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Understanding Diabetes Mellitus: Pathophysiology and Treatment

Explore the pathophysiologic concepts of Diabetes Mellitus, including the role of the pancreas, insulin, feedback mechanisms, types of diabetes, clinical manifestations, diagnostic criteria, treatments, and complications.

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Understanding Diabetes Mellitus: Pathophysiology and Treatment

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  1. Pathophysiology: A Clinical Approach Chapter 18: Combining Complex Pathophysiologic Concepts: Diabetes Mellitus

  2. Pancreas • Endocrine • Exocrine • Islets of Langerhans

  3. 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

  4. Feedback Mechanisms • Insulin increases when these increase: • Blood glucose, amino acids, glucagon, and gastrin • Insulin decreases when there is: • Low blood glucose, high insulin levels, and stimulation of alpha cells

  5. Diabetes Mellitus • Demonstrates the inability to regulate glucose, leading to the inadequate metabolism of macronutrients • Type 1 • Type 2 • Gestational

  6. Type 1 Diabetes Mellitus • 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

  7. Type 1 Diabetes MellitusClinical Manifestations • Polydipsia • Polyuria • Polyphagia • Weight loss • Fatigue, lethargy • Nocturia • Visual changes

  8. History and physical examination Blood glucose levels Fasting Random Glycosylated hemoglobin (HbA1C) Type 1 Diabetes MellitusDiagnostic Criteria

  9. Type 1 Diabetes MellitusTreatment • Carbohydrate (nutrient) intake • Exercise • Insulin replacement therapy

  10. Type 2 Diabetes Mellitus • Insulin resistance and a reduction in adequate insulin secretion • Obesity is greatest risk factor • More common than type 1 (90% of those with diabetes)

  11. Type 2 Diabetes Mellitus Clinical Manifestations • Often asymptomatic • Manifestations can be vague • Visual changes • Nephropathy • Coronary artery disease • Peripheral vascular disease • Recurrent infections • Neuropathy

  12. Type 2 Diabetes MellitusDiagnostic Criteria • Blood glucose level • Distinguish type 1 from type 2 • Test for presence of long-term complications

  13. Type 2 Diabetes MellitusTreatment • Weight control: diet, exercise • Oral glycemic agents • Goal: maintain optimal blood glucose levels

  14. Gestational Diabetes • Glucose intolerance with onset during pregnancy • Occurs in 4-14% of pregnancies • Requires diet modifications, exercise, and possibly insulin

  15. Acute Complications of Diabetes Mellitus • Hypoglycemia • Diabetic ketoacidosis (DKA) • Hyperglycemia hyperosmolar nonketotic syndrome (HHNK) • The Somogyi Effect and Dawn Phenomenon

  16. Chronic Complications of Diabetes Mellitus • Microvascular Complications • Macrovascular Complications • Neuropathies • Infection

  17. Chronic Complications of Diabetes

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