Diabetes mellitus type complications

Gestational diabetes mellitus (GDM) complicates roughly 7% of all pregnancies in the United States. Most women will return to normoglycemia postpartum, but 30% to 50% will develop type 2 DM or glucose intolerance later in life. 

The least well characterized autoimmune polyglandular syndrome is the type 3 syndrome. This syndrome is defined by the presence of autoimmune thyroid disease with another autoimmune disease, such as diabetes mellitus type l, autoimmune gastritis, or myasthenia gravis, but in the absence of Addison disease. APGS type 3 primarily involves females (the female to male ratio is 7 1) who have HLA-DR3-associated autoimmune disease and is probably the most common of the autoimmune polyglandular syndrome disorders. Since different and multiple clinical combinations can be found, the classification of this type of autoimmune polyglandular syndrome is probably more complicated than originally anticipated. 

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. 

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. 

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. 

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. 

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. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Diabetes mellitus causes about 50% of all patients being treated for End Stage Renal Disease (ESRD) in the USA and this is because the disease (type 2 disease) is pervasive. Recent studies have shown that the onset and progression of the disease can be ameliorated if treatment is instituted early on in the course of the disease. ESRD is the commonest complication of type 1 diabetes. A higher proportion of individuals with type 2 diabetes was found to have microalbuminuria and overt nephropathy shortly after the diagnosis of diabetes, because the diabetes had actually been present for many years before the diagnosis was made. There is a correlation between the degree of albuminuria and cardiovascular disease. 

Contraindications Diabetic complications, such as ketosis, acidosis, and diabetic coma monotherapy for type 1 diabetes mellitus severe hepatic or renal impairment stress situations, including severe infection, trauma, and surgery... 

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl 3 Med 2003 348 2294. 

Tamura Y, Tsukamoto K, Yakamoto N, Ishibashi S, Kadowaki T, Kimura S. A case of buformin treated type 2 diabetes mellitus without any other underlying disease complicated by acute renal failure, lactic acidosis, subsequent diarrhea and vomiting [Japanese]. Tonyobyo 2003 46 325-7. 

Persson B, Swahn ML, Hjertberg R, Hanson U, Nord E, Nordlander E, Hansson LO. Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus. Diabetes Res Clin Pract 2002 58(2) 115-21. 

The UK Prospective Diabetes Study (3) has shown that timely treatment, by reducing blood glucose concentrations before subjective complaints develop, reduces secondary complications in type 2 diabetes mellitus. 

Uzu T, Ichida K, Ko M, Tsukurimichi S, Yamato M, Takahara K, Ohashi M, Yamauchi A, Nomura M. [Two cases of lithium intoxication complicated by type 2 diabetes mellitus.]J Jpn Diabetes Soc 2001 44 767-70. 

Physical therapists and occupational therapists may help reinforce the importance of patient compliance during pharmacologic management of diabetes mellitus. Therapists can question whether patients have been taking their medications on a routine basis. Regular administration of insulin is essential in preventing a metabolic shift toward ketone body production and subsequent ketoacidosis, especially in patients with type 1 diabetes. In addition, therapists can help explain that adequate control of blood glucose not only prevents acute metabolic problems but also seems to decrease the incidence of the neurovascular complications. 

Correa RC, Alfieri A. Plasmatic nitric oxide, but not Willebrand factor, is an early marker of endothelial damage, in type 1 diabetes mellitus patients without microvascular complications. Journal of Diabetes and Its Complications 2003, 17, 264-268. 

Fadini GR Miorin M, Facco M, et al. Circulating endothelial progenitor cells are reduced in peripheral vascular complications of type 2 diabetes mellitus. J Am Coll Cardiol 2005 45 1449-1457. 

B. Buckingham and K. M. Reiser, Relationship between content of lysyl oxidase-dependent cross-links in skin collagen, nonenzymatic glycosylation, and long-term complications in type I diabetes mellitus, J. Clin. Invest., 1990, 86, 1046-1054. 

Pathogenesis and complications (A). Type I diabetes mellitus typically manifests in childhood or adolescence (juvenile onset diabetes mellitus) it is caused by the destruction of insulin-producing B cells in the pancreas. A genetic predisposition together with a precipitating factor (viral infection) could start an autoimmune reaction against B-cells. Replacement of insulin (daily dose-40U, equivalent to -1.6 mg) becomes necessary. 

Q8 In type 1 diabetes, because of a lack of insulin, a high level of triglyceride is stored in the liver and can subsequently be converted to phospholipids and cholesterol. Hepatocytes synthesize VLDLs, which can be converted to other types of lipoproteins. These lipoproteins are major sources of cholesterol and triglycerides for most other tissues. They leave the liver, enter the blood and can result in rapid development of vascular atherosclerosis. Increased levels of atherogenic oxidized low-density lipoproteins (LDLs) are seen in hyperglycaemic individuals and contribute to macrovascular disease, which is a complication of diabetes mellitus. 

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