DIABETES CURSO:
SEMINARIO DE FISIOPATOLOGÍA
DOCENTE:
DR. ROBINSON LEÓN ZULOETA
INTEGRANTES:
JUÁREZ MUÑOZ MORELIA MONGE ROJAS ANIBAL PAICO PAICO HIDALGO MAYRA MAYRA PALACIOS RIQUELME ANTHONY RACCHUMI CAVERO EVELYN ROJAS MONTALVÁN JEAN PIERRE SÁNCHEZ ZEVALLOS MARCELO
DIABETES MELLITUS ANAMNESIS: Pac!"#! $a%&" '! () a*+,- !, a'#'+ a/ ,!%$c+ '! 0%1!"ca, 2+% 2%!,!"#a% '!,'! 3ac! 0" !, 4a5a '! 2!,+- "+ c0a"#6ca'a- ,!",ac&" '! '!4/'a'- ,+"+/!"ca- 7 '!,'! 3ac! '+, '8a, ,!' 7 frecuencia urinaria incrementadas, a'!9, '! #+, 2%+'0c#$a 7 fiebre asta !" #C. E, 3+,2#a/:a'+ !" !/ ,!%$c+ '! !'c"a "#!%"a.
Antecedentes: T%a#a!"#++ !" ca%'+/+18a 2+% HT T%a#a!"# HTA A c+" !"a/a2%/ ;) 1< '8a- 7 F4% F4%/ac&" /ac&" a0%c0/a% a0%c0/a% c+" =a%6a%"a > 1<'8a- c+"#%+/ '! INR ;->. ACV ,?0@c+ 3ac! a*+, c+" /!$! 3!2a%!,a '!%!c3a c++ ,!c0!/a. H!%a"+ 'a4@#c+- a'%! 'a4@#ca 6a//!c'a 2+% ACV.
E$AMEN CL%NICO: PA >><> FC ))< %%!10/a% FR < T .> P!,+ )>. Ta PA Ta//a //a -(>. REG- REN- REH 0c+,a, ,!ca,. O%+6a%"1! c+"1!,#$a P0/+"!, %+"ca"#!, %+"ca" #!, !" ACP ACP-- cre&itantes !" 4a,! :?0!%'a. C+%a:&" RC a%%8#c+,- "+ ,+2/+,- "+ "10%1#ac&" 7010/a%. P0/,+, 2!'+, 2%!,!"#!, '! 4a5a "#!",'a'. N!0%+/&1c+ 60!%:a 0,c0/a% '! > !" 3!c0!%2+ 3! c0!%2+ '!%!c3+- ,!",4/'a' c+",!%$a'a.
E$'MENES AU$ILIARES: A/ "1%!,+. H!+1%aa (->)) /!0c+c#+, c+" '! a4a,#+"a'+,. EG a0,!"ca '! +"'a P !" D- D;. FC ))< E5! !"+, > 1%a'+,- 8"'c! '! S+K+/+= 2+,#$+. G(icemia de in)res* +m).d(. /B )(ic*si(ada A0c de ". R '! #&% #&%a a %a' %a'+ + +2a +2ac' c'a' a' !" 4a, 4a,!! '! 3! 3!#& #&%a %a :? :?0! 0!%'+%'+- ,/ ,/0!#a 0!#a ca%'+$a,c ca%'+$a,c0/a 0/a% % a0!"#a'a '! #aa*+. D0%a"#! ,0 3+,2#a/:ac&" F '! O5+ +,#%& %!#"+2a#8a 32!%#!",$a 7 'a4@#ca #2+ II. Ec* d*&&(er arteria( de miembr*s inferi*res inf*rmad* c*m* *bstrucci1n &arcia( 23-45 de fem*ra(es, tibia(es anteri*res 6 &edias, a &red*mini* derec*. E/!c#%+ +1%a68a 7 VCN '! !4%+, "6!%+%!, +,#%& "!0%+2a#8a ,!",#$+ +#+%a '! #2+ !#a4&/ca.
