Semiology of diabetes mellitus

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Semiology of Diabetes Mellitus

Semiology of Diabetes MellitusDaniel Fernando Isuhuaylas AguirreWhat is Diabetes?Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. 2Pathogenic processes involved Cell dysfunction and IR

Cell dysfunctionINSULIN RESISTANCE Glucose Uptake Blood glucose FFA Glucose Production insulin secretion LipolysisFactors

SymptomsAcute, life-threatening Hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.Long-term complicationsLong-term complications

Criteria for the diagnosis of diabetes

Natural progressionNormalIGTDM2Fasting plasma glucose Insulin Sensitivity Insulin SecretionInsulin sensitivityNormal insulin secretionNormoglycemiaHyperglicemia-cell failureInsulin resistance

DM2 + Long-term complicationsinsulin resistanceLong-term complications Macroangiopathy Microangiopathy NeuropathyCVD Cerebrovascular Disease Vascular disease of the lower limbsSymmetric sensory polyneuropathy Mononeuropathy Autonomic neuropathyRetinopathy Nephropathy Diabetic FootLong-term complicationsDiabetic Nephropathy GENETICS HYPERGLYCEMIA

Diabetic NephropathyDIABETES MELLITUSTHICKENING CAPILLARY BASAL GLOMERULAR

EXPANSION OF THE MATRIX PRESSURE MEMBRANEStagesHyperfiltration and renal hypertrophy Normoalbuminuria Incipient diabetic nephropathy: microalbuminuria Clinical Diabetic Nephropathy: Proteinuria End Stage Renal DiseaseDiabetic RetinopathyFUNCTIONAL AND MORPHOLOGICALNS HEMODYNAMIC ALTERATIOHYPERGLYCEMIALOST PERICYTESVASODILATION OF CAPILLARIESBASAL MEMBRANE ALTERATIONLOSS OF ENDOTHELIAL acellular capillaries

Hypoxia

VPF VEGF Neoformation CAPILLARIES

RD NO PROLIFERATIVERD PRE PROLIFERATIVERD PROLIFERATIVEDIABETIC RETINOPATHYPROLIFERATIVENO PROLIFERATIVE LIGHTNO PROLIFERATIVENO PROLIFERATIVE

Diabetic Neuropathy

DISTAL AND SYMMETRIC PERIPHERAL NEUROPATHYSymptoms Asymptomatic NumbnessParesthesiasHyperesthesiaPainSigns Sensitivity Weakness Atrophy

MononeuropathyNERVIO FEMORAL AMIOTROFIAPARES CRANEANOS

Autonomic Neuropathy

Diabetic FootIn 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.Diabetic FootDiabetic FootDiabetic Foot

Diabetic FootRisk FactorsDecrease 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.Clinical ExaminatiosColoration: Rubicund in neuropathy, venous engorgement. Pale in ischemia. Temperature: Hot in neuropathy. Cold in ischemia. Skin alterationsDry skin. Presence of calluses. OthersLimitation of joint mobility. Atrophy of intrinsic foot muscles.Examination of reflexes, pulse, vibration sensitivity.

ReferencesDiagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care, Volume 33, Supplement 1, January 2014. Care.diabetesjournals.orgStandards of Medical Care in Diabetes. American Diabetes Association. Diabetes Care, Volume 33, Supplement 2, January 2014. Care.diabetesjournals.orgFoot Care. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee Keith Bowering MD, FRCPC, FACP John M. Embil MD, FRCPC, FACP. March 2014.

InstrumentationFingerboard 128 mHz Semmens Weinstein monofilament 10 g Radiographs of both feet with support, front and profile Doppler Arteriography prior to surgery

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