regarding type 1 diabetes mellitus, which one statement is correct: regarding type 1 diabetes...
TRANSCRIPT
![Page 1: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/1.jpg)
![Page 2: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/2.jpg)
Regarding type 1 diabetes mellitusRegarding type 1 diabetes mellitus, ,
which one statement is correct:which one statement is correct:
a.a. Most commonly develops in old age Most commonly develops in old age
b.b. Type 1 diabetes is an autoimmune disease with Type 1 diabetes is an autoimmune disease with
pancreatic beta islet cell destruction caused by T-pancreatic beta islet cell destruction caused by T-
lymphocytes lymphocytes
c.c. Usually not associated with genetic susceptibilityUsually not associated with genetic susceptibility
d.d. Type 1 diabetes is an autoimmune disease with Type 1 diabetes is an autoimmune disease with
pancreatic beta islet cell destruction caused by B-pancreatic beta islet cell destruction caused by B-
lymphocytes lymphocytes
![Page 3: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/3.jpg)
Regarding type 1 diabetes mellitusRegarding type 1 diabetes mellitus,, which which
one statement is correct: one statement is correct:
a.a. Most commonly develops in old age Most commonly develops in old age
b.b. Type 1 diabetes is an autoimmune Type 1 diabetes is an autoimmune
disease with pancreatic beta islet cell disease with pancreatic beta islet cell
destruction caused by T-lymphocytesdestruction caused by T-lymphocytes
c.c. Usually not associated with genetic susceptibilityUsually not associated with genetic susceptibility
d.d. Type 1 diabetes is an autoimmune disease with Type 1 diabetes is an autoimmune disease with
pancreatic beta islet cell destruction caused by B-pancreatic beta islet cell destruction caused by B-
lymphocytes lymphocytes
![Page 4: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/4.jpg)
Regarding type-2 diabetes mellitusRegarding type-2 diabetes mellitus
(DM)(DM), which one statement is correct:, which one statement is correct:
a.a. Genetic factors less important than in type 1 Genetic factors less important than in type 1
DMDM
b.b. There is no link between obesity and DMThere is no link between obesity and DM
c.c. Insulin resistance is the primary event, followed Insulin resistance is the primary event, followed
by progressive pancreatic beta cell destruction by progressive pancreatic beta cell destruction
d.d. Regulation of adipokines may lead to insulin Regulation of adipokines may lead to insulin
resistance resistance
![Page 5: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/5.jpg)
Regarding type-2 diabetes mellitusRegarding type-2 diabetes mellitus
(DM)(DM), which one statement is correct:, which one statement is correct:
a.a. Genetic factors less important than in type 1 Genetic factors less important than in type 1
DMDM
b.b. There is no link between obesity and DMThere is no link between obesity and DM
c.c. Insulin resistance is the primary Insulin resistance is the primary
event, followed by progressive event, followed by progressive
pancreatic beta cell destructionpancreatic beta cell destruction
d.d. Regulation of adipokines may lead to insulin Regulation of adipokines may lead to insulin
resistance resistance
![Page 6: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/6.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using using
fasting plasma glucosefasting plasma glucose
a.a. 6.0 mmol/L6.0 mmol/L
b.b. 5.0 mmol/L5.0 mmol/L
c.c. 4.0 mmol/L4.0 mmol/L
d.d. 7.0 mmol/L7.0 mmol/L
![Page 7: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/7.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using using
fasting plasma glucose levels (FPG):fasting plasma glucose levels (FPG):
a.a. 6.0 mmol/L6.0 mmol/L
b.b. 5.0 mmol/L5.0 mmol/L
c.c. 4.0 mmol/L4.0 mmol/L
d.d. 7.0 mmol/L7.0 mmol/L
![Page 8: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/8.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using two using two
hour plasma glucose levelhour plasma glucose level using 75 using 75
gram oral glucose tolerance test gram oral glucose tolerance test
(OGTT):(OGTT):
a.a. 10.1 mmol/L10.1 mmol/L
b.b. 11.1 mmol/L11.1 mmol/L
c.c. 9.1 mmol/L9.1 mmol/L
d.d. 8.1 mmol/L8.1 mmol/L
![Page 9: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/9.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using using two two