RESOLUCI7N CASO CL%NICO:
ANAMNESIS: Pac!"#! $a%&" '! () a*+,- !, a'#'+ a/ ,!%$c+ '! 0%1!"ca, 2+% 2%!,!"#a% '!,'! 3ac! 0" !, 4a5a '! 2!,+- "+ c0a"#6ca'a- ,!",ac&" '! '!4/'a'- ,+"+/!"ca- 7 '!,'! 3ac! '+, '8a, ,!' 7 frecuencia urinaria incrementadas, a'!9, '! t*s &r*ducti8a7 fiebre asta !" #C. E, 3+,2#a/:a'+ !" !/ ,!%$c+ '! !'c"a "#!%"a. •
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C+" /a a"a"!,, 2+'!+, +4,!%$a% c!%#+, ,8"#+a, c++ ,+" ,!'- 2+/0%a 2@%''a '! 2!,+- '!4/'a' 0,c0/a%- 2+% /+ ?0! !,#a%8a+, 2!",a"'+ !" 0" 2+,4/! 2ac!"#! 'a4@#c+ ," !4a%1+ !,#+, ,8"#+a, 20!'!" !,#a% 2%!,!"#!, 2!%+ "+ ,+" !,2!c86c+, 2+% /+ ?0! ,! "!c!,#a +#%+, c%#!%+, c++ /a 32!%1/c!a 2a%a #!"!% 0" 'a1"&,#c+ ac!%#a'+ 7 2%!c,+. L+ ?0! 2+'!+, %!,ca#a% !" !,#a 2%!%a 2a%#! !, /a !'a' '!/ 2ac!"#!- () a*+,- 7a ?0! 2+% !2'!+/+18a 7 c+"c!2#+, !,#a4/!c'+, 1!"!%a/!"#! /a Da4!#!, '! #2+ ; #!"! 0" "c+ !" /a !'a' a'0/#a c+" %!,2!#+ a /a Da4!#!, #2+ /a c0a/ #!"! 0" c+!":+ 50$!"/. La #+: 2%+'0c#$a 7 /a 6!4%! "+, 3ac!" 2!",a% ?0! !,#! 2ac!"#! c0%,a c+" 0"a "6!cc&"- 2+% /+ #a"#+ #!"! 0" c+2%+,+ a "$!/ '! ,,#!a "0"+/&1c+ !/ c0a/ , ,! //!1a /a c+"c/0,&" '! ?0! !, 0" 2ac!"#! 'a4@#c+ ,0 2+,4/! '!,c+2!",ac&" 20'+ #!"!% 0"a ca0,a "6!cc+,a- 7a ?0! !" 0" c0a'%+ "6!cc+,+ ,! "c%!!"#a /a, "!c!,'a'!, '! ",0/"a 2+% 0" a0!"#+ '!/ c+%#,+/ 7 1/0ca1&".
Antecedentes: T%a#a!"#+ !" ca%'+/+18a 2+% HTA c+" !"a/a2%/ ;) 1< '8a- 7 F4%/ac&" a0%c0/a% c+" =a%6a%"a > 1<'8a- c+"#%+/ '! INR ;->. ACV ,?0@c+ 3ac! a*+, c+" /!$! 3!2a%!,a '!%!c3a c++ ,!c0!/a. H!%a"+ 'a4@#c+- a'%! 'a4@#ca 6a//!c'a 2+% ACV. E" !,#a 2a%#! '!/ ca,+ "+, 'a+, c0!"#a ?0! !, 0" 2ac!"#! ?0! c0%,a c+" 32!%#!",&" a%#!%a/ 2+% /+ ?0! !,#9 c+",0!"'+ 0" a"#32!%#!",$+ IECA c++ !, !/ !"a/a2%/ 7 #a4@" 2%!,!"#a 64%/ac8" a0%c0/a% c+",#a#a'a c+" /a a0,!"ca '! +"'a, P !" ,0 ECG !" /a '!%$ac&" 6,+/&1ca DII 2+% /+ ?0! !,#9 c+",0!"'+ =a%6a%"a 2a%a 2%!$!"% #%+4+!4+/,+,. Ya %!/ac+"a"'+ c+" /a a"a"!,, "+, 'a+, c0!"#a ?0! !/ 2ac!"#! 3a ,06%'+ 0" ACV ,?0@c+- 2+% /+ ?0! ,! !,#9 2!",a"'+ 0"a 2+,4/! 2a%#c2ac&" 2a#+1@"ca '! 0"a 2+,4/! Da4!#!, '+"'! 7a 3a7 0"a c+2/cac&" ac%+a"1+29#ca !,#a4/!c'a- 4!" ,!a 2+% 0" !"1%+,a!"#+ 3a/"+ '! /a 8"#a- !"1%+,a!"#+ '! /a 2a%!'- a"+%a/'a'!, '! /a c+a10/ac&"- !,#%!c3a!"#! '! /a /0: a%#!%a/ 7 2+% /a HTA. S! +4,!%$a 7a 0"a ca%1a 1!"@#ca 2+% 2a%#! '! ,0 a'%!- /a c0a/ !%a 'a4@#ca. •
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E$AMEN CL%NICO:
9A: 0++."+C: 0--.m irre)u(arFR < T .> 9es*: 0-+; . Ta//a -(>. REG- REN- RE/ 2muc*sas secas5 !" 3!c0!%2+ '!%!c3+- ,!",4/'a' c+",!%$a'a.
E$'MENES AU$ILIARES: A/ "1%!,+. H!+1%aa (->)) /!0c+c#+, c+" '! a4a,#+"a'+,. EG a0,!"ca '! +"'a P !" D- D;. FC ))< E5! !"+, > 1%a'+,- 8"'c! '! S+K+/+= 2+,#$+. G(icemia de in)res* +m).d(. /B )(ic*si(ada A0c de ". R '! #&%a %a'+ +2ac'a' !" 4a,! '! 3!#&%a :?0!%'+- ,/0!#a ca%'+$a,c0/a% a0!"#a'a '! #aa*+.
