sorbitol pathway
Intracellular glucose ↑ promotes conversion to sorbitol
via aldose reductase
↑ Sorbitol
• alters redox potential
• ↑ cellular osmolality
• generates reactive O2 species
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3. PKC Activation
Hyperglycemia ↑ DAG formation PKC activation
Effects of PKC activation :
• production of vascular endothelial growth factor(VEGF) neovascularization diabetic retinopathy
• ↑ activity of vasoconstrictor & ↓ activity of vasodilator in endothelial tissues
• production of molecule procoagulant ↓ fibrinolysis vascular occlusion
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Retinopathy
• Capillary endothelial change vascular leak microaneurysms capillary occlusion local hypoxia & ischemia new vessels formation
• Visual acuity and eye fundus examination
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Nephropathy
• Proteinuria detected on urine dipstick or• Microalbuminuria • Renin-angiotensin blockers• Refer to nephrologists if serum
creatinine > 200 µmol/L
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Neuropathy
• Light pressure sensation• Vibration• Ankle jerk• Pin prick
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5 neuropathies in DM: Distal symmetrical polyneuropathy, proximal asymmetrical neuropathy, mononeuritis multiplex, radiculopathy
and autonomic neuropathy
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Coronary heart disease
• Association with DM explained by concomitant risk factors
• Resting ECG• Cardiovascular risk assessment tool
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Diabetic foot
• Peripheral neuropathy• Vasculopathy- Claudication- Examine dorsalis pedis & posterior tibial
pulses
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Erectile dysfunction
• Vasculopathy, autonomic neuropathy and/or psychological factors
• Risk factor: ageing, longer duration of having DM, poor glycemic control, smoking and HPT
• Screen adult male > 40 years old• IIEF questionnaire
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Source: Ministry of Health Malaysia
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THANK YOUThe end.