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Transcript of endocrine II
Hyperglycemia and the polyol pathway
Protein kinase C
Chronic Complications of Diabetes Mellitus
Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
Dysfunction of the Pancreas
Demonstrates pancreatic atrophy and specific loss of beta cells
Macrophages, T and B lymphocytes, and natural killer cells are present
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
Immunologically mediated destruction of beta cells
Pathophysiology of Type 1 Diabetes
Diabetes Learning Objectives
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?
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
(cc) photo by medhead on Flickr
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
Dr. Lori D. Crawford
Epidemiology and Risk Factors of Type 2 Diabetes
Increased risk for diabetes
Highest for AA, AA, NA, PI
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)
Pathophysiology of Type 2 DM
Beta Cell Dysfunction
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)
Complications of Diabetes
•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
(cc) image by anemoneprojectors on Flickr
More Insulin deficiency
Combination of hypoglycemia & rebound
Early morning rise in blood glucose levels
Diabetes mellitus is a group of disorders with glucose intolerance
Diabetes mellitus can lead to microvascular complications, macrovascular complicantions, and death
Coronary Artery Disease
Peripheral Arterial Disease