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IMC 2!,+ K1 < a/#0%a!#%+,; .> OBESIDAD GRADO II E/ 2ac!"#! c0%,a c+" +4!,'a' /a c0a/ 2+% 6,+2a#+/+18a ,a4!+, ?0! DB #2+ ; !,#9 ca0,a'a 2+% /a %!,20!,#a "a'!c0a'a '! /a, c@/0/a, B 2a"c%!9#ca, a/ a0!"#+ '! %!,,#!"ca ",0/8"ca #82ca!"#! a,+ca'a c+" !"$!5!c!"#+- *besidad 7 ,!'!"#a%,+. L+ '! /a, 0c+,a, ,!ca, "+, 'a a !"#!"'!% ?0! !,#a '!,3'%a#a'+ 7 ?0! ,! !"c0!"#%a !" 0" !'+ 32!%+,+/a%- 2+% /+ ?0! 3a7 ?0! 3'%a#a%/+ c+" ,+/0c&" ,a/"a a/ ).. La O%+6a%"1! c+"1!,#$a 50"#+ c+" /+, 20/+"!, c%!2#a"#!,- /a #+, 2%+'0c#$a 7 !/ a0!"#+ "+#+%+ '! /+, /!0c+c#+, ,! '!4!%8a" a 0"a 2+,4/! "6!cc&" ?0! 20!'! ,!% TBC + "!0+"8a E" !/ !a!" "!0%+/&1c+ ,! +4,!%$a ?0! #!"! 0"a 60!%:a 0,c0/a% a/ > 2+% /+ ?0! 7a !,#9 2%!,!"#a"'+ c!%#a 32+#+"8a 7 '!4/'a' 0,c0/a% 2%+2a '! #%a",#+%"+, 1/c@c+,. E" !/ 3!+1%aa +4,!%$a+, ?0! /+, /!0c+c#+, !,#9" 2+% !"ca '! /+, $a/+%!, "+%a/!,- /+ c0a/ "+, c+%%+4+%a !/ 2%+c!,+ "6!cc+,+ ?0! c0%,a !,#! 2ac!"#!.
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E/ 8"'c! '! S+K+/+= 2+,#$+ "+, 'a 0" 'a1"&,#c+ '! H2!%#%+6a $!"#%c0/a% :?0!%'a 2%+2a '! 0"a 32!%#!",&" c%&"ca. S! +4#!"! !/ $a/+% '! /a 1/c!a >;) 1<'/ 7 $!+, ?0! !,#9 07 2+% !"ca '! ,0, $a/+%!, "+%a/!, G/c!a a/!a#+%a ;> 1<'/ La H!+1/+4"a 1/c+,/a'a (.> #a4@" !, 0" c%#!%+ 'a1"&,#c+ '! 'a4!#!,.
D0%a"#! ,0 3+,2#a/:ac&" F '! O5+ +,#%& %!#"+2a#8a 32!%#!",$a 7 'a4@#ca #2+ II. Ec* d*&&(er arteria( de miembr*s inferi*res inf*rmad* c*m* *bstrucci1n &arcia( 23-45 de fem*ra(es, tibia(es anteri*res 6 &edias, a &red*mini* derec*. E/!c#%+ +1%a68a 7 VCN '! !4%+, "6!%+%!, +,#%& "!0%+2a#8a ,!",#$+ +#+%a '! #2+ !#a4&/ca. •
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A/ 2ac!"#! ,! /! %!a/:& 0" 6+"'+ '! +5+ !" !/ c0a/ ,! /! 'a1"+,#c& %!#"+2a#8a 'a4@#ca ?0! 7a !, 0"a c+2/cac&" micr*8ascu(ar cr1nica !,2!c86ca '! /a 'a4!#!,- ?0! a6!c#a /+, $a,+, '! /a %!#"a. E/ !c+ '+22/!% a%#!%a/ 0!,#%a /a +4,#%0cc&" '! /+, $a,+, '! /+, !4%+, "6!%+%!, 2%+2a '! /a a#!%+!,c/!%+,, ?0! c0%,a !/ 2ac!"#!. La EMG 7 /a 2%0!4a '! $!/+c'a' '! c+"'0cc&" "!%$+,a 0!,#%a ?0! 7a !/ 2ac!"#! #!"! 0"a c+2/cac&" a "$!/ '! ,,#!a '! c+"'0cc&" "!0%+"a/ NEUROPATÍA DIABTICA 2%+2a '! /a 32!%1/c!a a/ c+"#%+/a'a. Da1"&,#c+ '!/ 2ac!"#! o
Da4!#!, #2+ ; '!4'+ a /a 2%!,!"ca '! SINTOMAS DE DIABETES 9, 1/c!a a7+% '! ;)) 1<'/ !" 0"a 0!,#%a '! ,a"1%! a/!a#+%a 2+% /+ ?0! ,! /! a#%407! #+'+, /+, ,8"#+a, !20!,#+, !" !,#! ca,+ a 'c3+ '!,+%'!" !#a4&/c+ !/ c0a/ a2a%!c& '!4'+ a 0"a '!,c+2!",ac&" 2+% 2a%#! '! 0" c%+%1a",+ ?0! '!,!"ca'!"+ /a "6/aac&" 7 /a 32!%1/c!a 2+% a0!"#+ '! c+%#,+/ 7 1/0ca1&" ,!1" 6,+2a#+/+18a '! /a "6/aac&" //!$a"'+ a,8 a 0"a '!,c+2!",ac&" '!/ 2ac!"#!.