hour plasma glucosehour plasma glucose level using 75 level using 75
gram oral glucose tolerance test gram oral glucose tolerance test
(OGTT):(OGTT):
a.a. 10.1 mmol/L10.1 mmol/L
b.b. 11.1 mmol/L11.1 mmol/L
c.c. 9.1 mmol/L9.1 mmol/L
d.d. 8.1 mmol/L8.1 mmol/L
![Page 10: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/10.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using using
randomrandom plasma glucose levels: plasma glucose levels:
a.a. 10.1 mmol/L10.1 mmol/L
b.b. 9.1 mmol/L9.1 mmol/L
c.c. 11.1 mmol/L11.1 mmol/L
d.d. 8.1 mmol/L8.1 mmol/L
![Page 11: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/11.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus criteria for diabetes mellitus using using
randomrandom plasma glucose levels: plasma glucose levels:
a.a. 10.1 mmol/L10.1 mmol/L
b.b. 9.1 mmol/L9.1 mmol/L
c.c. 11.1 mmol/L11.1 mmol/L
d.d. 8.1 mmol/L8.1 mmol/L
![Page 12: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/12.jpg)
Which one of these satisfy the Which one of these satisfy the
diagnostic criteria for diabetes diagnostic criteria for diabetes
mellitus using mellitus using blood blood glycosylated glycosylated
haemoglobinhaemoglobin levels in levels in
percentages:percentages:
a.a. HbA1c HbA1c << 5.5 % 5.5 %
b.b. HbA1c HbA1c << 4.5 % 4.5 %
c.c. HbA1c HbA1c >> 6.5 % 6.5 %
d.d. HbA1c HbA1c << 3.5 % 3.5 %
![Page 13: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/13.jpg)
Which one of these satisfy the diagnostic Which one of these satisfy the diagnostic
criteria for diabetes mellitus using criteria for diabetes mellitus using blood blood
glycosylated haemoglobin levelsglycosylated haemoglobin levels in in
percentagespercentages::
a.a. HbA1c HbA1c << 5.5 % 5.5 %
b.b. HbA1c HbA1c << 4.5 % 4.5 %
c.c. HbA1c HbA1c >> 6.5 % 6.5 %
d.d. HbA1c HbA1c << 3.5 % 3.5 %
![Page 14: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/14.jpg)
Patients with each of the following Patients with each of the following
conditions may manifest with conditions may manifest with elevated elevated
blood glucose levelsblood glucose levels except: except:
a.a. Pheochromocytoma Pheochromocytoma
b.b. Cushing’s syndrome Cushing’s syndrome
c.c. Glucagonoma Glucagonoma
d.d. Pancreatic beta cell neoplasms Pancreatic beta cell neoplasms
e.e. Elevated Growth hormone Elevated Growth hormone
![Page 15: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/15.jpg)
Patients with each of the following Patients with each of the following
conditions may manifest with conditions may manifest with elevated elevated
blood glucose levelsblood glucose levels except: except:
a.a. Pheochromocytoma Pheochromocytoma
b.b. Cushing’s syndrome Cushing’s syndrome
c.c. Glucagonoma Glucagonoma
d.d. Pancreatic beta cell neoplasmsPancreatic beta cell neoplasms
e.e. Elevated Growth hormone Elevated Growth hormone
![Page 16: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/16.jpg)
Complication of Complication of diabetes mellitus diabetes mellitus
(D.M)(D.M)
Brig Rizwan HashimBrig Rizwan Hashim
Pathology dept Pathology dept
Army Medical CollegeArmy Medical College
![Page 17: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/17.jpg)
![Page 18: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/18.jpg)
Diabetes Mellitus vs Impaired Fasting Glucose/Impaired Glucose Tolerance
DM – Risk of DM – Risk of macrovascularmacrovascular and and microvascularmicrovascular complications complications
IFG/IGT – Risk of IFG/IGT – Risk of macrovascularmacrovascular complications (But not microvascular)complications (But not microvascular)
![Page 19: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/19.jpg)
D.M ComplicationsD.M Complications
Short termShort term Complications: Complications: (metabolic)(metabolic) HypoglycemiaHypoglycemia Diabetic KetoacidosisDiabetic Ketoacidosis Non Ketotic hyperosmolar diabetic Non Ketotic hyperosmolar diabetic
comacoma Lactic acidosisLactic acidosis
![Page 20: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/20.jpg)
Patho-physiology of DKAPatho-physiology of DKA Relative or absolute insulin
deficiency in the presence of catabolic counter-regulatory stress hormones (particularly glucagon and catecholamines, but also growth hormone and cortisol) leads to hepatic overproduction of glucose and ketones.
