Diabetes mellitus complications

Wei J, Wu J, Jiang J, Wang S, Wang Z. (2004) Clinical study on improvement of type 2 diabetes mellitus complicated with fatty liver treatment by berberine. Zhong Xi Yi Jie He Ganbing Za Zhi 14 334-336. 

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. 

Huang SY, Jeng C, Kao SC, Yu, JJH, Liu DZ. Improved haemorrheological properties by Gingko biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy. Clin Nutr 2004 23 615-621. 

It has been proposed that the development of the complications of diabetes mellitus may be linked to oxidative stress and therefore might be attenuated by antioxidants such as vitamin E. Furthermore, it is discussed that glucose-induced vascular dysfunction in diabetes can be reduced by vitamin E treatment due to the inactivation of PKC. Cardiovascular complications are among the leading causes of death in diabetics. In addition, a postulated protective effect of vitamin E (antioxidants) on fasting plasma glucose in type 2 diabetic patients is also mentioned but could not be confirmed in a recently published triple-blind, placebo-controlled clinical trial [3]. To our knowledge, up to now no clinical intervention trials have tested directly whether vitamin E can ameliorate the complication of diabetes. 

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. 

Insulin is necessary for controlling type 1 diabetes mellitus that is caused by a marked decrease in the amount of insulin produced by die pancreas. Insulin is also used to control the more severe and complicated forms of type 2 diabetes mellitus. However, many patients can control type 2 diabetes with diet and exercise alone or with diet, exercise, and an oral antidiabetic drug (see section Oral Antidiabetic Dmgp ). Insulin may also be used in the treatment of severe diabetic ketoacidosis (DKA) or diabetic coma. Insulin is also used in combination with glucose to treat hypokalemia by producing a shift of potassium from die blood and into die cells. 

The neuromuscular complications of diabetes mellitus are most often neuropathic in origin, with distal sensorimotor polyneuropathies being the most common. In addition, ischemic infarction of skeletal muscle may occur due to occlusive vascular disease, with small and medium-sized arterioles particularly affected. This occurs in poorly-controlled diabetes and affects thigh, muscles in most cases. In acute stages, muscle biopsy findings are those of widespread muscle necrosis, edema, and phagocytic cell infiltration. Muscle regeneration may be incomplete and increased fibrous connective tissue may replace lost muscle tissue. 

Cillery, P., Monboisse, J.C., Maquart, F.X. and Borel, J.P. (1989). Does oxygen free radical increased formation explain long term complications of diabetes mellitus Med. Hypothesis 29, 47-50. 

Monnier, V.M., Vishwaneth, V., Frank, K.E., Elmets, G.A., Dauchot, P. and Kohn, R.R. (1986). Relation between complications of type Iv diabetes mellitus and collagen-linked fluorescence. N. Engl. J. Med. 314, 403-408. 

Sinclair A.J. (1993). Free radical mechanisms and vascular complications of diabetes mellitus. Diabet. Rev. 2, 7-10. 

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. 

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl I Med 1993 329 977-986. 

Foot ulcers and related infections are among the most common, severe, and costly complications of diabetes mellitus (DM). Fifteen percent of all patients with DM develop at least one foot ulcer, resulting in direct health care expenditures of approximately 9 billion annually in the United States.26,27 Diabetic foot ulcers and wounds are highly susceptible to infection. Related skin, soft tissue, and bone infections account for 25% of all diabetes-related hospitalizations.28 More than half of all nontraumatic lower extremity amputations (LEAs) performed each year in Western nations are linked to diabetic foot infection 80,000 LEAs are performed annually in the United States alone.29,30... 

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. 

Intravenous lipid emulsions are also a source of calories. The typical daily dose in adults is approximately 0.5 to 1 g/kg per day. In the absence of hypertriglyceridemia, substituting a portion of dextrose calories with lipid calories may be beneficial in situations where dextrose infusion may lead to complications (e.g., hyperglycemia). Some examples include patients with diabetes mellitus or pancreatic disease and patients under severe stress (e.g., trauma or burns) who are at risk for hyperglycemia. The maximum of dose of lipid emulsions is 2.5 g/kg per day,7 or 60% of total daily calories, although doses this high are used rarely in practice. 

Vitamin B6 (pyridoxine) and its derivative pyridoxamine are apparently able to inhibit superoxide production, reduce lipid peroxidation and glycosylation in high glucose-exposed erythrocytes [353], It was suggested that the suppression of oxidative stress in erythrocytes may be a new mechanism by which these natural compounds inhibit the development of complication in diabetes mellitus. 

Large quantities of pure insulin are required for the treatment of diabetes mellitus (see p. 160). The annual requirement for insulin is over 500 kg in a country the size of Germany. Formerly, the hormone had to be obtained from the pancreas of slaughtered animals in a complicated and expensive procedure. Human insulin, which is produced by overexpression in genetically engineered bacteria, is now mainly used (see p.262). 

This drug is also a derivative of first generation of sulfonylurea, and it possesses stimulatory action on 8-cells in pancreas, as well as the same range of action as all other drugs of the group of examined compounds. Tolazamide is used for non-insulin-dependeut diabetes mellitus without expressed microvascular complications. Synonyms of this drug are uor-glycin, tolanase, and others. 

Hypersensitivity to sulfonylureas diabetes complicated by ketoacidosis, with or without coma sole therapy of type 1 (insulin-dependent) diabetes mellitus diabetes when complicated by pregnancy. 

Lactic acidosis Lactic acidosis is a rare, but serious, metabolic complication that can occur because of metformin accumulation during treatment when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis also may occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever... 

The cornerstone of treatment in primary hyperlipidemia is diet restriction and weight reduction. Limit or eliminate alcohol intake. Use drug therapy in conjunction with diet, and after maximal efforts to control serum lipids by diet alone prove unsatisfactory, when tolerance to or compliance with diet is poor or when hyperlipidemia is severe and risk of complications is high. Treat contributory diseases such as hypothyroidism or diabetes mellitus. 

Vander Jagt, D. L. (2008). Methylglyoxal, diabetes mellitus and diabetic complications. Drug Metabol. Drug Interact. 23, 93-124. 

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