CUESTIONARIO
0< =CU'L ES LA ISIO9ATOLOG%A DE LA DIABETES TI9O I> ACCI7N DE LA INSULINA
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%!c!2#+% '! ",0/"a ,! !2%!,a 2%9c#ca!"#! !" #+'+, /+, #2+, '! c@/0/a, '! a86!%+. A2/a 1aa '! %!,20!,#a, 4+/&1ca, a /a ",0/"a. L+, #!5'+, '!c,$+, 2a%a /a %!10/ac&" '! /a 1/0c!a H81a'+- 0,c0/+ !,#%a'+ 7 #!5'+ a'2+,+. La, %!1+"!, !,2!c86ca, '!/ !"c@6a/+ 7 '! /+, ,/+#!, 2a"c%!9#c+, #a4@" ,+" +45!#$+, 2+%#a"#!, 2a%a /a ",0/"a. A "$!/ ,,#@c+- /a, acc+"!, '! /a ",0/"a ,+" a"#a1&"ca, Ca2#ac&"- 0,+ 7 a/ac!"a!"#+ '! 1/0c+,a- /82'+, 7 a"+9c'+, E,#0/a /a 1/0c+1@"!,,- /2+1@"!,, 7 ,8"#!,, '! 2%+#!8"a, I"34! !/ ca#a4+/,+ '! !,#+, c+20!,#+, E,#0/a a/ #%a",2+%#! '! ,0,#%a#+, 7 '! +"!, a/ "#!%+% '! /a, c@/0/a, Fa$+%!c! /a #%a",/+cac&" '! 2%+#!8"a, !"#%! c+2a%#!"#+, c!/0/a%!, R!10/a /a acc&" '! !":a, !,2!c6ca, C+"#%+/a /a #%a",c%2c&" 1@"ca 7 #%a'0cc&" '! RNA A/10"+, !6!c#+, '! /a ",0/"a +c0%%!" !" ,!10"'+, + "0#+,- c++ Ac#$ac&" '! /a 1/0c+,a Ac#$ac&" '!/ ,,#!a '! #%a",2+%#! '! +"!, E6!c#+, !#a4&/c+, I"34c&" '! /a /2+/,, + /a 2%+'0cc&" '! 1/0c+,a 3!29#ca F+,6+%/ac&" + '!,6+,6+%/ac&" '! !":a, !,2!c6ca, La ,8"#!,, '! 2%+#!8"a, 7 /a %!10/ac&" '! /a #%a",c%2c&" 1@"ca ,! a"6!,#a" a /+ /a%1+ '! "0#+, a 3+%a,. La 2%+/6!%ac&" 7 '6!%!"cac&" c!/0/a%!, +c0%%!" a /+ /a%1+ '! '8a,. L+, !6!c#+, !#a4&/c+, c++ /a "34c&" '! /a /2+/,, + /a 2%+'0cc&" '! 1/0c+,a 3!29#ca +c0%%!" c+" %a2'!:- !" 0"+, c0a"#+, "0#+,. L+, "c%!!"#+, '!#!c#a4/!, !" /a !/"ac&" '! /a 1/0c+,a !" ,a"1%! 20!'!" #a%'a% ca, 3. La $a%a4/'a' !" /a c"@#ca '! acc&" '! /a ",0/"a !,#9 %!/ac+"a'a c+" R!c!2#+%!, '! ",0/"a !" '6!%!"#!, #!5'+, D6!%!"#!, $8a, '! ,!*a/:ac&" "#%ac!/0/a% C"@#ca "3!%!"#! '! $a%+, 2%+c!,+, c+"#%+/a'+, 2+% /a ",0/"a
ISIO9ATOLOG%A ? DIAGN7STICO DE LA DIABETES MELLITUS /OMEOSTASIS DE LA GLUCOSA ? DIAGN7STICO DE DIABETES
/*me*stasis n*rma( de (a )(uc*sa: G/0c+,a 2/a,9#ca !" a70"+ >.( +/.( a (. +/ 1<)) / Int*(erancia a (a )(uc*sa 2IGT5 C+"c!"#%ac&" '! 1/0c+,a !"#%! . 7 . +/ 1 '! ,+/0c&" /?0'a '! 1/0c+,a Diabetes me((itus:
9ATOGENIA DE LA DIABETES TI9O 0
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< =CU'L ES LA ISIO9ATOLOG%A DE LA DIABETES TI9O II> La 'a4!#!, !//#0, #2+ ; !,#9 %!/ac+"a'a ca, ?0! "!c!,a%a!"#! a /a c+"'c&" '! +4!,'a' 7- 2+% /+ #a"#+- c+" /a %!,,#!"ca a /a ",0/"a RI- 2!%+ ,! %!?0!%! a'c+"a/!"#! '! 0" '!#!%+%+ '! /a 60"c&" '! /a c@/0/a 4 2a"c%!9#ca. Pa%a $!"c!% /a RI/a c@/0/a 4 "ca 0" 2%+c!,+ ?0! #!%"a !" !/ a0!"#+ '! /a a,a c!/0/a%- 2%+'0c!"'+ a7+% ca"#'a' '! ",0/"a 32!%",0/",+- ?0! "ca/!"#! /+1%a c+2!",a% /a RI- 7 a"#!"!% /+, "$!/!, '! 1/0c!a "+%a/!, ," !4a%1+- c+" !/ #!2+- /a c@/0/a 4 2!%'! ,0 ca2ac'a' 2a%a a"#!"!% /a 32!%",0/"!a c+2!",a#+%a- 2%+'0c@"'+,! 0" '@6c# %!/a#$+ '! ",0/"a c+" %!,2!c#+ a /a RI. A2a%!c! 6"a/!"#! /a 32!%1/0c!a- "ca/!"#! !" /+, !,#a'+, P+,#2%a"'a/!, 7 /0!1+ !" a70"a,- a 2a%#% '! /+ c0a/ ,! !,#a4/!c! !/ 'a1"&,#c+ '! DM;.
