Endocrine Patho -Complications of Diabetes

Question 1

When do complications of chronic hyperglycemia occur and when do they increase?

Answer 1

In type 1 or type 2 diabetes and increase over the time a person has diabetes

Question 2

What happens to glucose in chronic hyperglycemia?

Answer 2

Glucose is converted to sorbitol. Excess sorbitol can’t all be converted to fructose and the extra sorbitol in the cells pulls water into the cells and therefore damages them.

Question 3

What happens with an increase in glycoproteins during chronic hyperglycemia?

Answer 3

Damage basement membrane of eyes, kidneys, blood vessels

Question 4

What tissues are affected in chronic hyperglycemia

Answer 4

Nerves, retina, and blood vessels

Question 5

What functions are affected during chronic hyperglycemia?

Answer 5

Excess glucose is converted to sorbitol
Increased glycoproteins
defective RBC function

Question 6

When do peripheral neuropathies occur?

Answer 6

after a patient has had diabetes for more than 10 years

Question 7

What happens in peripheral neuropathies?

Answer 7

There is thickening of walls of blood vessels which decreases the flow of oxygen and nutrients to the nerves which then causes a loss of nerve myelin sheath in places and a disruption of nerve conduction

Question 8

What is a consequence of somatic nerves being affected by PN?

Answer 8

Diminished sensory perception(pain, temp, and vibration) > skin damage, gait, and balance problems
Painful neuropathy- prickling and shooting pain sensation, bothersome especially at night

Question 9

What is a consequence of autonomic nerves being affected by PN?

Answer 9

Problems with bladder, reflexes, sexual dysfunction

Question 10

What occurs during gastroparesis, another complication of long term diabetes

Answer 10

delayed emptying of the stomach which may lead to nausea or vomiting, diarrhea, or constipation

Question 11

Nephropathy

Answer 11

high glucose damages glomerulus: allows blood proteins into filtrate (albuminuria)

• microalbuminuria used to screen for kidney disease
• glomerulosclerosis

Question 12

What occurs during retinopathy, a complication of long term Diabetes?

Answer 12

• Increased vascular permeability in eye vessels which causes a leaking of fluids which leads to the formation of microaneursyms.
• Neovascularization occurs; abnormal new vessels are formed which are associated with hemmorrhages
• Retinal dettachment

Question 13

What occurs in Macrovascular Disease caused by diabetes?

Answer 13

• Athrocleratic plaque builds up in large blood vessels because they have been damaged by high glucose levels.
• Accelerated Coronary Artery disease; patients can develop a myocardial infarction with the occlusion of a major artery
• small vessel disease with occlusion of small vessels in the heart
• accelerated cerebrovascular disease and stroke due to occlusion of vessels in the head
• accelerated peripheral arterial disease where patients develop poor circulation and are threatened with gangrene

Question 14

What are the mechanisms involved in vascular damage in diabetes?

Answer 14

Hyperglycemia
Hyperlipidemia
Altered platelet function 
Endothelial dysfunction 
Systemic Inflammation
*Many of these are present in type 2

Question 15

Diabetic foot ulcers

Answer 15

• result of neuropathy and vascular disease
• impaired sensation - do not sense trauma
• feet deformed from motor neuropathy > abnormal pressure areas
• poor arterial circulation
  tx: may involve antibiotics, growth factors, hyperbaric oxygen

Question 16

What infections are diabetics prone to?

Answer 16

Soft tissue infection of extremities, osteomylitis, UTI, yeast infections, dental caries and periodontal disease

Question 17

Why are diabetics more prone to disease?

Answer 17

Hypoxia - lack of oxygen for tissues
Pathogens - grow well in high glucose environment
poor blood supply fro inflammation
white blood cells impaired