INTRODUCTION
Diabetes mellitus (DM) is a group of metabolic diseases in
which a person has high blood sugar, either because the body does
not produce enough insulin, or because cells do not respond to the
insulin that is produced. This high blood sugar produces the classical
symptoms of polyuria, polydipsia, and polyphagia. When the glucose
concentration in the blood is raised beyond its renal threshold (about
10 mmol/L), reabsorption of glucose in the proximal renal tubuli is
incomplete, and part of the glucose remains in the urine (glycosuria).
This increases the osmotic pressure of the urine and inhibits
reabsorption of water by the kidney, resulting in increased urine
production (polyuria) and increased fluid loss. Lost blood volume will
be replaced osmotically from water held in body cells and other body
compartments, causing dehydration and increased thirst.
Type 1DM results from the body's failure to produce insulin, and
presently requires the person to inject insulin (Also referred to as
insulin-dependent diabetes mellitus (IDDM) or "juvenile" diabetes).
Type 2 DM results from insulin resistance, a condition in which cells
fail to use insulin properly, sometimes combined with an absolute
insulin deficiency (formerly referred to as noninsulin-dependent
diabetes mellitus (NIDDM) or "adult-onset" diabetes). If the amount
of insulin available is insufficient, if cells respond poorly to the effects
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of insulin (insulin insensitivity or resistance), or if the insulin itself is
defective, then glucose will not have its usual effect, it will not be
absorbed properly by those body cells that require it, nor will it be
stored appropriately in the liver and muscles. The net effect is
persistent high levels of blood glucose, poor protein synthesis, and
other metabolic derangements, such as acidosis.
Type 2 Diabetes is a chronic disease that affects an estimated
16 million or more Americans. Studies show that the number of
people suffering from Type 2 Diabetes is increasing in almost every
country around the globe. Every year more than 3 million people
worldwide die of Type 2 Diabetes. Globally, as of 2010, an estimated
285 million people have type 2 diabetes, making up about 90 percent
of all diabetes cases.
The glucose level in the body in Type 2 Diabetes patients is
higher than in normal people who do not suffer from this condition.
Generally after eating, the food reaches the stomach where it breaks
down into a sugary substance known as glucose. This glucose is then
carried through the blood stream to all the cells in the body. In Type 2
Diabetes patients the insulin, which is the substance that does the
work of converting glucose into energy, is produced in insufficient
quantities. Because of this, cells found in the body's fat, liver and
muscles are unable to utilize the glucose that is present leading to a
drastic increase in the glucose level of the blood while cells that need
glucose to function properly are deprived of it. This has very severe
consequences and after a period of time the blood vessels and
nerves could get seriously affected and lead to other related illnesses
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including blindness, nerve problems, kidney disease, and heart
attacks. In extreme cases, drastic action including amputation of
limbs is called for.
Diabetes mellitus and hypertension are common diseases that
coexist at a greater frequency than chance alone would predict.
Diabetic nephropathy is an important factor involved in the
development of hypertension in diabetics. The hallmark of
hypertension in type I and type II diabetics appears to be increased
peripheral vascular resistance. Increased exchangeable sodium may
also play a role in the pathogenesis of blood pressure in diabetics.
There is increasing evidence that insulin resistance/ hyperinsulinemia
may play a key role in the pathogenesis of hypertension in both
subtle and overt abnormalities of carbohydrate metabolism.
Population studies suggest that elevated insulin levels, which often
occurs in type II diabetes mellitus, is an independent risk factor for
cardiovascular disease. Other cardiovascular risk factors in diabetic
individuals include abnormalities of lipid metabolism, platelet function,
and clotting factors.
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Chapter 5
ANATOMY AND PATHOPHYSIOLOGY
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The endocrine system is the system of glands, each of which
secretes a type of hormone directly into the bloodstream to regulate
the body. The endocrine system is in contrast to the exocrine system,
which secretes its chemicals using ducts. It derives from the Greek
words "endo" meaning inside, within, and "crinis" for secrete. The
endocrine system is an information signal system like the nervous
system, yet its effects and mechanism are classifiably different. The
endocrine system's effects are slow to initiate, and prolonged in their
response, lasting from a few hours up to weeks. The nervous system
sends information very quickly, and responses are generally short
lived. Hormones are substances (chemical mediators) released from
endocrine tissue into the bloodstream where they travel to target
tissue and generate a response. Hormones regulate various human
functions, including metabolism, growth and
development,tissue function, and mood. The field of study dealing
with the endocrine system and its disorders is endocrinology, a
branch of internal medicine.
Features of endocrine glands are, in general, their ductless
nature, their vascularity, and usually the presence of intracellular
vacuoles or granules storing their hormones. In contrast, exocrine
glands, such as salivary glands, sweat glands, and glands within the
gastrointestinal tract, tend to be much less vascular and have ducts
or a hollow lumen.
In addition to the specialized endocrine organs mentioned
above, many other organs that are part of other body systems, such
as the kidney, liver, heart and gonads, have secondary endocrine
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functions. For example the kidney secretes endocrine hormones such
as erythropoietin and renin.
The endocrine system is made of a series of glands that
produce chemicals called hormones. A number of glands that signal
each other in sequence are usually referred to as an axis, for
example, the hypothalamic-pituitary-adrenal axis.
Pancreas
The pancreas is an elongated organ located toward the back of
the abdomen behind the stomach. The pancreas has digestive and
hormonal functions. One part of the pancreas, the exocrine pancreas,
secretes digestive enzymes. The other part of the pancreas, the
endocrine pancreas, secretes hormones called insulin and glucagon.
These hormones regulate the level of glucose (sugar) in the blood.
The pancreas houses two distinctly different tissues. The bulk
of its mass is exocrine tissue and associated ducts, which produce an
alkaline fluid loaded with digestive enzymes which is delivered to the
small intestine to facilitate digestion of foodstuffs. Scattered
throughout the exocrine tissue are several hundred thousand clusters
of endocrine cells which produce the hormones insulin and glucagon,
plus a few other hormones.
Insulin and glucagon are critical participants in glucose
homeostasis and serve as acute regulators of blood glucose
concentration. From a medical perspective, insulin in particular is
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enormously important - a deficiency in insulin or deficits in insulin
responsiveness lead to the disease diabetes mellitus.
SECRETED FROM
EFFECT
HORMONE CELLS
Intake of glucose,
Insulin (Primarily) β Islet cells glycogenesis and
glycolysis in liver and musclefro
m blood
intake of lipids and synthesis
of triglycerides in adipocytes. O
ther anabolic effects.
Glucagon (also α Islet cells Glycogenolysis and gluconeog
primarily) enesis in liver
increases blood glucose level.
Somatostatin δ Islet cells Inhibits release of insulin,
inhibits release of glucagon and
suppresses the exocrine
secretory action of pancreas.
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Chapter 6
PATHOPHYSIOLOGY
Modifiable Factor Non-modifiable
Factor
Love to eat sweets Obese
With history of DM
Insulin Resistance
Hyperglycemia
Decrease Blood Blood sugar Gluconeogenesis
Glucose cannot
Osmolality exceeds renal activation
enter cell
threshold
Glycosuria
Fluid shifting from
intracellular to Cellular Lipolysis
extracellular Starvation
Osmotic Fatty Acids
Increase Urine
Diuresis Sensation of
Intracellular DHN hunger
Polyuria Hypertension
Polyphagia
Thirst Sensation
Polydipsia Increase Blood Favors
viscosity bacterial
growth
Decrease
Blood Flow
Decrease
Tissue Edema
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Perfusion
Decrease
