In this session Dr. Mobeen discusses how chronically elevated blood glucose levels cause tissue damage.

Following pathological mechanisms are discussed:

• Non-enzymatic glycosylation or glycation.
  • Advanced glycation end products (AGE) are discussed.
  • Extracellular matrix thickening and fibrosis is discussed.
  • Tunica intima damage and the acceleration of atheroma formations is discussed.
  • Micro and macro vascular damage.
  • Neuropathies due to microvascular pathologies.
  • Activation of the inflammatory processes due to glycation is reviewed.
  • Renal tissue damage is discussed.
  • Formation of the HbA1c is discussed.
  • Albumin glycation is discussed.
• Activation of the protein kinase C (PKC) and tissue damage due to the raised levels of the PKC.
  • Diacylglyceroal (DAG) pathway is presented.
  • Elevated glucose levels leading to increased formation of the DAG.
  • Angiogenesis/Neovascularization due to the eleveated DAG. This leads to retinal pathologies.
  • Tumor growth factor beta (TGF-beta) levels increased leading to increased formation of the extracellular matrix. This in turn leads to the thickening of the skin and other tissues.
• Polyol pathway acceleration and osmotic damage due to sorbitol accumulation in various tissues.
  • Sorbitol accumulation.
  • Increased working of the polyol pathway allows reactive oxygen species to accumulate and cause damage.
  • Myeline sheath pathologies due to the osmotic damage.