![Page 21: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/21.jpg)
Patho-physiology of DKA Lack of insulin combined with Lack of insulin combined with
excess stress hormones excess stress hormones promotes promotes lipolysislipolysis, with the , with the release of non-esterified release of non-esterified fatty fatty acidsacids (NEFA (NEFAss) from adipose tissue ) from adipose tissue into the circulation.into the circulation.
![Page 22: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/22.jpg)
Mechanisms of ketoacidosis. NEFA, non-esterifies fatty acids.
![Page 23: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/23.jpg)
Clinical features of diabetic ketoacidosis.
![Page 24: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/24.jpg)
ComplicationsComplications
Long termLong term complications: complications:(microangiopathy)(microangiopathy) Angiopathy, Angiopathy, Retinopathy, Retinopathy, Nephropathy, Nephropathy, NeuropathyNeuropathy
![Page 25: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/25.jpg)
Long termLong term Complications:Complications:
AngiopathyAngiopathy AtherosclerosisAtherosclerosis Hyaline arteriolosclerosisHyaline arteriolosclerosis Diabetic microangiopathyDiabetic microangiopathy
NephropathyNephropathy Nodular glomerulosclerosisNodular glomerulosclerosis
RetinopathyRetinopathy Non Proliferative & ProliferativeNon Proliferative & Proliferative
NeuropathyNeuropathy Peripheral axonal neuropathyPeripheral axonal neuropathy
![Page 26: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/26.jpg)
PathogenesisPathogenesis of of Microangiopathy:Microangiopathy:
LongLong standing diabetes standing diabetes Combination of glucose with proteins - Combination of glucose with proteins -
Particularly collagen in blood vessels - Particularly collagen in blood vessels - GlycosylationGlycosylation..
Excess Excess depositiondeposition of glycosylated type of glycosylated type IV collagen in the basement membraneIV collagen in the basement membrane
ThickThick and and LeakyLeaky blood vessels. blood vessels. Chronic Chronic IschemiaIschemia & & proteinprotein loss into loss into
tissues.tissues. Organ damage...Organ damage...
![Page 27: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/27.jpg)
Microvascular complicationsMicrovascular complications Proposed mechanismsProposed mechanisms
HyperglycaemiaHyperglycaemia- stimulates aldol - stimulates aldol reductase enzymes – metabolise reductase enzymes – metabolise glucose to glucose to sorbitolsorbitol (polyol sugar) - (polyol sugar) - tissue accumulationtissue accumulation
Non-enzymatic glycationNon-enzymatic glycation of of proteins (Amadori products, ‘ proteins (Amadori products, ‘ advanced glycation endproducts’)advanced glycation endproducts’)
![Page 28: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/28.jpg)
C
(CHOH)4
| CH2OH
NH||CH|(CHOH)4
|CH2OH
Glucose Protein
Schiff base
H 0
NH|CH2
|C=O|(CHOH)3
|(CH2OH)
N
N
Protein cross-link in
advanced glycosylation
end products
Amadori product
NH2
ReversibleK1
K-1(hours)
K2 K-2 Reversible (days)
KN
Irreversible (Weeks)
A
![Page 29: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/29.jpg)
![Page 30: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/30.jpg)
Ischemic Stage of Diabetic Retinopathy(low magnification)
The microphotograph shows multiple capillary aneurysms
![Page 31: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/31.jpg)
Pathogenesis of RetinopathyPathogenesis of Retinopathy
![Page 32: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/32.jpg)
Diabetic Eye DiseaseDiabetic Eye Disease
![Page 33: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/33.jpg)
![Page 34: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/34.jpg)
Diabetic RetinopathyDiabetic Retinopathy
Cotton wool spots
![Page 35: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/35.jpg)
![Page 36: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/36.jpg)
![Page 37: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/37.jpg)
New vessels on the iris (rubeosis iridis). There is also vitreous haemorrhage.
![Page 38: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/38.jpg)
Diabetic cataract
![Page 39: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/39.jpg)
Diabetic Diabetic NephropathNephropath
yy
![Page 40: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/40.jpg)
![Page 41: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/41.jpg)
![Page 42: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/42.jpg)
Evolution of diabetic nephropathy
![Page 43: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/43.jpg)
Diabetic GlomerulosclerosisDiabetic Glomerulosclerosis
![Page 44: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/44.jpg)
End-Stage Lesion of Diabetic Nephropathy
The glomerulus in the center of the microphotograph is completely sclerotic. The most common cause of chronic renal failure in the United States is diabetic nephropathy.
