clin manifestations of DM Flashcards
classic presentation
the poly’s
what is the honeymoon period in T1DM?
period in which insulin is not yet required, can be knocked out by infection or stress
low insulin promotes what activity in the muscle and liver?
glycogenolysis b/c they don’t take up the glucose
ketoacidosis presentation
n/v/dehydration and tachypnea; common first presentation
cause of hyperosmolar nonketotic coma?
hyperglycemia along with not enough water intake
most common cause of death in DM?
end organ damage seen 15-20 years post diagnosis
CV damage
MI is the most common cause of mortality
3-7x RR
enhanced hyaline arteriolosclerosis
microangiopathy (thick, leaky capillaries)
atherosclerosis of the aorta, large and med arteries
Kidney damage
second most common mortality
DNP is most common ESRD cause
GBM thick, mesangial prolif, aff. and eff. arteriole hyaline arteriolosclerosis, nodular glom.sclerosis - Kimmelstiel-Wilson lesion -> glom ischemia with granular renal cortical surfaces
what is a Kimmelsteil-Wilson lesion?
hyaline nodule associated with capillaries in the peripheral glom.
clin pres of DNP
microproteinuria (30-300 mg/day) -> progressing to macro
renal artery stenosis (HTN)
necrotizing papillitis
pyelonephritis
peripheral neuropathy
more common, numbness, paresthesia, pain, abnomal propioception, reduced motor function;
symptoms: extreme pain, esp at night, foot drop, cranial nerve paralysis, radiculopathy
autonomic neuropathy
abnormal GI, bladder and erectile dysfunction
prob. caused by microangiopathic ischemia, increase cap. perm and glycosylation of axonal proteins, oxidative stress (sorbitol metabolism)
eye damage
cataracts, glaucoma and retinal damage
non-proliferative - minute hemorrhages, microaneurysms, exudates, venous dilatations, microangiopathy and edema in the retina
proliferative - vitreal and retinal fronds with bleeding and fibrosis -> detachment and blindness
pancreas
variable islet cell loss, insulinitis (lymphocytic infiltrates) and amyloid deposits
other
more severe infections esp. fungal infections of the skin, TB, pneumonia, kidney
reduction in blood flow and abnormal leukocyte function
malignant OM (external ear pseudomonas)
mucormycosis (mucor or rhizopus invading into the brain)
emphysematous cholecystitis (c. perfringens gallbladder)
emphysematous pyelonephritis
