Semiology of diabetes mellitus
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Semiology of diabetes mellitus
- 1. Semiology of Diabetes Mellitus Daniel Fernando Isuhuaylas Aguirre
- 2. What is Diabetes? • Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
- 3. Pathogenic processes involved HYPERGLYCEMIA Autoimmune destruction of the β-cells of the pancreas (resistance to insulin action) Deficient action of insulin on target tissues. Inadequate insulin secretion and/or diminished tissue responses to insulin.
- 4. β – Cell dysfunction and IR β – Cell dysfunction INSULIN RESISTANCE Glucose Uptake insulin secretion Glucose Production Lipolysis FFA Blood glucose Factors
- 8. Symptoms Weight loss Polyphagia • Acute, life-threatening Polyuria Blurred vision Polydipsia Hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.
- 9. Long-term complications Hypertension and abnormalities of lipoprotein metabolism Atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease.
- 10. Long-term complications Retinopathy • Loss of vision Nephropathy • Renal Failure Peripheral neuropathy • Risk of foot ulcers, amputations, and Charcot joints Autonomic neuropathy • Gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction
- 12. Criteria for the diagnosis of diabetes
- 13. Natural progression Normal IGT DM2 Fasting plasma glucose Insulin Sensitivity Insulin Secretion Insulin sensitivity Normal insulin secretion Normoglycemia Hyperglicemia Insulin resistance β-cell failure DM2 + Long-term complications insulin resistance
- 14. Long-term complications • Macroangiopathy • Microangiopathy • Neuropathy CVD Cerebrovascular Disease Vascular disease of the lower limbs Retinopathy Nephropathy Symmetric sensory polyneuropathy Mononeuropathy Autonomic neuropathy • Diabetic Foot
- 15. Long-term complications • biochemical alterations • functional alterations REVERSIBLE STAGE IRREVERSIBLE • Structural alterations STAGES
- 16. Diabetic Nephropathy DIABETES MELLITUS GENETICS HYPERGLYCEMIA Diabetic Nephropathy THICKENING CAPILLARY BASAL GLOMERULAR EXPANSION OF THE MATRIX ↑ PRESSURE MEMBRANE
- 17. Stages • Hyperfiltration and renal hypertrophy • Normoalbuminuria • Incipient diabetic nephropathy: microalbuminuria • Clinical Diabetic Nephropathy: Proteinuria • End Stage Renal Disease
- 18. Diabetic Retinopathy FUNCTIONAL AND MORPHOLOGICALNS HEMODYNAMIC ALTERATIO HYPERGLYCEMIA LOST PERICYTES VASODILATION OF CAPILLARIES BASAL MEMBRANE ALTERATION LOSS OF ENDOTHELIAL acellular capillaries Hypoxia ↑VPF VEGF Neoformation CAPILLARIES RD NO PROLIFERATIVE RD PRE PROLIFERATIVE RD PROLIFERATIVE
- 19. DIABETIC RETINOPATHY NO PROLIFERATIVE LIGHT NO PROLIFERATIVE PROLIFERATIVE NO PROLIFERATIVE
- 21. DISTAL AND SYMMETRIC PERIPHERAL NEUROPATHY Symptoms • Asymptomatic • Numbness • Paresthesias • Hyperesthesia • Pain Signs • ↓ Sensitivity • Weakness • Atrophy
- 22. Mononeuropathy NERVIO FEMORAL AMIOTROFIA PARES CRANEANOS
- 24. Diabetic Foot • In patients with peripheral neuropathy incidence annual foot injuries is 7.2%. • The etiology, 60% of injuries are neuropathic, 30% are neuro-ischemic and ischemic 10%. • Injuries are related to patient age, the glycemic control and age of the disease.
- 25. Diabetic FootDiabetic Foot Peripheral neuropathy Loss of sensation Muscle atrophy Change in foot pressure areas Developing new lines of force Micro trauma Ulceration in the foot.
- 26. Diabetic Foot
- 27. Diabetic Foot • Risk Factors – Decrease or abolition of aquiliano reflex. – Decrease or abolition of vibratory sensation. – Orthopedic disorders: • Hammer toes. • Hallux valgus. • Calluses • Atrophy of foot muscles themselves. • Pes cavus with deformed anterior arch. – Decrease or abolition of tibial and dorsalis pedis pulses. – History of previous ulcer.
- 28. Clinical Examinatios • Coloration: – Rubicund in neuropathy, venous engorgement. – Pale in ischemia. • Temperature: – Hot in neuropathy. – Cold in ischemia. • Skin alterations – Dry skin. – Presence of calluses. • Others – Limitation of joint mobility. – Atrophy of intrinsic foot muscles. – Examination of reflexes, pulse, vibration sensitivity.
- 30. References • Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care, Volume 33, Supplement 1, January 2014. Care.diabetesjournals.org • Standards of Medical Care in Diabetes. American Diabetes Association. Diabetes Care, Volume 33, Supplement 2, January 2014. Care.diabetesjournals.org • Foot Care. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee Keith Bowering MD, FRCPC, FACP John M. Embil MD, FRCPC, FACP. March 2014.
- 31. Instrumentation • Fingerboard 128 mHz • Semmens Weinstein monofilament 10 g • Radiographs of both feet with support, front and profile • Doppler • Arteriography prior to surgery
- 32. Thank you for your attention