![Page 45: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/45.jpg)
Renal Tubules(high magnification)
The basement membrane of the tubules are markedly thickened leading to tubular atrophy and dysfunction
![Page 46: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/46.jpg)
Renal Necrotizing Papillitis
Necrotizing papillitis is can occur in diabetics as a renal complication. The papilla extending into the minor calyces become necrotic as demonstrated in the microphotograph (arrows). Necrotizing papillitis can also be caused by sickle cell disease (vaso-occlusive) and indomethicin (toxicity).
![Page 47: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/47.jpg)
Diabetic Diabetic NeuropathyNeuropathy
![Page 48: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/48.jpg)
![Page 49: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/49.jpg)
Generalized wasting of the interossei (and hypothenar eminence) caused by bilateral ulnar nerve palsies in a diabetic patient.
![Page 50: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/50.jpg)
![Page 51: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/51.jpg)
Neuropathic foot, showing clawed toes, dry skin and prominent veins.
![Page 52: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/52.jpg)
Typical neuropathy ulcer.
Note the surrounding callus.
![Page 53: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/53.jpg)
Distended veins on the dorsum of the foot of a diabetic patient with painful peripheral neuropathy.
![Page 54: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/54.jpg)
Neuroischaemic damage caused by tightly fitting shoes.
![Page 55: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/55.jpg)
MacroMacrovascular Diseases vascular Diseases in Diabetesin Diabetes
![Page 56: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/56.jpg)
Diabetic Macrovascular DiseasePathophysiologyPathophysiology Multiple metabolic changesMultiple metabolic changes Lipid changes in DMLipid changes in DM
- - RaisedRaised total cholesterol, LDL and triglycerides total cholesterol, LDL and triglycerides - - LowLow HDL HDL
LDL subfraction profile (small dense LDL)LDL subfraction profile (small dense LDL) Glycation and peroxidation of:Glycation and peroxidation of:
- Lipoproteins- Lipoproteins - - Thrombotic/thrombolytic factorsThrombotic/thrombolytic factors
![Page 57: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/57.jpg)
![Page 58: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/58.jpg)
Lipid disorder in DMLipid disorder in DM
![Page 59: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/59.jpg)
Motility disorders associated with diabetes at various levels of the gastrointestinal tract.
![Page 60: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/60.jpg)
Candidiasis
![Page 61: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/61.jpg)
Other investigations:
•Serum Urea.
•Serum Creatinine
•Serum Lipid profile: cholesterol; triglyceride; LDL-C; HDL-C.
•Serum sodium, potassium,
•24 hour urine for: protein; creatinine clearance; microalbumin;
•Spot urine for microalbumin
•Spot urine for albumin creatinine ratio- ACR
![Page 62: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/62.jpg)
Other investigations and evaluations:
Blood complete picture
•Urine routine examination: glucose; protein/, albumin, WBC, sp gravity.
•Urine for ketone bodies
•Arterial blood gases-ABG’s
•Ultra sound liver- Fatty liver
•Fundoscopy- for diabetic retinopathy;
•Routine eye exam: diabetic cataract
•Blood pressure measurement
•Examination of feet- ulcer; poor sensations/neuropathy
![Page 63: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/63.jpg)
Insulin pens
Management
![Page 64: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/64.jpg)
Monitoring Monitoring
![Page 65: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/65.jpg)
Metabolic abnormalities leading to Microvascular Metabolic abnormalities leading to Microvascular complications in DMcomplications in DM
![Page 66: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/66.jpg)
Figure 18.4Figure 18.4
![Page 67: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/67.jpg)
Flowchart for the investigation of diabetic ketoacidosis
![Page 68: Regarding type 1 diabetes mellitus, which one statement is correct: Regarding type 1 diabetes mellitus, which one statement is correct: a. Most commonly](https://reader036.vdocuments.site/reader036/viewer/2022062314/56649e185503460f94b04ca2/html5/thumbnails/68.jpg)
The stages and
determinants of diabetic
nephropathy.(AER, albumin
excretion rate.)
Diabetic nephropathy