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Pathophysiology of Microvascular Changes in Diabetes Mellitus
Diabetes Update Case Study K.R. is a 50 year old homemaker. She has always been a little overweight, but now that she is in menopause, her weight has increased to 180 lbs. Her height is 5’5”. She was diagnosed with Diabetes Mellitus about 2 years ago. Initially Kelly did well with just one medication, diet and exercise. However, at her last two visits her Hgb A1C was greater than 8% with fasting blood sugars of 190 mg/dL. Therefore, Januvia has been added to her medications. KR has also been admonished to increase her exercise to 20 minutes of aerobic exercise three times a week. Although she did join a gym her busy schedule is such that she can only do aerobic exercise for 15 minutes 2 times during the weeks. Medications: Metformin 500 mg tablets PO BID Januvia 50mgs PO BID
Describe the pathophysiology of the microvascular changes that are seen with DM. What symptoms would she have as these develop?
Pathophysiology of Microvascular Changes in Diabetes Mellitus
Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Over time, uncontrolled diabetes can lead to various complications, including microvascular changes that affect small blood vessels throughout the body. Understanding the pathophysiology of these microvascular changes is crucial for managing and preventing complications in individuals like K.R. with diabetes.
Pathophysiology of Microvascular Changes:
1. Hyperglycemia: Persistent high levels of glucose in the blood, as seen in uncontrolled diabetes, can damage the endothelial cells lining the small blood vessels. This damage triggers a cascade of inflammatory responses and oxidative stress, contributing to microvascular complications.
2. Advanced Glycation End Products (AGEs): Elevated glucose levels lead to the formation of Advanced Glycation End Products, which accumulate in tissues and disrupt normal cellular function. AGEs contribute to the development of microvascular complications by promoting inflammation and fibrosis.
3. Polyol Pathway: In diabetes, excess glucose is shunted through the polyol pathway, leading to the accumulation of sorbitol and fructose in tissues. This process contributes to osmotic stress, cellular dysfunction, and oxidative damage in small blood vessels.
4. Activation of Protein Kinase C (PKC): Prolonged hyperglycemia activates Protein Kinase C, a signaling molecule that plays a role in vascular permeability, angiogenesis, and inflammation. PKC activation contributes to microvascular changes by altering vascular function and promoting vascular remodeling.
Symptoms of Microvascular Changes:
1. Diabetic Retinopathy: Microvascular changes in the retina can lead to diabetic retinopathy, characterized by symptoms such as blurred vision, floaters, vision loss, and difficulty seeing at night. Retinopathy can progress to more severe stages, including proliferative retinopathy and macular edema.
2. Diabetic Neuropathy: Microvascular changes affecting nerves can result in diabetic neuropathy, causing symptoms such as numbness, tingling, burning pain, and weakness in the extremities. Neuropathy can impact sensory, motor, and autonomic nerves, leading to complications such as foot ulcers and gastroparesis.
3. Diabetic Nephropathy: Microvascular changes in the kidneys can lead to diabetic nephropathy, characterized by proteinuria, hypertension, fluid retention, and declining kidney function. Patients may experience symptoms such as edema, fatigue, anemia, and decreased urine output as nephropathy progresses.
4. Peripheral Vascular Disease: Microvascular changes in peripheral blood vessels can result in poor circulation to the extremities, causing symptoms such as leg pain, cramping, slow wound healing, cold feet, and increased risk of infections and ulcers.
In conclusion, the pathophysiology of microvascular changes in diabetes involves a complex interplay of hyperglycemia-induced mechanisms that damage small blood vessels throughout the body. Recognizing the early signs and symptoms of microvascular complications is essential for timely intervention and management to prevent further progression and improve outcomes for individuals like K.R. with diabetes.