4. Hyperglyceamia Nonenzymatic glycosylation of collagen and other proteins in interstitial tissue and blood vessel wall Formation of irreversible advanced glycosylation end products ( AGES ) Cause cross link between polypeptides Trap plasma and interstitial proteins including LDL Promote the deposition of cholesterol in the blood vessel intima Accelerated the process of atherogenesis Formation of atherosclerotic plaque Atherosclerosis
5. Glucose Sorbitol Fructose NADPH + H + NADP + NAD + NADH + H + Aldose reductase Polyol dehydrogenase Disturbance in polyol pathway GSH (reduced) GSSG (oxidized) Glutathione reductase
6. Hyperglycaemia stimulate polyol pathway accumulation sorbitol + fructose in Schwann cells Increase IC osmolality influx of water osmotic cell injury damage schwann cell (demyelination ) axon degeneration irreversibly disrupt neural function Diabetic neuropathy
10. b) Neuropathy Neuropathy Motor Sensory Autonomic ↓ nociception ↓ Proprioception, Unawareness of foot position Reduced sweating Dry skin Fissures and cracks Muscle wasting Foot weakness Postural deviation Deformities, stress and shear pressures Trauma Stress on bones & joints Plantar pressure Callus formation Infection Ulcer
11.
12. Claw toe Severe atrophy of the intrinsic foot muscles (lumbrical & interossei) d/t motor neuropathy resulted in imbalance of foot muscles & cocked-up toes.
19. Diffentiation of Ischaemic and Neuropathy Ulcer Painless Sites of pressures (metatarsal heads, heels) Painful At the distal and over bony prominences Ulceration Warm palpable pulses Cold Pulseless Palpation High arch + clawing of toes No trophic changes Surrounded by callus Dependent rubor Trophic changes Gangrenous digits Inspection Usually painless Or painful neuropathy Claudication Rest pain Symptoms Neuropathy Ischaemia