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Etiology & Complications of Diabetes Mellitus

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 Etiology of Diabetes Mellitus

Types of Diabetes Mellitus

Primary DM

 Type 1- Early onset, young below 30 year

         Also known as Juvenile DM

         Due to lack(absolute/partial) of insulin,immune mediated beta cell damage

         Typical clinical features DM are present(polyuria, polydipsia, polyphagia) 

         Pathophysiology; Due to genetic predisposition and environmental factors autoantigens form on insulin-producing beta cells and circulate in the blood stream and lymphatics.This lead to processing and presentation of autoantigen by antigen presenting cells thus activating T helper 1 lyphocytes and T helper 2 lymphocytes activating macrophages with release of Inter leukin 1 and activating B lymphocytes to produce islet cell autoantibodies respectively. This led to destruction of beta cells with decreased insulin secretion.


 Type2 - Late onset,over 30 years of age

         Due to insulin resistence/insufficient insulin, genitically beta cell dysfunction

         Thus reduce glucose uptake(muscle,fat)

         Thus increase glucose production(liver).

         Metabolic causes are haemachromatosis.

         Mechanism of insulin resistence is unclear. Both genetic and environmental factors are involved.

         Post insulin receptor defects.

Secondary DM

 Type 3 - Due to endocrine reasons-hyperthyroidism,acromegaly,cushing's syndrome

          Due to drugs(thiazide)

          Due to chronic pancreatitis

 Type 4 - Hyperglycemia during pregnancy

          Normoglycemia after delivery

          Prone to develop DM later



Complications of Diabetes Mellitus

Acute complications;

  • Keto acidotic coma
  • Lactic acidosis
  • Hypoglycemic coma
  • Hyperosmolar non ketotic coma

Chronic complications; 

  • Diabetic neuropathy- hyperglycemia damages nerves in the peripheral nervous system.This may result in pain/numbness. Feet wounds may go undetected, get infected and lead to gangrene.
  • Diabetic nephropathy- Thickening of capillary basement membrane. Mesangial matrix expansion, some areas of glomerulosclerosis, have significant albuminuria, diminished Glomerular Filtrate Rate.
  • Diabetic retinopathy- Cotton wool spots, hard exudates, micro hemorrhages can occur.
  • Atherosclerosis

Macrovascular complications of DM;

  • Transient ischeamic attack
  • stroke
  • Angina
  • Myocardial infarction
  • Cardiac failure
  • Peripheral vascular disease


Microvascular complications of DM;

  • Diabetic retinopathy
  • Microalbuminuria
  • End-stage renal disease
  • Erectile dysfunction
  • Autonomic neuropathy
  • Osteomyelitis
  • Amputation