Module 13 Assignment
1. Briefly explain how does diabetes Mellitus contribute to the development or acceleration of
coronary heart disease? To renal
... [Show More] failure?
Chronic hyperglycemia increases the production of reactive oxygen species and the
detrimental effects of oxidative stress. Increased platelet adhesion and decreased
fibrinolysis promote thrombus formation and vascular occlusion. Macrovascular disease is
a major cause of morbidity and mortality especially among those with diabetes. The fibrous
plaques of atherosclerosis are associated with the proliferation of subendothelial smooth
muscle in the arterial wall. Other factors in the serum of individuals with diabetes also
stimulate this proliferation. The exact process responsible for destruction of kidneys in
diabetes is unknown however several mechanisms contribute to nephropathy including
hyperglycemia, systemic hypertension, hyperperfusion, hyperfiltration, increased blood
viscosity, increased glomerular pressure, albuminuria, protein kinase C, growth factors,
advanced glycation end products, inflammatory cytokines, oxidative stress, the reninangiotensin-aldosterone system, and hypercholesterolemia. The glomeruli are injured by
protein denaturation by high glucose levels and adverse effects of intraglomerular
microcirculatory hypertension.
2. Explain the rationale for the development of diabetic ketoacidosis in IDDM and HHNKS in
NIDDM. Why is the serum glucose more elevated in HHNKS?
Diabetic ketoacidosis (DKA) occurs when there is an absolute or relative deficiency of
insulin. It is more common in those with diabetes type 1. The most common predisposing
factor for DKA is intercurrent illness such as infection, trauma, surgery, or myocardial
infarction. Additionally, interruption of insulin administration can also result in DKA.
Emotional factors and stress are also thought to be contributing factors. DKA occurs
because in a state of relative insulin deficiency there is a rise in insulin counterregulatory
hormones such as catecholamines, cortisol, glucagon, and GH. These hormones antagonize
insulin by increasing glucose production and also decrease the use of glucose. This
profound insulin defic [Show Less]