57 Questions
What is the main focus of Lecture 17 in the BSMS203 course?
Hyperosmolar Hyperglycaemic State Pathophysiology
What is the normal range for Blood Glucose mentioned in the lecture?
3.9-5.6
What is the primary cause of Microvascular Complications of Diabetes discussed in the lecture?
Chronic Hyperglycemia
What is the key focus of Section 1 of 4 in the lecture?
Hyperosmolar Hyperglycaemic State Pathophysiology
Which condition is characterized by blood glucose levels of 330-400 mmol/L and normal blood osmolarity of 275-295 mOsm/kg?
Hyperosmolar Hyperglycaemic State (HHS)
What is the primary cause of Hyperosmolar Hyperglycaemic State (HHS)?
Unchecked diabetic pathology
What is the pathophysiological mechanism of HHS?
Hyperglycemia-induced osmotic diuresis leading to severe dehydration
What are the consequences of severe hyperosmolarity in HHS?
Nervous system depression and coma
At what blood osmolarity does nervous system depression begin in HHS?
300 mOsm/kg
Which condition is characterized by blood glucose levels of 14.9-50 mmol/L and normal blood osmolarity of 275-295 mOsm/kg?
Diabetic Ketoacidosis (DKA)
What is the primary cause of Diabetic Ketoacidosis (DKA)?
Acute absolute insulin deficiency
What is the pathophysiological mechanism of DKA?
Insulin promoting lipolysis as an alternate source of energy
What are the common presentations of DKA?
Polydipsia, polyuria, vomiting, and abdominal pain
What is the initial treatment strategy for HHS?
Fluid replacement to reduce hyperosmolarity
What is the initial treatment strategy for DKA?
Fluid replacement to reduce hyperosmolarity
Which process in diabetes leads to osmotic damage and oxidative stress in cells?
Polyol Pathway
What is the main factor promoting the formation of new blood vessels in diabetic retinopathy?
Vascular Endothelial Growth Factor (VEGF) expression
What is the primary characteristic of diabetic nephropathy?
Basement membrane thickening
What is the main consequence of diabetic neuropathy?
Ischemia to neurons
Which area of the retina is most affected in diabetic retinopathy?
Fovea
What are the macrovascular complications of diabetes?
Strokes, myocardial infarction, ischemia/hypoxia to limbs
What is the focus of treatment strategies for macrovascular complications of diabetes?
Early detection and prevention
What is the main factor leading to accelerated atherosclerosis in diabetes?
Damage occurring in the small vessels
What is the primary cause of chronic complications in Type 2 diabetes patients?
Hyperglycemia
What does excess glucose metabolize to in the Polyol Pathway?
Sorbitol
What is the consequence of Protein kinase C (PKC) activation in diabetes?
Vascular Endothelial Growth Factor (VEGF) expression
What is the characteristic feature of diabetic nephropathy causing protein leakage into the urine?
Podocyte cell loss
What is the subtle but important difference between Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS)?
DKA is characterized by severe hyperglycemia and ketosis, while HHS is characterized by extreme hyperosmolarity without significant ketosis.
What are the primary macrovascular complications associated with diabetes?
Coronary artery disease and peripheral vascular disease
What is the primary pathophysiological mechanism of diabetic retinopathy?
Activation of Protein kinase C (PKC) leading to increased vascular permeability and angiogenesis
What is the primary focus of the lecture's learning outcomes regarding diabetic emergencies and chronic complications?
Exploring the pathophysiology behind acute and chronic complications of diabetes
What are the long-term effects emphasized in the lecture regarding diabetes complications?
Progression of atherosclerosis and microangiopathy
What is the primary focus of the lecture regarding the acute complications of diabetes?
Exploring the differences between diabetic ketoacidosis and hyperosmolar hyperglycaemic state
What is the primary cause of Diabetic Ketoacidosis (DKA)?
Acute and absolute lack of insulin
Which section of the lecture covers diabetic retinopathy, nephropathy, and neuropathy?
Section on microvascular complications
At what blood osmolarity does nervous system depression begin in Hyperosmolar Hyperglycaemic State (HHS)?
300-320 mOsm/kg
What is the primary cause of hyperosmolarity in diabetes?
Low blood water and high blood glucose
What is the characteristic feature of diabetic nephropathy causing protein leakage into the urine?
Proteinuria
What is the consequence of elevated blood glucose in the kidneys?
Increased glomerular filtration rate and glucose in the urine
What is the consequence of excess glucose metabolization in the Polyol Pathway?
Osmotic damage and oxidative stress in cells
What leads to severe dehydration in uncontrolled hyperosmolarity?
Polyuria due to increased glomerular filtration rate
What is the focus of treatment for Hyperosmolar Hyperglycaemic State (HHS)?
Gradual electrolyte replacement and insulin as a last resort
Which condition presents with symptoms that are much nastier and earlier compared to hyperosmolarity?
