Type 1 PathophysiologyStage 1:genetic predispositionStage 2:environmental triggersSpring and fallEpidemics of various viral diseasesStage 3:active autoimmunityICA’s and insulin antibodies progressively decrease the effective circulating insulin levelStage 4:progressive beta cell destructionStage 5:overt Diabetes Essay mellitusType 2 PathophysiologyInsulin is a building (anabolic) hormone. w/o 3 metabolic problems occurDecreased glucose utilizationIncreased fat mobilizationIncreased protein utilizationDecreased Glucose UtilizationCells that require insulin as a carrier for glucose can take in only 25% of the glucose they require for fuelDo Not Require Insulin for Glucose TransportRequire InsulinNerve tissueAdipose tissueErythrocytesSkeletal muscleCells of intestinesCardiac muscleLiverKidney tubulesInadequate amounts of insulin = levels of glucose riseElevation continues to rise b/c liver cannot store glucose as glycogen w/o sufficient insulin levelsReturn to homeostasis = kidney excretes excess glucose = urine acting as osmotic diuretic = increased water loss aka fluid volume deficit.Increased Fat MobilizationBody turns to fat stores for energy production when glucose unavailableType 1Type 2 w/severe stressFat metabolism causes breakdown products called ketonesKetones accumulate in the blood, are excreted through kidney ; lungs, is measured in blood and urine.High levels = uncontrolled diabetesKetones interfere w/body’s acid-base balance by producing hydrogen ionsDecreased pH = metabolic acidosisSodium follows excreted ketones = sodium depletion and further acidosisExcreted ketones also = increase in osmotic pressure = increased fluid lossB/c fats are primary source of energy body lipids increase to 5x normal = atherosclerosisIncreased Protein UtilizationProtein wasting = lack of insulinw/o insulin to stimulate protein synthesis, the balance is altered = catabolismamino acids are converted to glucose in the liver increasing glucose levelsuntreated = emanciated appearanceDiagnosis of DiabetesPhysical exam, medical history, labsLabsFasting Glucose >125Casual Glucose >200Postprandial >200HbA1c C-peptide .Order now
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