Tips for the revision period:

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Tips for the revision period

• Leave plenty of time to revise
• Develop a timetable
• Take short breaks.
• Try several revision techniques
• Don't drink too much coffee/drugs
• Regular moderate exercise Walk, Yoga, tai chi
  etc. improve your concentration levels and help
  you to sleep better.

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Pathology of Diabetes

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Introduction

• Diabetes mellitus (sweet urine)
• 3 of world population, 100 million people
• Commonest non communicable disease
• High Morbidity mortality

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Diabetes Mellitus

• Disorder of metabolism (Carb, Prot Fat)
• Due to Absolute or relative deficiency of
  insulin.
• Characterized by hyperglycemia.
• Clinically Polyuria, Polydypsia, Polyphagia.

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Classification

• Primary DM.
• Type I IDDM / Juvenile 10.
• Type II NIDDM /Adult onset 80.
• MODY 5 maturity onset - young - Genetic
• Secondary DM islet destruction.
• Infectious congenital rubella, CMV.
• Pancreatitis/tumors/Hemochromatosis.
• Endocrinopathy, gestational DM, downs.
• Drugs Corticosteroids.

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Normal Pancreatic Islets
ß cells Glucagon cells
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Pathogenesis of Type I DM
Environment ? Viral infe..??
Genetic HLA-DR3/DR4
Autoimmune Insulitis
ß cell Destruction
Severe Insulin deficiency
Type I DM
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Pathogenesis of Type II DM
Environment Obesity ???
ß cell defect Genetic
Insulin resistance
Abnormal Secretion
Relative Insulin Def.
ß cell exhaustion
IDDM
Type II DM
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Type-I Type-II

• Age lt 40 Years
• Duration Weeks
• Ketonuria Common
• Insulin- Dependent
• Autoantibody Yes
• Family History No
• Insulin levels very low
• Islets Insulitis
• Complications
• Acute Metabolic

• gt 40 Years
• Months to years
• Rare
• Independent
• No
• Yes
• Normal or high
• Normal / Exhaustion
• Complications
• Late and vascular.

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Insulitis Type I
Insulinitis
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Islets in Type II Diabetes

• Loss of ß cells
• Amyloid deposits
• Hyalinization

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Complications

• Short term Complications (metabolic)
• Hypoglycemia
• Diabetic Ketoacidosis
• Non Ketotic hyperosmolar diabetic coma
• Lactic acidosis
• Long term Complications(microangiopathy)
• Angiopathy, Retinopathy, Nephropathy, Neurophathy

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Pathogenesis of Microangiopathy

• Long standing diabetes
• Combination of glucose with proteins -
  Particularly collagen in blood vessels -
  Glycosylation.
• Excess deposition of glycosylated type IV
  collagen in the basement membrane
• Thick and Leaky blood vessels.
• Chronic Ischemia protein loss into tissues.
• Organ damage...

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Microangiopathy
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Long term Complications

• Angiopathy
• Atherosclerosis
• Hyaline arteriolosclerosis
• Diabetic microangiopathy
• Nephropathy
• Nodular glomerulosclerosis
• Retinopathy
• Non Proliferative Proliferative
• Neuropathy
• Peripheral axonal neuropathy

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Neuropathy
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Diabetic Gangrene
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Candidiasis
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Pathogenesis of Retinopathy
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Normal Retina
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Diabetic Retinopathy
Cotton wool spots
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Proliferative Retinitis

• Neovascularization
• Haemorrhagia
• Fibroplasia
• Retinal detachment
• Laser cauterization

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Pathogenesis of Nephropathy
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Diabetic Glomerulosclerosis
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Laboratory Diagnosis

• Urine glucose - dip-stick Screening
• Random or fasting blood glucose (lt11)
• Fasting gt 7mmol, Random gt11mmol
• If Fasting level is between 7-11 then OGTT
• HbA1c - for follow-up, not for diagnosis
• Fructosamine - for long term maintenance.

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Points to remember

• Type-I - Acute Metabolic complications
• Ketoacidosis.
• Type-II - Chronic Vascular complications
• Microangiopathy Kidney,Retina,Brain, BV.
• Hypoglycemia is more dangerous. Not hyper
• Infections are due to microangiopathy and
  ischemia, immuno suppression and hyperglycemia.
  (not just hyperglycemia)

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Tips for the exam itself

• Avoid panic. Panicking will just make it harder
• close your eyes and take several long, slow deep
  breaths.
• mentally repeating "I am calm and relaxed" or "I
  know I will do fine".
• If you still can't remember the information then
  move on to another question and return to this
  question later.
• don't spend endless time criticising yourself for
  where you think you went wrong.
• Congratulate yourself - for the things you did
  right,
• learn from the bits - Important.