endocrine and metabolic disorders
Complications of Diabetes Mellitus
Introduction
In patients with Diabetes Mellitus (DM) , years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular), or both. The mechanisms by which vascular disease develops include Glycosylation of serum and tissue proteins with formation of advanced glycation end products Superoxide production Activation of protein kinase C, a signaling molecule that increases vascular permeability and causes endothelial dysfunction Accelerated hexosamine biosynthetic and polyol pathways leading tosorbitolaccumulation within tissues Hypertension and Arterial microthromboses Proinflammatory and prothrombotic effects of hyperglycemia and hyperinsulinemia that impair vascular autoregulation Microvascular diseaseunderlies 3 common and devastating manifestations of diabetes mellitus: Diabetic Retinopathy None Diabetic Nephropathy None Diabetic Neuropathy None Microvascular disease may also impair skin healing, so that even minor breaks in skin integrity can develop into deeper ulcers and easily become infected, particularly in the lower extremities. Intensive control of plasma glucose can prevent or delay many of these complications but may not reverse them once established. Macrovascular diseaseinvolves atherosclerosis of large vessels, which can lead to Angina Pectoris and Transient Ischemic Attack (TIA) and Peripheral Arterial Disease None is another major complication and develops from the direct effects of hyperglycemia on Cellular Components of the Immune System . Patients with diabetes mellitus are particularly susceptible to bacterial and fungal 