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Diabetes Mellitus
Diabetes revision
| Question | Answer |
|---|---|
| Cause of diabetes? | Deficiency or absence of insulin due to destruction of β-islet cells of the pancreas |
| Effect of insulin deficiency? | Disruption of carbohydrate and fat metabolism |
| Epidemology | Occurs in children and young adults |
| Presentation | Sudden onset |
| Gluconeogenesis | The production of new glucose from proteins |
| Effects of ↑ plasma protein level | cells unable to take up and use glucose from blood stream; conversion of glucose to glycogen in liver and muscles is ↓; gluconeogenesis from protein in response to deficiency of intracellular glucose |
| Glucosuria | Glucose in urine |
| Cause of glucosuria | diabetes raises the renal threshold for glucose, it is not all reabsorbed by tubules. |
| Cause of increased urine | Remaining glucose in filtrate raises its osmotic pressure, water reabsorption is reduced and the volume of urine produce is ↑ |
| Effects of glucosuria | Electrolyte imbalance, Excretion of urine of high specific gravity, Can lead to hypovolaemia, extreme thirst (polydipsia) and ↑ thirst |
| What causes weightloss? | Cells fail to metabolise glucose in normal way |
| How does the body compensate for cells failing to metabolise glucose in a normal way? | gluconeogenesis from amino acids and body protein |
| What is the effect of gluconeogenesis? | muscle wasting, tissue breakdown and further ↑ blood glucose, Catabolism of body fat, releasing some of its energy, Excess production of ketone bodies (from fats being broken down) |
| Why do ketosis and ketoacidosis occur? | Alternative energy sources must be used → leading to ↑ breakdown of fat occurs |
| What is the effect of ketosis and ketoacidosis? | Alternative energy sources must be used → leading to ↑ breakdown of fat occurs |
| What are the effects of ketoacidosis? | Excessive production of ketone bodies which are weakly acidic. |
| What does not change providing the level of ketone bodies is not excessive? | Normal systems maintain pH balance. |
| What causes ketosis? | Accumulation ketone bodies |
| Effects of ketosis? | Excretion of ketones |
| Where are ketones excreted from? | Urine and lungs (acetone/pear drop smell) |
| What is ketoacidosis? | Swampping of compensatory buffer systems by acidosis |
| Effects of ketoacidosis? | control of acid/base balance is lost, blood pH ↓ |
| What are the consequences of ketoacidosis? | ↑ acidosis (↓ blood pH) due to accumulation of ketoacids, ↑ hyperglycaemia, Hyperventilation as lungs excrete excess hydrogen ions as CO2, Acidification of urine – result of kidney buffering, polyuria, |
| More consequences of ketoacidosis? | Dehydration and hypovolaemia (↓BP and ↑ pulse) – caused by polyuria, Disturbances of electrolyte balance accompanying fluid loss, hyponatraemia (↓ plasma potassium), Confusion, coma and death |
| What are the acute complications? | Diabetic ketoacidosis (Hyperglycaemia) and Hypoglycaemic coma |
| Causes of ketoacidosis | ↑ insulin requirement, ↑ resistance to insulin due to some added stress such as microbial infection, May be caused by failure to administer prescribed dose or to adjust dose during times of ↑ need |
| What are the common causes of hypoglycaemia? | accidental overdose, delay in eating after insulin administration, • gastrointestinal disturbances which carb absorption is ↓ e.g vomiting, diarrhoea, • ↑ metabolic rate in, e.g., unexpected exercise, acute febrile illness, an insulin secreting tumour |
| Effects of hypoglycaemia | Anxiety, blurred vision, feeling cold, feeling weak, feeling weak, euphoria, headache, hunger, irritability, nervousness, pounding heart, restless sleep, sweating, trembling and unconsciousness. |
Created by:
minipod2002
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