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131231L - HISTORY TAKING DISORDERS OF THE ENDOCRINE PANCREAS ESPECIALLY DIABETES (Word Slide)

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Session by Dr Omar Hasan Kasule Sr. for 4th year medical students on December 31, 2013


Comparison of two types of diabetes


Type 1 (insulin dependent)
Type 2 (non insulin dependent)
Age
<30 yr
>30 yr
Weight
Lean
Overweight
Heredity
Genetic susceptibility
Genetic determination
Metabolic syndrome
Na
Associated (HT, CVA, MI, obesity, lipids etc)
Pathogenesis
Auto immune, ? environment
Not auto immune, Insulin resistance
Other factors
Environment
Early malnutrition
Insulin
Deficiency
Partial deficiency
Complications
Ketoacidosis
Hyperosmolar state
Biochemical
C-peptide eventually disappears
C-peptide persists

Clinical presentation
·         Asymptomatic: usually discovered on routine screening
·         Symptoms: thirst, polyuria,  weight loss,? polyphagia,

Arterial /macrovasculsr complications problems
·         HT
·         MI
·         Gangrene

Microvascular complications
·         diabetic retinopathy
·         cataract

Diabetic nephropathy
·         Albuminuria
·         renal failure
·         anemia
·         UTI

Diabetic neuropathy
·         sensory polyneuropathy
·         acute painful neuropathy

Autonomic neuropathy
·         tachycardia due to vagal neuropathy
·         postural hypotension due to loss of sympathetic tone
·         bladder dysfunction
·         male erectile dysfunction


Two forms of diabetic foot: ischemic vs neuropathic

Ischemic
Neuropathic
Symptoms
Claudication, pain at rest
Usually painless, may be painful
Appearance
Redness, skin changes
No skin changes, toes clawed
Palpation
Cold, pulseless
Warm. Strong pulse
Ulceration
Painless on heels and toes
Painless on plantar aspect