#Biochemistery
#Carbohydrate_metabolism
#بوست_رقم (22)
الليلة ح نواصل في باقي ال
Diabetes
وح نتكلم عن
📌 Complication of diabetes mellitus.
📌 Diagnosis of diabetes mellitus.
📌 Investigation.
📌 Coma in diabetes.
📌 Type of diabetes.
يلا بسم الله نبدأ
🌸 Complication:
1. Immediate:
دا بتظهر في وقت بدري واللي هي
Diabetic ketoacidosis and coma
واكتر حاجه في type I
2. Late complication:
دي بتظهر متأخر نتيجة ل change في ال blood vessels
These are 2 type:
1. Involvement of large vessels.
2. Involvement of small vessels.
يلا نشوفهم واحد واحد
1. Large vessels involvement:
Atherosclerosis and its effects:
●اللي بتكون في ال coronary vessels وهنا بحصل MI (Myocardial infarction)
● واللي بتكون في ال cerebral vessels هنا بحصل stroke
2. Small vessels involvement:
● Thickening of basement membrane.
● Microvascular changes.
من ال disease اللي بتحصل
1. Diabetic retinopathy: 70%
بحصل haemorrhages وبالتالي يحصل sudden blindness
وممكن يحصل cataract.
2. Diabetic nephropathy: characterized by:
1. Proteinuria.
2. Hypertension
3. Oedema.
ديل الثلاثة مع بعض كدا بسموهم Kimmelsteil-wilson syndrome
3. Neuropathy:
بحصل loss of sensation and tingling ودا من المحتمل يكون بسبب myoinositol deficiency
وبرضو ممكن يحصل weakness of muscles و myopathies .
4. Gangrene:
بحصل نتيجة ل diminished blood supply نتيجة ل atherosclerotic changes في ال blood vessels
وبرضو ممكن نتيجة لل tissue hypoxia نتيجة ل information of HbA1c ونتيجة ل less oxygen carrying capacity
5. Skin lesions:
بكون معرض ل infections زي ال boils وال ulcers وممكن يحصل necrosis of skin بسموهو Necrobiosis diabeticorum
6. Pulmonary tuberculosis:
بكونوا معرضين ل tuberculosis.
🌸Diagnosis of diabetes mellitus:
If patient with symptoms:-
1. Measurement of fasting plasma glucose level (8-12
hours after last meal):
a) If concentration is 65-110 mgfdl —> Normal blood glucose.
b) If concentration is 110-126 mg/dl —> Impaired glucose
utilization.
c) If concentration is > 126 mg/dl —> Diabetes mellitus.
2. Measurement of two-hours postprandial plasma
glucose level: (2 hours after last meal):
a) If concentration is 65-140 mg/dl—> Normal blood glucose.
b) If concentration is 140-200 mg/dl—> Impaired glucose
utilization.
c) If concentration is > 200 mg/dl —> Diabetes mellitus.
If patient has no symptoms:
Oral glucose tolerance test (OGTT) is done:
1. Indication of the test: There are only two indications for
performing OGTT:
a) People with no or mild symptoms of diabetes mellitus.
b) To determine the renal threshold for glucose.
2. Procedure:
a) Fasting plasma sample is taken after overnight fast (8-12
hours).
b) Then patient is given 75 grams glucose orally.
c) Plasma and urine glucose concentrations are determined in
fasting and at 30 ~inutes intervals for the next 3 hours after
glucose ingestion.
🌸 Investigations for follow up of diabetes mellitus:
1. Glycosuria.
2. Glycated proteins:
The rate of formation of such glycoprotein is related to the concentration of glucose.
🌸 Coma in diabetes mellitus:
Three types of coma may result in advanced uncontrolled diabetes. These are:
A. Ketotic coma: due to acidosis (ketosis).
B. Hyperglycemic. hyperosmolar. nonketotic coma:
due to hyperglycemia, increased osmolality and dehydration of
brain cells. Here, there is neither ketosis nor fall in blood pH.
C. Lactic acidosis: due to hyperlactatemia. This type may occur
in some patients who receive an oral hypoglycemic drug called:
Phenformin (cidophage).
🌸Note:
Insulin increases the transfer of potassium and
inorganic phosphate into cells. In case of treatment of
diabetic coma with intravenous insulin and glucose, it may
be fatal if potassium is not given at the same time due to
hypokalemia —> Cardiac affection.
🌸Types of diabetes:
1. Diabetes mellitus: caused by defective insulin action.
2. Diabetes insipidus: hereditary disease caused by defective
action of antidiuretic hormone.
3. Diabetes innocence (renal diabetes): caus
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