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La adi&*nectina P%+#!8"a 2%+'0c'a 2+% !/ a'2+c#+- 2a%!c! #!"!% %!/ac&" c+" /a +4!,'a' 7 /a, +#%a, a'2+c"a, '! '@"#c+ +%1!" c++ /+ ,+" !/ TNF a/23a- /a IL( 7 /a %!,,#"a60"'a!"#a/!, !" /a %!,,#!"ca a /a ",0/"a. Pa%!c! ?0! /a a'2+"!c#"a !,#9 ',"08'a !" /a +4!,'a' 7 !" /a %!,,#!"ca a /a ",0/"a- a" !" 2!%,+"a, "+ +4!,a,- 7 ,! ac+2a*a '! ',"0c&" '! /82'+, a "$!/ '! 381a'+ 7 !" ,c0/+. !%" !# a/- !" ;))- !a"a%+" /a !2%!,&" '! /a a'2+"!c#"a 7 !/ TNF a/23a !" !/ #!5'+ a'2+,+ 30a"+ !"c+"#%a%+" 0"a a,+cac&" ,1"6ca#$a !"#%! /a a'2+"!c#"a 7 /a !2%!,&" '!/ TNF a/23a. E, 2+,4/! ?0! a/ ',"0% /a !2%!,&" '! /a a'2+"!c#"a ,! 2%+$+?0! a 0" a0!"#+ !" /a ,!c%!c&" '!/ TNF 2+% !/ #!5'+ a'2+,+ !,#a /#a !/!$a%8a /a IL( 2/a,9#ca ?0! #a4@" ,! a,+ca c+" /a %!,,#!"ca a /a ",0/"a- "'!2!"'!"#! '! /a +4!,'a'. L+, 'a#+, ,01!%!" ?0! !/ TNF 7 /a a'2+"!c#"a ,+" 20"#+, '! c+"#%+/ !" !/ #!5'+ a'2+,+ ?0! 2%+'0c!" /a !2%!,&" '! +#%a, c#+c"a, c++ /a IL( 7 !/ $8"c0/+ c+" !/ '!,a%%+//+ '! /a ac00/ac&" '! /82'+, !" /+, #!5'+,- 7 !/ _,8"'%+! '! %!,,#!"ca a /a ",0/"a_.
Resistencia a (a insu(ina L+, !ca",+, %!,2+",a4/!, 2+% /a %!,,#!"ca a /a ",0/"a "c/07!" '!6!c#+, 1!"@#c+, a "$!/ '! /a c@/0/a 4/a"c+- a"#c0!%2+, a /a ",0/"a 7 a ,0 '!1%a'ac&" ac!/!%a'a. La +4!,'a'- ?0! !, /a ca0,a 9, c+" '! %!,,#!"ca a /a ",0/"a- !,#9 a,+ca'a a 0"a ',"0c&" '!/ "!%+ '! %!c!2#+%!, 7 a 0"a 6a//a '!/ 2+,%%!c!2#+% 2a%a ac#$a% /a #%+,8"?0"a,a- ! "ca2ac'a' '! /a a0#+6+,6+%/ac&" '! /a #%+,8"?0"a,a. La %!,,#!"ca a /a ",0/"a !, 07 2+%#a"#! !" /a 2a#+1!"a '!/ '!,a%%+//+ '!/ _,8"'%+! !#a4&/c+_- ?0! "c/07! 0"a + #+'a, '! /a, ,10!"#!, 32!%",0/"!a- "#+/!%a"ca a /a 1/0c+,a + DM #2+ ;- +4!,'a' c!"#%82!#a- 32!%#!",&" a%#!%a/- ',/2'!a ?0! "c/07! #%1/c!%'+, a/#+,',"0c&" '! /a, HDLC- LDL 2!?0!*a, 7 '!",a,- ! 32!%c+a10/a4/'a' ca%ac#!%:a'a 2+% 0"a a0!"#+ '!/ PAI2/a,"+1!"ac#$a#+%"34#+% . La "ac#$'a' 68,ca- !/ ,+4%!2!,+<+4!,'a' 7 /+, 6ac#+%!, 1!"@#c+,- ,+" /+, ca0,a"#!, '!/ ,8"'%+! !#a4&/c+- !"#%a, ?0! !/ !5!%cc+ !" 6a,!, #!2%a"a, %!'0c! !/ %!,1+ '! ,0 2%+1%!,&". E" !/ ,c0/+ !,?0!/@#c+- /a %!,,#!"ca a /a ",0/"a 20!'! ,!% ca0,a'a 2+% $a%a, a"+%a/'a'!,- "c/07!"'+ '!6!c#+, !" !/ #%a",2+%#a'+% '! /a 1/0c+,a GLUT #%a",2+%#a'+% !'a'+ 2+% /a ",0/"a 9, 2+%#a"#!. D!"#%+ '! /+, 6ac#+%!, ?0! a6!c#a" /a ,!",4/'a' ",0/8"ca- '6!%!"#!, a/ #2+ '! 64%a 0,c0/a%- /+, 9c'+, 1%a,+, /4%!, ,+" c+",'!%a'+, !"#%! /+, 2%"c2a/!,. S! 3a" 6+%0/a'+ '6!%!"#!, 32&#!,, 2a%a !2/ca% !/ !ca",+ 2+% !/ c0a/ /+, AGL 2%+'0c!" ",0/"+%%!,,#!"ca a cc/+ '! Ra"'/! + cc/+ 1/0c+,a9c'+ 1%a,+- 4,+4%!%%!ac#$'a' '! /a $8a 3!+,a"a- c a0!"#+ '! TG "#%a+c!/0/a%- ' a/#!%ac&" '! /a, 2%+2!'a'!, 6,c+?08ca, '! /a !4%a"a 2/a,9#ca- 7 ! "c%!!"#+ "#%ac!/0/a% '! a/+"/C+A.
