Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''
Semiology of diabetes mellitus
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Transcript of Semiology of diabetes mellitus
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Semiology of Diabetes Mellitus
Daniel Fernando Isuhuaylas Aguirre
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What is Diabetes?
• Diabetes is a group of metabolic diseasescharacterized by hyperglycemia resulting fromdefects in insulin secretion, insulin action, orboth.
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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.
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β – Cell dysfunction and IR
β – Cell
dysfunction
INSULIN
RESISTANCE
Glucose
Uptake
Blood glucose FFA
Glucose
Production
insulin secretion
Lipolysis
Factors
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Symptoms
• Acute, life-threatening Hyperglycemia with ketoacidosis or the nonketotic
hyperosmolar syndrome.
Polyuria Blurred vision
PolyphagiaWeight loss
Polydipsia
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Long-term complications
Hypertension and abnormalities of
lipoprotein metabolism
Atheroscleroticcardiovascular,
peripheralarterial, and
cerebrovascular disease.
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Long-term complications
• Loss of vision
Retinopathy
• Renal Failure
Nephropathy
• Risk of foot ulcers, amputations, and Charcot joints
Peripheral neuropathy
• Gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction
Autonomic neuropathy
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Criteria for the diagnosis of diabetes
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Natural progressionNormal IGT DM2
Fasting plasma glucose Insulin Sensitivity Insulin Secretion
Insulin sensitivity
Normal insulin secretion
Normoglycemia
Hyperglicemia
β-cell failure
Insulin resistance
DM2 + Long-termcomplications
insulin resistance
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Long-term complications
• Macroangiopathy
• Microangiopathy
• Neuropathy
CVD
Cerebrovascular Disease
Vascular disease of the lower limbs
Symmetric sensory polyneuropathy
Mononeuropathy
Autonomic neuropathy
Retinopathy
Nephropathy
• Diabetic Foot
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Long-term complications
• biochemicalalterations
• functional alterationsREVERSIBLE
STAGE
• Structural alterationsIRREVERSIBLE STAGES
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Diabetic Nephropathy
GENETICS HYPERGLYCEMIA
Diabetic Nephropathy
DIABETES MELLITUS
THICKENING CAPILLARY
BASAL GLOMERULAR
EXPANSION OF THE
MATRIX
↑ PRESSURE
MEMBRANE
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Stages
• Hyperfiltration and renal hypertrophy
• Normoalbuminuria
• Incipient diabetic nephropathy:microalbuminuria
• Clinical Diabetic Nephropathy: Proteinuria
• End Stage Renal Disease
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Diabetic RetinopathyFUNCTIONAL 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
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DIABETIC RETINOPATHY
PROLIFERATIVE
NO PROLIFERATIVE LIGHT NO PROLIFERATIVE
NO PROLIFERATIVE
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Diabetic Neuropathy
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DISTAL AND SYMMETRIC PERIPHERAL NEUROPATHY
Symptoms
• Asymptomatic
• Numbness
• Paresthesias
• Hyperesthesia
• Pain
Signs
• ↓ Sensitivity
• Weakness
• Atrophy
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Mononeuropathy
NERVIO FEMORAL AMIOTROFIA
PARES CRANEANOS
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Autonomic Neuropathy
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Diabetic Foot
• In patients with peripheral neuropathyincidence 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, theglycemic control and age of the disease.
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Diabetic FootDiabetic Foot
Ulceration in the foot.
Micro trauma
Developing new lines of force
Change in foot pressure areas
Peripheral neuropathy
Loss of sensation Muscle atrophy
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Diabetic Foot
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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 pedispulses.
– History of previous ulcer.
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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.
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References
• Diagnosis and Classification of Diabetes Mellitus.American Diabetes Association. Diabetes Care, Volume33, Supplement 1, January 2014.Care.diabetesjournals.org
• Standards of Medical Care in Diabetes. AmericanDiabetes Association. Diabetes Care, Volume 33,Supplement 2, January 2014. Care.diabetesjournals.org
• Foot Care. Canadian Diabetes Association ClinicalPractice Guidelines Expert Committee Keith BoweringMD, FRCPC, FACP John M. Embil MD, FRCPC, FACP.March 2014.
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Instrumentation
• Fingerboard 128 mHz
• Semmens Weinstein monofilament 10 g
• Radiographs of both feet with support, frontand profile
• Doppler
• Arteriography prior to surgery
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Thank you for your attention