Chapter20.pptx

Chapter 20 Integrated Pathophysiologic Concepts Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Insulin Anabolic hormone Required for the uptake of glucose by many cells, particularly those of the liver, muscle, and adipose cells Promotes protein synthesis and formation/sto...

Chapter 20 Integrated Pathophysiologic Concepts Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Insulin Anabolic hormone Required for the uptake of glucose by many cells, particularly those of the liver, muscle, and adipose cells Promotes protein synthesis and formation/storage of lipids Facilitates transport of potassium, phosphate, and magnesium into the cells Copyright © 2023 Wolters Kluwer · All Rights Reserved Pancreas Endocrine  Insulin  Glucagon Exocrine  Digestive enzymes  Alkaline fluids Islets of Langerhans  Alpha, beta, and delta cells Copyright © 2023 Wolters Kluwer · All Rights Reserved Feedback Mechanisms Insulin increases when these increase: o Blood glucose, amino acids, potassium, phosphate, magnesium, glucagon, and gastrin Insulin decreases when there is o Low blood glucose, high insulin levels, and stimulation of alpha cells Copyright © 2023 Wolters Kluwer · All Rights Reserved Diabetes Mellitus Demonstrates the inability to regulate glucose, leading to the inadequate metabolism of macronutrients Type 1 Type 2 Gestational Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 1 Diabetes Mellitus Pathophysiology Absolute or significant deficit of insulin Cell-mediated immunodestruction of beta cells in the pancreas Multifactorial: genetic, environmental influences Approximately 10% of those with diabetes mellitus Hyperglycemia, hyperketonemia, ketoacidosis Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 1 Diabetes Mellitus Clinical Manifestations Polydipsia  Nocturia Excessive thirst Polyuria  Excessive urination Polyphagia  Excessive hunger Fatigue Lethargy Weight loss Blurred vision Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 1 Diabetes Mellitus Diagnostic Criteria History and physical examination o Presence of clinical manifestations Blood glucose levels o Fasting: >126 mg/dL o Random: >200 mg/dL Urinalysis: ketones, glucose Glycosylated hemoglobin (HbA1C): ≥8% Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 1 Diabetes Mellitus Treatment Glycemic control (glucose 70 to 120 mg/dL) o Self-monitoring blood glucose systems o Carbohydrate (nutrient) intake Exercise Insulin replacement therapy o Rapid onset, short acting (regular) o Intermediate acting o Slow onset, long acting Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 2 Diabetes Mellitus Pathophysiology Insulin resistance (reduced tissue sensitivity) Reduction in adequate insulin secretion Genetic and environmental factors o Obesity (greatest risk factor) o Age >30 years o Family history o Native American, Hispanic, or African American Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 2 Diabetes Mellitus Clinical Manifestations Often asymptomatic Manifestations can be vague o Visual changes o Changes in kidney function o Coronary artery disease o Peripheral vascular disease o Recurrent infections o Neuropathy Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 2 Diabetes Mellitus Diagnostic Criteria History and physical examination o Presence of clinical manifestations Blood glucose level o Fasting: >126 mg/dL (“pre”:110 to 125 mg/dL) o Random: >200 mg/dL Distinguish type 1 from type 2 Test for presence of long-term complications Copyright © 2023 Wolters Kluwer · All Rights Reserved Type 2 Diabetes Mellitus Treatment Weight control o Diet o Exercise Oral glycemic agents Insulin replacement therapy Goal: maintain optimal blood glucose levels Copyright © 2023 Wolters Kluwer · All Rights Reserved Gestational Diabetes Glucose intolerance with onset during pregnancy Usually temporary, but can lead to type 2 Occurs in up to 15% of pregnancies Requires diet modifications, exercise, and possibly insulin Untreated, can lead to fetal macrosomia, hypoglycemia, hypocalcemia, birth defects Copyright © 2023 Wolters Kluwer · All Rights Reserved Acute Complications of Diabetes Mellitus Hypoglycemia o Excessive insulin dose o Inadequate/unbalanced food intake or vomiting o Strenuous exercise or infection Diabetic ketoacidosis (DKA) Hyperglycemia hyperosmolar nonketotic syndrome (HHNK) The Somogyi effect and dawn phenomenon Copyright © 2023 Wolters Kluwer · All Rights Reserved Chronic Complications of Diabetes Mellitus #1 Microvascular Neuropathies  Retinopathy (eyes)  Nerve degeneration  Nephropathy (kidneys)  Symptoms  Numbness, tingling Macrovascular  Vascular diseases  Coronary artery  Cerebrovascular  Peripheral  Weakness  Muscle wasting  Pain Infection Copyright © 2023 Wolters Kluwer · All Rights Reserved Chronic Complications of Diabetes Mellitus #2 Copyright © 2023 Wolters Kluwer · All Rights Reserved