Potential complications associated with diabeties mellitus for 4 mark
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Based on the textbook content, here is a well-structured 4-mark answer on complications of diabetes mellitus:
Complications of Diabetes Mellitus
The long-term complications of diabetes arise from sustained hyperglycemia through four main mechanisms: formation of Advanced Glycation End-products (AGEs), activation of Protein Kinase C (PKC), disturbances in the polyol pathway, and overload of the hexosamine pathway. - Robbins, Cotran & Kumar Pathologic Basis of Disease, p.1027
Complications are broadly classified as:
1. Microvascular Complications (Small Vessel Disease)
These are directly related to hyperglycemia and are reduced by tight glycemic control.
- Diabetic Retinopathy - characterized by microaneurysms, retinal infarcts, lipid exudates, cotton wool spots, and microhemorrhages (preproliferative); may progress to proliferative retinopathy with new vessel formation, vitreous hemorrhage, and blindness. It is the 5th leading cause of severe vision loss worldwide.
- Diabetic Nephropathy - affects 20-40% of patients; manifests as proteinuria, progressive decline in GFR, and can lead to end-stage renal disease.
- Diabetic Neuropathy - peripheral neuropathy (sensory loss, pain, foot ulcers) and autonomic neuropathy (postural hypotension, gastroparesis, bladder dysfunction).
2. Macrovascular Complications (Large Vessel Disease)
- Atherosclerosis - accelerated coronary artery disease leading to ischemic heart disease (the most common cause of death in diabetics).
- Peripheral vascular disease - lower extremity ischemia, contributing to diabetic foot and risk of gangrene/amputation.
- Cerebrovascular disease - increased risk of stroke.
3. Other Complications
- Cataracts and glaucoma (ocular)
- Increased susceptibility to infections (e.g., UTIs, skin infections, tuberculosis) due to impaired neutrophil function
- Diabetic foot - combination of neuropathy + ischemia + infection
Summary Table:
| Type | Complication |
|---|---|
| Microvascular | Retinopathy, Nephropathy, Neuropathy |
| Macrovascular | Ischemic heart disease, PVD, Stroke |
| Other | Cataracts, infections, diabetic foot |
- Washington Manual of Medical Therapeutics, p.903; Robbins & Cotran Pathologic Basis of Disease, p.1026
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