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+< =9ARA EL DIAGN7STICO DE DBM ES MEOR LA GLUCOSA EN A?UNAS O LA /BGLICOSILADA> E$9LI@UE LA RA7N La 1/0c!a !" a70"a, !, /a 2%0!4a 9, ,!"c//a 2a%a !/ #a:a5! +2+%#0"8,#c+ '! DM !" 2!%,+"a, a,"#+9#ca, ?0! 2+% a/1" +#$+ ac0'!" a 0" ,!%$c+ '! ,a/0'. La 3!+1/+4"a 1/c+,/a'a H4Ac !, 2%+'0c#+ '! 0"a 0"&" %%!$!%,4/!- !"#%! /a 3!+1/+4"a 2%+#!8"a %!,2+",a4/! '! #%a",2+%#a% !/ +81!"+ !" /a ,a"1%! 7 /a 1/0c+,a ,a"108"!a. E,#a %!acc&" !,#9 '%!c#a!"#! %!/ac+"a'a c+" /a, ca"#'a' '! 1/0c+,a c%c0/a"'+ !" ,a"1%! 7 /a $'a !'a '! /+, 1/&40/+, %+5+, ?0! !, '! a2%+a'a!"#! ;) '8a,. E" c+"'c+"!, "+%a/!,- /a 3!+1/+4"a 1/c+,/a'a %!6/!5a /a c+"c!"#%ac&" '! 1/0c+,a !" ,a"1%! 2%+!'+ '!/ +%1a",+ '0%a"#! /+, ; !,!, a"#!%+%!, a/ a"9/,,. La 3!+1/+4"a 1/c+,/a'a #!"! $a%a, 6%acc+"!, H4Aa- H4A4- 7 H4Ac 7 '! !//a,/a 9, !,#a4/!- /a ?0! #!"! 0"a 0"&" c+" /a 1/0c+,a 9, !,2!c86ca !, /a 6%acc&" H4Ac. P+% /+ #a"#+- /a 2%0!4a '! H4Ac '! /a ca"#'a' '! 1/0c+,a a'3!%'a a /+, 1/&40/+, %+5+,. E/ %!,0/#a'+ !, !2%!,a'+ !" 2+%c!"#a5! . La 6%acc&" !,#a4/! '! /a 3!+1/+4"a 1/0c+,/a'a- Ac- !, 0" %!6/!5+ '! /a 1/0c+,a ,a"108"!a #a"#+ !" a70"+ c++ 2+,#2%a"'a/ 2+% ,!,!"#a a "+$!"#a '8a,. E/ "$!/ '! 3!+1/+4"a Ac c+%%!,2+"'!"#! a "$!/!, "+%a/!, '! 1/0c+,a ,a"108"!a !, '! a (. Pa%a 3ac!% !/ 'a1"&,#c+ 7 '!#!%"a% !/ %!,1+ '! '!,a%%+//a% 'a4!#!, 0#/:a"'+ /a 3!+1/+4"a 1/c+,/a'a ,! ,01!%!" /a, ,10!"#!, c6%a,
E,#a 2%0!4a #!"! /a $!"#a5a '! ?0! /a 0!,#%a '! ,a"1%! ,! 20!'! !#%a!% !" c0a/?0!% +!"#+ '!/ '8a- !, '!c%- /a 2!%,+"a "+ %!?0!%! !,#a% !" a70"+ 7a ?0! ,0 %!,0/#a'+ "+ ,! $! a6!c#a'+ 2+% $a%ac+"!, a c+%#+ 2/a:+ E5. c+",0+ '! a/!"#+,- !5!%cc+- !,#%@,- !#c. La, $!"#a5a, '! 0,a% Ac ,+4%! /a 1/0c+,a !" a70"+- 2%0!4a %!c+!"'a'a c++ 2%!6!%!"ca/ 3a,#a !,#! +!"#+- ,+" /a 0!,#%a '! ,a"1%! "+ #!"! ?0! ,!% #+a'a !" a70"+- /a 0!,#%a #!"! !"+, $a%a4/'a' 7 !, 9, !,#a4/! !" !/ 2!%+'+ 2%!a"9/,, 7 /+, $a/+%!, "+ ,0!/!" $a%a% #a"#+ c++ /a 1/0c+,a !" a70"+ !" /+, 2ac!"#!, c+" 0" !,#%@, a10'+. S" !4a%1+- /a Ac 20!'! $a%a% !" ',#"#+, 1%02+, @#"c+,- ,0!/! ,04% 0" 2+c+ a !''a ?0! ,! a$a":a !" !'a' 7 "+ !, c+"6a4/! !" 2!%,+"a, ?0! 3a" %!c4'+ #%a",60,+"!, '! ,a"1%!- ?0! #!"!" a"!a, 3!+/8#ca,- !"6!%!'a' %!"a/- 3!+1/+4"+2a#8a, + a"!a 6!%%+2@"ca. La 2%0!4a '! Ac #!"! 0" c+,#+ a7+% ?0! /a 1/0c+,a 2/a,9#ca !" a70"+ + /a 2%0!4a '! #+/!%a"ca '! 1/0c+,a Pa%a !/ 'a1"&,#c+ '! /a 'a4!#!, !//#0, #2+ ;- !, !5+% %!a/:a% /a 2%0!4a '! 3!+1/+4"a 1/c+,/a'a H4Ac 2+%?0! !,#a "+, 'a 0" a"9/,, 2%+!'+ '! /a 1/0c!a '! 0"a 2!%,+"a '0%a"#! /+, ; + !,!, 2%!$+, a/ a"9/,,- 7a ?0! a !''a ?0! ,! "c%!!"#a /a 1/0c!a !,#a ,! 0"! a /a 3!+1/+4"a 2%!,!"#! !" /+, !%#%+c#+,- a '6!%!"ca '! /a 1/0c!a !" a70"a, GPA ?0! "+, '! /a 1/0c!a !" ,a"1%! ca2/a% !" 0" 2!%8+'+ ; 3+%a, ," "1!%% a/!"#+,.
