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DIABETES MELLITIUS

DIABETES MELLITIUS. Cells and Molecules Clinical Application Presented 9/6/02 By M. Grant Ervin MD,MHPE,FACEP. Objectives. Correlate clinical presentation of patient with DKA with occurrences on cellular level Describe mechanisms by which glucagon and insulin regulate glycolysis

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DIABETES MELLITIUS

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  1. DIABETES MELLITIUS Cells and Molecules Clinical Application Presented 9/6/02 By M. Grant Ervin MD,MHPE,FACEP

  2. Objectives • Correlate clinical presentation of patient with DKA with occurrences on cellular level • Describe mechanisms by which glucagon and insulin regulate glycolysis • Discuss therapeutic measures used to treat the patient in DKA and the cellular impact

  3. A 45 year old male is brought into the ED c/o increased thirst, dizziness, weakness for the past week. He denies any medical problems, medications, allergies.BP – 100/60, RR-24, HR – 120, Temp.99.9 F

  4. What are the abnormalities? • Thirst • Weakness • Low blood pressure • Fast heart rate • Fast respiratory rate

  5. Simultaneous Diagnostic, Therapeutic, and Rescuscitative Measures Pulse Ox EKG IV line, blood for I-stat, extra tubes to be determined Cardiac monitor, BP monitor Physical Exam significant dry mucus membranes and abnormal vital signs as stated

  6. Carbon monoxide/cyanide exposure Alcohol Touluene Methanol uremia DKA Paraldehyde ingestion Isoniazid/Iron Lactic acidosis Ehtylene glycol salicylates Causes of Elevated Anion Gap Metabolic Acidosis

  7. Cellular Correlations • Elevated glucose levels secondary to decreased insulin, liver has diminished enymatic capacity to remove glucose • Decreased glucokinase activity • Loss of insulin’s action on key enzymes of glycogenesis and the glycolytic pathway • Liver stuck in gluconeogenesis fueled by substrate from body protein degradation

  8. Cellular Correlations (con.) • Muscle fails to take up glucose with decreased insulin • Adipose tissue is stimulated to lipolysis due to low insulin/glucagon ration • Leads to increased blood levels fatty acids • Accelerated ketone body production • Metabolic acidosis • Increase respiratory rate is trying to correct acidosis

  9. Overall metabolism is stuck in every tissue continuing its catabolic state producing more fuel despite increase glucose. Insulin/ glucagon ration is unbalanced

  10. Therapeutic Measures • Fluids • Insulin • Correct electrolyte deficiencies • Look for precipitating causes

  11. Summary • In Insulin Dependent and Non-Insulin Dependent Diabetes the insulin/ glucagon ratio is vital in intracellular glucose control • Therapeutic measures are directly tied to what is occurring on a cellular level

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