Diabetes mellitus chronic complications

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

O Diabetes mellitus (DM) describes a group of chronic metabolic disorders that are characterized by hyperglycemia and are associated with long-term microvascular, macrovascular, and neuropathic complications. 

Because side effects can complicate the use of corticosteroids, a careful history and certain tests may be advisable, particularly if a patient may require prolonged ocular therapy. Steroids should be used with great caution in patients with diabetes mellitus, infectious disease, chronic renal feilure, congestive heart feilure, and systemic hypertension. Systemic administration is generally contraindicated in patients with peptic ulcer, osteoporosis, or psychoses. Topical steroids should be used with caution and only when necessary in patients with glaucoma. 

A 27-year-old woman with diabetes mellitus, complicated by diabetic retinopathy and chronic renal insufficiency with anemia, developed methemoglobinemia (11%) after peribulbar blockade with prilocaine 80 mg, bupivacaine 30 mg, hyaluronidase, and napha-zoline (325). She recovered uneventfully after methylthioninium chloride 1.5 mg/kg. 

The Amadori sugar-amino acid residue adducts in proteins are produced with prolonged hyperglycemia and undergo progressive nonenzymatic reactions involving dehydration, condensation, and cyclization. These compounds are collectively known as advanced glycosylation end products and are involved in the chronic complications of diabetes mellitus (cataracts and nephropathy) (Chapter 22). 

One of the chronic complications of diabetes mellitus is diabetic nephropathy, which leads to end-stage renal disease. An initial biochemical parameter of diabetic nephropathy in the asymptomatic state is a persistent... 

ACE inhibitors are well tolerated in most patients but are not absent of side effects. ACE inhibitors decrease aldosterone and can increase potassium serum concentrations. Usually the increase in potassium is small, but hyperkalemia is possible. It is seen primarily in patients with chronic kidney disease or diabetes mellitus and in those on concomitant ARBs, nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics. Judicious monitoring of potassium and serum creatinine values within 4 weeks of starting or increasing the dose of an ACE inhibitor often can identify these abnormalities before they evolve into more serious complications. 

Diabetes mellitus is a group of metabolic diseases characterized by an increased blood glucose level secondary to defects in insulin secretion and/or action. According to the American Diabetes Association, as of 2002, the United States diabetes prevalence is 18.2 million people (6.3% of the population). Diabetics suffer from acute complications of the disease such as diabetic ketoacidosis and hyperosmolar nonketotic syndrome as well as chronic complications ranging from microvascular disease (nephropathy, neuropathy, retinopathy) to macrovascular disease (1). 

Chronically elevated levels of glucose in the blood may contribute to the y w J development of the microvascular complications of diabetes mellitus, such as diabetic retinal damage, kidney damage, and nerve damage, as well as macrovascular complications such as cerebrovascular, peripheral vascular, and coronary vascular insufficiency. The precise mechanism by which long-term hyperglycemia induces these vascular changes is not fully established. 

Sorbinil 282 is a compound of potential therapeutic interest, because it prevents or alleviates the chronic complications of diabetes mellitus, due to its ability to inhibit the enzyme aldose reductase. Sarges et al. prepared 282 and its enantiomer by the reaction sequence shown in Scheme 12.71, involving a brucine resolution of the racemic hydantoin precursor 284. " The free base of brucine forms a crystalline complex with 282, whereas the other enantiomer of 282 only forms a crystalline complex with brucine hydrochloride. Since this resolution technique does not work with certain congeners of sorbinil, a synthesis via an asymmetric induction sequence (Scheme 12.72) has also been developed that seems generically applicable to optically active spiro hydantoins. Both methodsrequired 2,3-dihydro-6-fluoro-47/-l-benzopyran-4-one 283 and the introduction of the amino acid functionality... 

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