Lecture 9: Chronic Complications

Question 1

Hyperglycemia

Answer 1

Polyuria, polyphagia, polydypsia, weight loss, COMA

Question 2

Hypoglycemia

Answer 2

Occurs with alcohol, fasting, exercise, complications of exessive insulin

Question 3

Diabetic Ketoacidosis

Answer 3

- Mostly Type 1
Severe insulin deficiency
Lipolysis and ketogenesis
Fluid and electrolyte shifts
Excess counter regulatory hormones
Coma
Metabolic Acidosis
Nausea
Vomiting
Abdominal Pain

Question 4

Hyperosmolar Coma

Answer 4

Absence of ketosis
Severe water deficiency
Renal insufficiency

Question 5

Retinopathy

Answer 5

Visual Loss
Cataracts
Leading cause of blindness in the world
Can injure retina or cause complete detachment
Can be treated with laser photocoagulation, small burns keep vessels from bleeding

Question 6

Cardiovascular Disease

Answer 6

Most common cause of death

Question 7

Diabetic Neuropathy

Answer 7

Foot ulcers, gangrene, amputations
Patients asymptomatic, or complain of numbness or tingling
Feet mostly unaffected
Ulcerations can get infected and go unnoticed
Charcot Arthropathy- Diabetic neuropathic arthropathy, loss of feeling in feet makes it difficult to walk, so microfractures occur that don’t heal properly

Question 8

Nephropathy

Answer 8

Leading cause of end stage renal disease
20-30% of diabetes develop evidence of this
Glomeruli become thickened and then sclerotic
Protein cal leak in urine before glomerular filtration falls

Question 9

Macrovascular Complications

Answer 9

Ischemic heart disease, cerebrovascular disease, peripheral artery disease

Question 10

Ketoacidosis More

Answer 10

Cells think that they are starving

Lipolysis occurs, but the krebs cycle goes into gluconeogenesis, so the ketoacids have nowhere to go

Question 11

Chronic Complications Theory

Answer 11

1. Hyperglycemia in one way or another increases oxidative phosphorylation, which in turn increases the amount of oxidative stress and superoxide ions
   Glycation- High concentration of glucose causes it to ligate to proteins and cause dysfunction
   Increased hyperglycemia increases oxidative phosphorylation, which increases membrane potential for TCA cycle. Inhibits complex II which increases half life of superoxide ions

Question 12

Rhino Cerebral

Answer 12

Fungi that likes rich glucose environments at a low pH
Increased diabetic treatment reduces chronic symptoms
Epigenetic metabolism may retain hyperglycemic conditions even when glucose has been controlled therapeutically.