Health science-2211 Module 3 Lecture 1 (Part 3)
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Health science-2211 Module 3 Lecture 1 (Part 3)
diabetes pathophysiology (complications of Diabetes Mellitus)
what are the acute complications and chronic complications of diabetes mellitus related to?
related to excessive hyperglycemia
related to insults to microvasculature or microvasculature
what are the 6 acute complications of diabetes mellitus?
hypoglycemia (low blood glucose)
hyperglycemia (high blood glucose)
hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
what can cause hypoglycemia?
can result from
skipping meals, an excess of either insulin or oral diabetes medication
How are most hypoglycemic reactions that are mild managed?
self-administrating the sugar needed to correct the situation (sugar product or fruit juice)
what happens in severe hypoglycemia?
results in coma
and the assistance of health care professionals may be required
what are some symptoms of hypoglycemia? (5)
how does hyperglycemia develop?
develops when there is
too much glucose, not enough insulin or insufficient insulin activity in the blood stream
what are the symptoms of hyperglycemia? (4)
how can hyperglycemia be managed?
rehydration if dehydrated
oral anti-diabetic agent or insulin
what is diabetic ketoacidosis and which diabetes is it much more common in?
life-threatening biochemical imbalance
more common in type 1 diabetes
how does diabetic ketoacidosis (DKA) occur?
hyperglycemia accelerated because most tissues cant utilize glucose without insulin
too little insulin causes energy-starved cells to break down lipids, results in production of acidic ketone bodies
they accumulate in blood stream and urine
leads to disruption of blood pH
what does diabetic ketoacidosis result in?
results in the loss of lean muscle mass
what are the early symptoms of diabetic ketoacidosis? if untreated what other symptoms occur? what are the late signs?
frequent urination that lasts for days or more
fruity smelling breath
what are the risk factors of diabetic ketoacidosis in people with already diagnosed type 1 diabetes? (5)
when people with diabetes miss their insulin treatment
DKA can be the ____________________ in people who don't yet have other symptoms.
first sign of type 1 diabetes
Is diabetes ketoacidosis a complication for people with type 2 diabetes? how is it triggered?
can occur but very rare
usually triggered by severe illness
which ethnic groups are more likely to have DKA as a complication of type 2 diabetes? (2)
Treatment for DKA is aimed at the correction of the 3 main problems which are?
what does HHNS stand for?
Hyperosmolar hyperglycemic nonketotic syndrome
what happens in HHNS?
lack of effective insulin which results in hyperglycemia
in HHNS hyperglycemia, the
body tries to get rid of the excess sugar by polyuria (excessive urination)
leads to sever dehydration
where is HHNS most frequently seen?
frequently seen in
elderly patients of type 2 diabetes
(may occur with type 1, but less often)
What are the symptoms of HHNS? (4)
initially high urine production, frequent bathroom visits
urine becomes very dark
polydipsia (excessive thirst)
severe dehydration will lead to seizures followed by coma, eventually death
what are the warning signs for HHNS? (6)
dry, parched mouth
plasma glucose level over 600 mg/dl
warm, dry skin
weakness on one side of body
Treatment for HHNS involves 4 approaches, what are they?
vigorous intravenous re-hydration
administration of insulin
diagnosis and management of precipitating and coexisting problems
what are some ways to prevent HHNS? (3)
check plasma glucose regularly
know their target blood glucose range
when ill check blood glucose more often, and drink glass of liquid every hour
what is the somogyi effect?
occurs when the blood glucose level swings high following hypoglycemia
what is the cause of somogyi effect? (2)
caused by high level of insulin in blood during night (when person takes long-acting insulin)
release of stress hormones which may follow hypoglycemic episode
what is the dawn phenomenon? (3)
hormones that are released as a defensive mechanism against low plasma glucose level in the early morning hours
may partially block the effect of insulin
blood sugar levels may rise resulting in elevated before-breakfast plasma glucose levels
what are the
long term chronic complications
of DM? (3)
high blood glucose damages blood vessels
(high blood pressure, atherosclerosis, blindness)
infections of the skin and gums
what organs do chronic complications of DM effect? (6)
brain and cerebral circulation
heart and coronary circulation
peripheral nervous system
peripheral vascular tree
what are the 4 main chronic complications for diabetes mellitus?
microvasculature (small blood vessel level)
macrovasculature (large blood vessel)
what is the microvascular disease? what does it cause?
thickening of the basement membrane, which results in decreased tissue perfusion
causes hypoxia and ischemia of various organs mainly eyes, kidneys, nerves
what 3 organs does mircovascular disease affect and what does it cause?
what is diabetic retinopathy?
leading cause of adult-onset blindness caused by changes in blood vessel in the retina
what is diabetic nephropathy? (2)
with the blood glucose levels elevated, the kidney's filtration mechanism is stressed
earliest sign is thickening in glomerulus, allowing blood proteins to leak into the urine
what is diabetic neuropathies? what is one complication it can cause?
group of diseases that affect all types of nerves including peripheral, autonomic and spinal nerves
can cause loss of sensitivity and decreased sensations of pain and temperature
Gastrointestinal dysfunction is a result of diabetic autonomic neuropathy, what are the most common alterations of the GI tract? (4)
: delayed gastric emptying, bloating, nausea, vomiting
constipation and diarrhea
: bladder voiding-loss of sensation of a full bladder, urinary retention
: erectile dysfunction, retrograde ejaculation
what are the 3 main diabetic macrovascular disease?
coronary artery disease (CAD)
peripheral arterial disease
what are the dermatological manifestations of Diabetes Mellitus?
disorders of healing
complications of diabetes that contribute to the increased risk of foot infections are: (3)
: loss of pain and pressure sensation;increased dryness and fissuring of skin
: poor circulation of the lower area contributes to poor wound healing & development of gangrene
: hyperglycemia impairs ability of specialized leukocytes to destroy bacteria; lower resistance to infections in poorly controlled diabetes
what are some infections in diabetic patients? (3)
dermatological and soft tissue infection
respiratory tract infections
Individuals with DM are at increased risk for infection throughout the body because of? (3)
microvascular and macrovascular complications cause decreased oxygen supply to tissue
pathogens are able to multiply rapidly because increased glucose in body fluids provides excellent source of energy