pathogenesis and classification of glycemic disorders
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Pathogenesis and Classification ofGlycemic Disorders
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Hyperglycemia
Excessiveglucose production
Impairedglucose clearance
Tissue injury1
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Hyperglycemia Damages Tissues
Effects of hyperglycemiaGlycation of proteins (eg, hemoglobin, collagen) Accumulation of sorbitol and fructose (eg, in nerves, lens)Activation of protein kinase C (eg, on vascular cells)
Tissue changesAltered protein function and turnover, cytokine activationOsmotic and oxidative stress Reduced motor and sensory nerve conduction velocityIncreased glomerular filtration rate and renal plasma flow
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Medical Complications of Hyperglycemia
Retinopathy, nephropathy, neuropathyCardiovascular disorders Infections, cataracts, connective tissue disorders
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Hyperglycemia
Brownlee M. Metabolism. 2000;49(suppl 1):9-13; Greene DA et al. N Engl J Med. 1987;316:599-606; Sheetz MJ, King GL. JAMA. 2002;288:2579-2588
Glycationpathway
Sorbitolpathway
Sorbitol and fructose Glycated proteins(eg, A1C)
Oxidativeeffects
Osmoticeffects
Advanced glycationend products (AGEs)
Altered functionor turnover
Receptor-mediatedcytokine effects
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