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endocrine II

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by

Lori Crawford

on 20 October 2013

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Transcript of endocrine II

Hyperglycemia and nonenzymatic glycosylation
Hyperglycemia and the polyol pathway
Protein kinase C
Chronic Complications of Diabetes Mellitus
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
Somogyi effect
Dawn phenomenon
Acute Complications
Dysfunction of the Pancreas
Demonstrates pancreatic atrophy and specific loss of beta cells
Macrophages, T and B lymphocytes, and natural killer cells are present
Two types
Immune
Nonimmune
Pathophysiology of Type 1 Diabetes
Group of clinically heterogeneous disorders that have glucose intolerance in common
Describe a syndrome characterized by chronic hyperglycemia and other disturbances of fat, carbohydrates, protein metabolism
ADA classifies four categories of diabetes mellitus
Type 1 (absolute insulin deficiency)
Type 2 (insulin resistance with insulin secretory deficit)
Other specific types
Gestational diabetes
Definition/Classification
Genetic susceptibility
Environmental factors
Immunologically mediated destruction of beta cells
Pathophysiology of Type 1 Diabetes
Diabetes Learning Objectives
Clinical Manifestations
Hyperglycemia
Polydipsia
Polyuria
Polyphagia
Weight loss
Fatigue
Cite the diagnostic criteria for diabetes mellitus.
Describe the similarities and differences in the etiology and pathophysiology between type 1 diabetes mellitus and type 2 diabetes mellitus.
Describe the common clinical manifestations of diabetes mellitus.
Describe the possible causes of insulin resistance.
Identify and describe the acute complications of diabetes mellitus: hypoglycemia (insulin shock), diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), the Somogyi effect, and the dawn phenomenon.
So What is Diabetes ?
Epidemiology of Type 1 Diabetes
Accounts for 5-10% of all cases of diabetes
Rates for whites 1.5 to 2 times higher than nonwhites
Generally normal weight
Why is insulin important?
Big and....
... small
Energy
Glucose Metabolism
Stimulates the storage of glucose as glycogen in the liver and muscles.
Stimulates the synthesis of fatty acids and triglycerides.
Stimulates the uptake of triglycerides into adipose tissue.
Inhibits lipolysis and the resulting production of ketones.
Enhances the incorporation of amino acids into proteins.
Insulin actions in fed state
Insulin
Glucagon
(cc) photo by medhead on Flickr
Cortisol
Epinephrine
Growth hormone
Type 2 Diabetes Mellitus
Most cases of diabetes mellitus
Fasting Plasma Glucose >126 mg/dL (7mmol/L)
American Diabetes Association Criteria
no caloric intake for at least 8 h
2-h plasma glucose >200mg/dL (11.1mmol/L)
during an oral glucose tolerance test (OGTT)
a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
Random plasma glucose >200 mg/dL with classic sumptoms
A1C greater than 6.5
Type 1 Diabetes Mellitus
Endocrine Lecture
Dr. Lori D. Crawford
Epidemiology and Risk Factors of Type 2 Diabetes
Increased risk for diabetes
Highest for AA, AA, NA, PI
Obesity
Prediabetes
Fasting plasma glucose 100 mg/dL to 125 mg/dL (5.6 mmol/L) or (6.9 mmol/L) (IFG)
2-h plasma glucose in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)
A1C 5.7–6.4%
Metabolic Syndrome
Pathophysiology of Type 2 DM
Beta Cell Dysfunction
Obesity's Role
Insulin Resistance
Glucagon
Insulin
Amylin
Incretins
Incretins
Ominous Octet
Clinical Manifestations
Any glucose intolerance with onset or first recognition during pregnancy
Perform a 75-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h, at 24–28 weeks’ gestation in women not previously diagnosed with overt diabetes.
OGTT should be performed in the morning after an overnight fast of at least 8 h.
The diagnosis of GDM is made when any of the following plasma glucose values are exceeded
Fasting ≥ 92 mg/dL (5.1 mmol/L)
1 h ≥180 mg/dL (10.0 mmol/L)
2 h ≥153 mg/dL (8.5 mmol/L)
Gestational Diabetes
Complications of Diabetes
Hypoglycemia
•Newborns glucose levels less than 35 mg/dl for the first 48 hours
•45 to 60 mg/dl in children and adults •Some causes include insulin, sulfonylurea agents, exercise
Hyperosmolar Hyperglycemic Nonketotic Syndrome
Compare
(cc) image by anemoneprojectors on Flickr
Diabetic Ketoacidosis
More Insulin deficiency
More Ketone-forming
Kussmaul respirations
More hypergylcemia
Less lipolysis
Somogyi
Effect
Dawn's Phenomenon
Compare
Combination of hypoglycemia & rebound
hyperglycemia
Early morning rise in blood glucose levels
Chronic Complications
Microvascular Complications
Summary
Diabetes mellitus is a group of disorders with glucose intolerance
Diabetes mellitus can lead to microvascular complications, macrovascular complicantions, and death
Coronary Artery Disease
Stroke
Peripheral Arterial Disease
Macrovascular Complications
Full transcript