< =9OR @U ES IM9ORTANTE EL ONDO DE OO EN UN DIABTICO> La %!#"+2a#8a 'a4@#ca !, 0"a c+2/cac&" c%+$a,c0/a% c%&"ca !,2!c86ca '! /a 'a4!#!,- ?0! a6!c#a /+, $a,+, '! /a %!#"a. A/%!'!'+% '!/ () '! /+, 2ac!"#!, c+" Da4!#!, '! > + 9, a*+, '! '0%ac&"- 7a 2%!,!"#a" $a,+, ,a"10"!+, 'a*a'+, !" /a R!#"a+%1"a"'+ a,8 /a _R!#"+2a#8a Da4@#ca_. E, 2+%#a"#! %!$,a% !,#! #%a,#+%"+- 2+%?0! /+, ',#"#+, 1%a'+, '! a/#!%ac&" $,0a/ ?0! @,#a ,0!/! 2%+$+ca% $a%8a" '!,'! 0"a ,2/! '6c0/#a' $,0a/...3a,#a /a c!10!%a.
ETIOLOG%A E"#%! +#%+, 6ac#+%!,- /a 32!%1/0c!a c%&"ca 'a*a /a, c@/0/a, '! ,+,#@" ?0! !,#!" !" /+, ca2/a%!, '! /a %!#"a 2!%c#+, 7 c+"6+%a" /a 4a%%!%a 3!a#+%!#"a"a "#!%"a.
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3< =9OR @U ES IM9ORTANTE LA EMG EN EL DIABTICO> C+",,#! !" %!c+1!% /a ac#$'a' !/@c#%ca '! /+, ,c0/+,. La c+"#%acc&" '! 0" ,c0/+ ,! '!4! a /a '!,ca%1a !/@c#%ca '!/ "!%$+ ?0! /+ c+"#%+/a. S !/ "!%$+ !,#9 a6!c#a'+- ,0 60"c+"a!"#+ ,! %!,!"#! 7 $a%8a" /a, ca%ac#!%8,#ca, '! /+, 20/,+, !/@c#%c+, ?0! #%a",#!. A'!9,- /a, $a%ac+"!, !" !,+, 20/,+, ,+" ',#"#a, !" 60"c&" '! ?0! !/ "!%$+ !,#@ !"6!%+ + ,&/+ c+2%'+- 7 #a4@" ,+" '6!%!"#!, ,!1" !/ 1%a'+ '! c+2%!,&". `Q0@ 2!%#! E/ EMG ,%$! 2a%a !$a/0a% !/ !,#a'+ '! /+, "!%$+, ?0! c+"#%+/a" /a 0,c0/a#0%a 2!%#! '!#!c#a% c+" ,0a 2%!c,&" !/ 1%a'+ '! c+2%!,&" + '! ,06%!"#+ '! /+, "!%$+,. U,+ !" 'a4@#c+
S0 0,+ 2a%#c0/a% !" 0" 2ac!"#! 'a4@#c+ !, ?0! 2+% !5!2/+- 0" 2ac!"#! 'a4@#c+ a/ c+"#%+/a'+ 7 '! /a%1+ #!2+ '! !$+/0c&"- !" !/ ?0! ,0, "!%$+, !,#9" a6!c#a'+, _"!0%+2a#8a 'a4@#ca_ 7 ?0!- a'!9,- #!"! 0"a 3!%"a ',ca/ c+" a2a%!"#! c+2%!,&" '! 0"a %a8: "!%$+,a. E" /a !2/+%ac&" 68,ca ,! 20!'! '!#!c#a% ?0! /a %a8: "!%$+,a "+ 60"c+"a c+%%!c#a!"#! 2!%+ !/ EMG 20!'! ',c%"a%- a'!9,- ?0@ !, a#%404/! a /a 'a4!#!, 7 ?0@ a /a 3!%"a ',ca/. E,#a "!0%+2a#8a 'a4@#ca ,! 'a 2+%?0! !" 2!%,+"a, c+" 'a4!#!,- /+, "!%$+, !" !/ c0!%2+ 20!'!" %!,0/#a% 'a*a'+, 2+% 0"a ',"0c&" '!/ 6/05+ ,a"108"!+ 7 0" "$!/ '! a:ca% !" /a ,a"1%! a/#+. E,#a a6!cc&" !, 9, 2%+4a4/! , !/ "$!/ '! a:ca% !" /a ,a"1%! "+ !,#9 4!" c+"#%+/a'+. A2%+a'a!"#! /a #a' '! /+, 'a4@#c+, 2a'!c!" 'a*+ "!0%+/&1c+. L+, ,8"#+a, a !"0'+ "+ c+!":a" 3a,#a 0c3+, a*+, '!,20@, '!/ 'a1"&,#c+ '! 'a4!#!,. A/10"a, 2!%,+"a, ?0! #!"!" 'a4!#!, ?0! ,! '!,a%%+//a /!"#a!"#! 7a #!"!" 'a*+ a /+, "!%$+, c0a"'+ ,! /!, 'a1"+,#ca 2+% 2%!%a $!:.