Diabetic ketoacidosis
What leads to the presence of ketosis in Diabetic Ketoacidosis (DKA)?
Insulin deficiency
What type of blood vessels are affected by macrovascular changes in diabetes?
Large blood vessels
What role does insulin play in preventing diabetic ketoacidosis?
Preventing lipolysis and the subsequent production of ketone bodies
What distinguishes diabetic ketoacidosis from hyperosmolar hyperglycemic state?
Presence of ketosis
What can lead to a sudden drop in insulin production, triggering diabetic ketoacidosis?
Malfunctioning insulin pumps
What is the consequence of increased osmolarity in diabetic ketoacidosis?
Severe symptoms when blood acidity levels shift
What is the primary cause of cardiovascular collapse in the progression of diabetic ketoacidosis?
Worsening acidosis
What is the main factor leading to severe symptoms prompting earlier patient presentation in diabetic ketoacidosis?
Presence of ketosis
What is the primary cause of diabetic ketoacidosis (DKA)?
Absolute insulin deficiency leading to the presence of ketones in the blood
What contributes to the development of diabetic ketoacidosis?
Breakdown of muscle and fat
Which cells are particularly sensitive to elevated glucose levels in diabetes?
Nerves, kidneys, and retinal blood vessels
Which type of diabetes is more commonly associated with diabetic ketoacidosis?
Type 1 diabetes
What are the chronic complications of diabetes that can arise from prolonged elevated glucose levels?
Neuropathy, nephropathy, and retinopathy
What is the pathophysiological mechanism behind diabetic ketoacidosis and hyperglycemic states?
Absolute insulin deficiency leading to the presence of ketones in the blood
Study Notes
Microvascular and Macrovascular Complications of Diabetes Mellitus
- Microvascular complications of diabetes include neuropathy, nephropathy, and retinopathy, which are chronic complications of hyperglycemia and may be present at diagnosis in Type 2 diabetes patients.
- Excess glucose is metabolized to sorbitol in the Polyol Pathway, leading to osmotic damage and oxidative stress in cells.
- Hyperglycemia produces advanced glycation end products (AGEs), leading to basement membrane thickening and damage to blood vessel wall components.
- Protein kinase C (PKC) activation due to the end product of glycolysis, DAG, promotes Vascular Endothelial Growth Factor (VEGF) expression, driving the formation of new blood vessels.
- Diabetic retinopathy involves basement membrane thickening, endothelial cell loss, and the formation of new blood vessels in the retina.
- Diabetic nephropathy is characterized by basement membrane thickening, podocyte cell loss, and subsequent leakage of protein into the urine, leading to glomerular scarring and impaired renal function.
- Diabetic neuropathy causes damage to the microvasculature, leading to ischemia to neurons and lack of nerve function, resulting in muscle weakness and impaired signaling of pain, touch, and temperature.
- The fovea of the retina is the area with the greatest concentration of rods and cones.
- Macrovascular complications of diabetes include strokes, myocardial infarction, and ischemia/hypoxia to limbs, and patients with Type 2 diabetes have multiple risk factors for their development.
- Much of the damage occurring in the small vessels is also occurring in the larger blood vessels, leading to accelerated atherosclerosis.
- Treatment strategies for macrovascular complications focus on early detection and prevention, as many of these complications can be life-threatening or severely life-altering.
- It is important to understand the pathophysiological processes leading to both macrovascular and microvascular complications of diabetes mellitus.
Diabetic Ketoacidosis and Complications
- Diabetic ketoacidosis can cause rapid deterioration in health within 24 hours due to a failed insulin pump.
- Symptoms of diabetic ketoacidosis include fruity breath, vomiting, abdominal pain, and fruity-smelling bodily excretions.
- Treatment for diabetic ketoacidosis involves fluid replacement, insulin administration, and electrolyte management.
- Diabetic ketoacidosis is caused by absolute insulin deficiency, leading to the presence of ketones in the blood.
- The breakdown of muscle and fat contributes to the development of diabetic ketoacidosis.
- While more common in type 1 diabetes, diabetic ketoacidosis can also occur in type 2 diabetes.
- The pathophysiology behind diabetic ketoacidosis and hyperglycemic states may involve the secretion of antidiuretic hormone (ADH).
- Chronic complications of diabetes, such as neuropathy, nephropathy, and retinopathy, can arise from prolonged elevated glucose levels.
- Some cells, such as those in the nerves, kidneys, and retinal blood vessels, are particularly sensitive to elevated glucose levels.
- Diabetic neuropathy, nephropathy, and retinopathy are slow-building complications that develop over time.
- These chronic complications do not manifest suddenly and result from long-term uncontrolled hypoglycemia.
- The text does not provide information on how diabetic infections are contracted.
Test your knowledge on the microvascular and macrovascular complications of diabetes mellitus, including neuropathy, nephropathy, retinopathy, and diabetic ketoacidosis. Learn about the pathophysiological processes, symptoms, and treatment strategies associated with these complications.
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