Diabetes

During a routine office visit, a 64-year-old woman who has had type 2 diabetesfor more than 10 years complains of increased pedal edema. The edema is minimalon awakening and worsens throughout the day.

How does amyloid in the pancreatic islets contribute tothe development and progression of type 2 diabetes?

Dr Gregory Rutecki's interactive teaching case, “A Middle-Aged Man WithPolyuria: The Initial Visit” (CONSULTANT, March 2001, page 357), provided awelcome opportunity for me to review the care I provide to my patients with type 2diabetes, who comprise a very large percentage of my practice.

Cutaneous manifestations develop inapproximately 30% of persons withdiabetes. Premature atherosclerosisis a common complication of thedisease and can cause peripheral infarction,ulceration, and necrosis.

Diabetic retinopathy is the most common cause of legal blindness in personsbetween the ages of 20 and 65 years. In this 56-year-old man with a 20-yearhistory of type 2 diabetes, multiple, scattered intraretinal (dot-blot) hemorrhagesand superficial nerve fiber layer (splinter) hemorrhages can be seen.An occasional Roth spot-an intraretinal hemorrhage with a white center thatrepresents a fibrin thrombus which occludes a ruptured blood vessel-is alsoevident. Numerous yellow, waxy, hard exudates are seen between the innerplexiform and inner nuclear layers of the retina. Cotton-wool spots are alsopresent, although no neovascularization is present.