Pathology of Diabetes for pre clinical & clinical medical students and residents.

1. More people would learn from their mistakes if they weren't so busy denying them. -Harold J. Smith

11. Be like the tongue in the midst of the teeth, carefully, confidently & courageously going about its task, without getting bitten..! - Baba Divine Discourse on the Bhagavad Gita, 1984

12. Pathology of Diabetes Dr. Venkatesh M. Shashidhar Assoc. Prof. & Head of Pathology

14. World Statistics:

17. Pancreas Normal Anatomy:

18. Normal Pancreas:

19. Normal Pancreas: Islet of Langerhans (Endocrine Pancreas) Pancreatic acini (Exocrine Pancreas) Duct

20. Normal Pancreatic Islet: (ipx stain) α cells 20% (Glucagon) ß cells 70% (Insulin) δ cells (Somatostatin) pp Cells (pan prot) ß α

22. Normal Insulin secretion:

24. Insulin Functions:

29. Your life should rest on morality and truth. Base your life on truth & love for all. Money comes and goes but morality comes and grows. - Sai - Summer Showers, 1973.

31. Insulitis – Type I Lymphocytes.

32. DM1 Course:

33. Progression of Type II Years ..

34. Pathogenesis of Type II DM Relative Insulin Def. ß cell Exhaustion (IDDM)

35. DM2 Islets: Normal early  amyloid late:  Normal. Loss of ß cells ( only in late stage ) replaced by Amyloid protein deposit (hyalinization).

37. Type-I Type-II Insulitis: Lymphocytic infiltrate within islets. Islet Hyalinization: Central hyaline deposits replacing dead beta cells

38. Diagnosis: (WHO)

40. Being true human is maintaining complete harmony between thought, word and deed. Divergence between thought, word and deed is the cause of all our problems…! - BABA.

45. DM: Complications:

46. The best gift of Nature to man is the briefness of his life…! Latin quote

50. DM-Neuropathy – Myelin stain Myelin loss in nerve Normal

52. Neuropathic ulcers FEATURES: Painless, surrounded by callus At pressure points. associated with good foot pulses May not be associated with gangrene

53. Diabetic Amyotrophy Painful muscle wasting

58. Nodular Glomerulosclerosis – KW lesion.

59. Diabetic Glomerulosclerosis B A

60. Diabetic Glomerulosclerosis B A

62. Diabetic Glomerulosclerosis Hyaline nodule

63. Nephropathy – Progression:

64. DM with Infarction: Papillary necrosis

68. Normal Retina

69. Diabetic Retinopathy

70. Diabetic Retinopathy Fluorescein angiogram of the eye of a diabetic patient. Note the numerous, small, dot-like capillary microaneurysms.

71. Diabetic Retinopathy Pre retinal Hemorrhage - detachment

73. Retina ? diagnosis

74. You must learn to distinguish between good and bad, truth and untruth. You must use your education for the purpose of serving community. - Sai - Summer Showers, 1973.

76. Atherosclerosis:

77. Fungal infections: Candidiasis

78. Macrosomia With Polycythemia

79. Blood vessel calcification: Amputated thumb

80. Cataract – Sorbitol.. Polyol..osmotic.. Lens epithelium (Insulin independent) is exposed to Hyperglycaemia, excessive flux of glucose to sorbitol by the polyol pathway. The accumulation of intracellular sorbitol exerts osmoprotection and prevents cell shrinkage. The excessive accumulation of sorbitol, causes an increased osmotic load within the lens causing swelling, fibre breakdown, and opacification (the osmotic hypothesis). Other mechanisms, including glycation and oxidative stress, may also be responsible for lens opacification.

84. “ It's not that I'm so smart, it's just that I stay with problems longer”…! --Albert Einstein

102. It is a matter of great satisfaction if you are educated on the right lines, become an example to others and accept positions of responsibility. In all these things, always keep “ Truth & Love for all ” as your goal. Then only you will get the Grace of God….! - Sai - Summer Showers, 1973.

109. Site of action of Anti DM drugs:

110. Metabolic (short term) complications:

111. Diagnostic criteria for DM, IFG, and IGT

112. DECODE: increased 2-hour glucose is associated with increased mortality rate (adjusted for age, center, and gender).

113. Cumulative incidence of diabetes mellitus (based on American Diabetes Association criteria) according to study group in the DPP. * The incidence of diabetes differed significantly among the 3 groups (p <0.001 for each comparison. Reprinted with permission from Knowler et al. 13

115. GAME-PLAN for DM2:

116. Diabetic Retinopathy Neovascularization Cotton wool spots

117. Diabetic Retinopathy Cotton wool Dot hem Blot hem Neovascul. Cotton wool

118. Diabetic Retinopathy Advanced fibrous plaques

119. Diabetic Retinopathy - Proliferative

120. Diabetic Retinopathy - Proliferative

121. Normal Retina:

122. Progression of Type I

124. DM - Clinical Examination:

125. Daily changes in hormone…

126. Gestational DM:

127. MODY: Maturity Onset DM of Youth.