F< =CU'L ES LA ISIO9ATOLOG%A DE LA NEURO9AT%A DIABTICA> La "!0%+2a#8a 'a4@#ca '+/+%+,a !, 0"a '! /a, c+2/cac+"!, 6%!c0!"#!, '! /a 'a4!#!, !//#0, 7 ,! 2%+'0c! c++ c+",!c0!"ca '! /a ',60"c&" '! /+, "!%$+, 2!%6@%c+, ,! a"6!,#a- !" /a a7+%8a '! /+, ca,+,- 2+% /a a2a%c&" '! 0" #2+ !,2!c86c+ '! '+/+% "!0%+29#c+ ?0! 2%+$+ca 1%a" ,06%!"#+- a/#+, 1%a'+, '! "$a/'!: ! 2+%#a"#! '!#!%+%+ '! /a ca/'a' '! $'a. E/ '+/+% !" /a "!0%+2a#8a 'a4@#ca '+/+%+,a ,! 2!%c4! c++ !/ %!,0/#a'+ '! /a "#!1%ac&" '! '+, ,!",ac+"!, 0"a !" /a '!",&" 68,ca + ,!",+%a/- a /a ?0! 'a ,+2+%#! !/ a2a%a#+ 6,+/&1c+ 7 +#%a !" /a '!",&" 2,8?0ca + a6!c#$a!+c+"a/ ?0! a2+%#a '+, #2+, '! ,!"#!"#+, 0"+ '! %!20/,&" 7 %!c3a:+- '! ca%9c#!% "!'a#+?0! 1!"!%a 0" '!,!+ %%!,,#4/! '! !,ca2a% '!/ !,#80/+%92'a!"#! 7 +#%+, /1a'+, a /a, c+",!c0!"ca, "!'a#a, 7 #a%'8a, '!/ 'a*+. D! !,#+, ,!"#!"#+, "ac!" c+"'0c#a, !+c+"a/!, '! 6%0,#%ac&"- a",!'a' 7 '!2%!,&" ?0! !"%a%!c!" /a 2!%c!2c&" ,!",+%a/ 7 ?0! a2+%#a" !/!!"#+, c+2/!5+, 7 '! a2/6cac&" ?0! ,0!/!" c+2/ca% /a #!%a2a c0a"'+ !/ '+/+% 2!%a"!c! '0%a"#! /a%1+ #!2+. U"a a/#a 2%+2+%c&" '! 2ac!"#!, 'a4@#c+, '0%a"#! a/10"+, a*+,,06%%9b /1!%a + +'!%a'a "!0%+2a#8a '60,a ,!",+%a/. S! ac+2a*a 6%!c0!"#!!"#! '! 2a%!,#!,a, '+/+%+,a, 7 ?0!a"#!, 7 '+/+% /a"c"a"#! ,+4%! #+'+ !" 2!,- #+4//+, 7 2a"#+%%//a, '! a"!%a 4/a#!%a/ 7 ,@#%ca ,0!/! 'a%,! '0%a"#! /a "+c3! 7 a6!c#a% a/ ,0!*+. La 2%!,!"ca '! '+/+% "'ca%ab /a a6!c#ac&" '! 64%a, '! 2!?0!*+ ca/4%!. E,#! 0"a c/a%a %!/ac&" !"#%! !/ 1%a'+ '! 32!%1/0c!a- /a 3!+1/+4"a 1/c+,/a'a 7 /a 2%!,!"ca '! "!0%+2a#8a. La 'a4!#!, 20!'! +ca,+"a% "!0%+2a#8a, c%a"!a/!,- +"+"!0%+2a#8a, '! #%+"c+ 7 !#%!'a'!,- "!0%+2a#8a +#+%a 2%+a/ a+#%+6a 'a4@#ca- "!0%+2a#8aa0#+"&ca 7 2+/"!0%+2a#8a ,!",#$a + ,!",#$++#+%a. A,8b 20!,- !/ !,#0'+ 7 $a/+%ac&" '! /a, '!",+"!, '!/ '+/+% !" ca'a !"6!%+ c+" "!0%+2a#8a'a4@#ca '+/+%+,a "+ !, 0"a c0!,#&" !%a!"#! ,!9"#ca- ,"+ ?0! #!"! 0" "#!%@,#!%a2@0#c+ "'0'a4/!.
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BIBLIOGRA%A:
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