Now that we established the definition of
hyperglycemia and all the differentials we’ve
looked at, let us now take a look at complications
specifically for type I and type II diabetes.
We will organize our complications initially
with acute and chronic and as we move forward,
we will then take a look at some of these
issues and complications in much greater detail.
With acute complication type I diabetes, if
not controlled properly, the patient maybe
in a state of ketoacidosis.
Remember that this would be an endogenous
production of keto acids, therefore would
be referred to as being or experiencing metabolic
acidosis with an anion gap, which we shall
Type II diabetes mellitus, if untreated, complications
here acutely rarely would it be diabetic ketoacidosis,
but it would be hyperosmolar, hyperglycemic
state or sometimes worst case scenario hyperosmolar,
hyperglycemic type of coma, but it would be
The reason in type II diabetes to be non-ketotic
is because there might be residual amounts
of insulin and just enough insulin and make
sure that your biochemistry is strong here,
that if you have just enough insulin that
you may not be forced to break down your lipid
and have beta oxidation taking place.
So, therefore, the hyperosmolar is being caused
by the hyperglycaemia in type II diabetes
if it’s uncontrollable.
Remember all these mellitus and now that we’re
doing medicine, let’s be a little bit more
technical versus insipidus.
Remember that in insipidus, you will have
and mellitus, you would have both polydipsia
However, in insipidus, you would not have
Our focus beyond acute is chronic complications.
The chronic complications would be quite similar
for both type I and type II diabetes mellitus
if left untreated or poorly controlled.
If it’s type I diabetes, then the complications
chronically would be accelerated only because
remember the glycemic control in type I, if
uncontrolled, can be quite variable.
Whereas in type II diabetes mellitus, the
one that we see quite a bit is chronic complications
and here refer to decades; the microvascular
diseases you may then end up having diabetic
retinopathy, diabetic nephropathy and diabetic
neuropathy and we call this stock and glove
type of complication.
The macrovascular disease will be coronary
arterial disease, peripheral vascular disease
or stroke being caused by what’s known as
atherosclerosis in your arteries and referred
to cerebrovascular accident or cerebrovascular
Now, keep in mind that you want to know in
great detail what kind of complications are
taking place within these blood vessels.
So, therefore, if it’s macrovascular, you
are referring to arterial or arteriole thus
more commonly you would find atherosclerosis.
If you’re referring to microvascular, then
you are referring to arterioles.
Would you please tell me what kind of... what
sort of arteriolosclerosis will be taking
place within arterioles in diabetes?
It would be hyaline arteriolosclerosis.
Lastly, just to make sure that we are completely
comfortable with our complications within
our blood vessel, more commonly within your
capillaries with the pathogenesis causing
damage to your capillary and that was our
discussion earlier with non-enzymatic glycosylation.
Make sure that those sets of blood vessels
are well organized in your head before we
move on otherwise you’re confusing all of
the complications that are taking place on
a vascular level.