• Pranav Kumar Prabhakar Lovely Faculty of Applied Medical Sciences, Lovely Professional University


Diabetes mellitus (DM) is the most common endocrine metabolic disorder, characterised by hyperglycemia. The cause of this hyperglycemia is either insufficient or inefficient insulin which leads to the imbalance in the metabolism of not only carbohydrates but also protein and lipids. Diabetes mellitus is associated with various kind of abnormalities which affects almost all the parts of the body including eye, kidney, brain, foot etc. Hyperglycemia is not the only reason which gives diabetes mellitus a tag of most apocalyptic disease; it is the complications which arise from the higher concentration of glucose or metabolites comes from its variant metabolic pathways. DM causes both microvascular and macrovascular complications. Microvascular complications, caused by the damage of small blood vessels, includes nephropathy (kidney disease), retinopathy (eye damage) and neuropathy (nerve damage) whereas macrovascular complication, caused by the damage of large blood vessels, includes blood vessels arteries and veins. There are six metabolic pathways are there which normally leads to these complications. These pathways are sorbitol pathway, advanced glycation pathway, Hexosamine pathway, PKC pathway, ketoaldehyde pathway and oxidative stress.


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Table 3: Long-term complications of diabetes caused because of hyperglycemia (reference)

Long-term complications of diabetes

Tissue or organ affected What happens Complications

Blood vessels Fatty material builds up and blocks large or medium-sized

arteries in the heart, brain, legs, and penis. The walls of

small blood vessels are damaged, and they do not transfer

oxygen to tissues

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Poor circulation causes wounds to heal poorly and can

lead to heart disorders, strokes, gangrene of the feet

and hands, erectile dysfunction, and infections

Eyes The small blood vessels of the retina are damaged Decreased vision and ultimately, blindness occur

Kidneys Blood vessels in the kidney thicken. Protein leaks into urine Kidneys malfunction and ultimately kidney failure occur

Nerves Nerves are damaged because glucose is not metabolized

Autonomic nervous


normally and the blood supply is inadequate

Legs gradually weaken. People have reduced sensation,

tingling, and pain in their hands and feet

The nerves that control blood pressure and digestive

processes are damaged

Skin Blood flow to the skin is reduced, and sensation is

decreased resulting in repeated injury

Swings in blood pressure occur. Digestive function is

altered; Erectile dysfunction develops. Swallowing

becomes difficult

Sores and deep infections (diabetic ulcers) develop.

Healing is poor

Blood White blood cell function is impaired People become more susceptible to infections

(urinary tract and skin)

Connective tissue Glucose is not metabolized causing tissues to thicken

or contract

Carpal tunnel syndrome and Dupuytren’s contracture


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How to Cite

Prabhakar, P. K. “PATHOPHYSIOLOGY OF SECONDARY COMPLICATIONS OF DIABETES MELLITUS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 9, no. 1, Jan. 2016, pp. 32-36,



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