diabetes and its complication dr. miada mahmoud rady ems / 474 endocrinal emergencies lecture ii
TRANSCRIPT
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Diabetes and Its Complication
Dr. Miada Mahmoud Rady
EMS / 474
Endocrinal Emergencies lecture II
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Lecture Topics
1. Definition.
2. Hormones That Affect Glucose Metabolism.
3. Regulation of Blood Glucose.
4. Pathophysiology and clinical presentation of diabetes.
5. Complication of diabetes
6. Types of diabetes.
7. Diagnosis of diabetes.
8. Diabetic emergencies.
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Diabetes
Definition : hyperglycemic metabolic disorders caused by
either insulin Deficiency or Insufficiency .
Deficiency means → decrease .
Insufficiency means → inappropriate action.
Diabetes mellitus affects protein , fat and carbohydrate
metabolism but the hallmark of D.M is Hyperglycemia
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Hormones That Affect Glucose Metabolism
Several hormones affect blood glucose level either by
increasing or decreasing :
Examples of hormones that increase blood glucose level :
glucagon , growth hormones , thyroid hormones and
cortisol.
Examples of hormones that decrease blood glucose level:
Only Insulin .
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GlucagonThyroid hormone Growth hormone Corticosteroids
What are the hormones that affect blood glucose level
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Insulin
The only Hypoglycemic hormone in the body.
Secreted from Beta Cells of islet of Langerhans.
Main functions of insulin :
1. Increase glucose transport into cells.
2. Increase glucose metabolism by cells.
3. Increase liver glycogen levels.
4. Insulin antagonize effects of glucagon.
So It Decrease Blood Glucose Concentration Toward Normal
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Glucose movement into the cell with insulin and the inability of glucose to get into the cell
without insulin.
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Glucagon
It is secreted from alpha cells of the pancreas.
It increases blood glucose level through :
1. Glycogenolysis : break down of stored glycogen in liver
and other storage sites into glucose.
2. Gluconeogensis : glucose formation through breakdown
of fats and fatty acids.
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Pancreatic secretions
in response
to changes in
blood glucose level.
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Regulation of Blood Glucose
Hypoglycaemia:
1. Low blood sugar.
2. Stimulates α cells.
3. Release glucagon.
Hyperglycaemia:
1. High blood sugar.
2. Stimulates β cells.
3. Release insulin.
4. Also lost in urine (osmotic diuresis) .
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Glucose metabolism
Eating
BGL rises
Insulin is secreted from pancreas
Allow glucose to enter cell
Blood glucose level decreases
Glucagon is released
Blood glucose level is normalized
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Pathophysiology and clinical presentation of diabetes
in diabetic patient insulin deficiency or inappropriate action
result in failure of the body to utilize simple sugars which
accumulate in the different body tissues and organs:
1. Kidney : excess sugar produces osmotic diuresis, which
leads to polyuria , which causes the polydepsia.
2. Tissues saturated with sugars are more liable to trauma ,
infection and also heals badly , that’s why diabetic patient
is more liable to infection.
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Clinical presentation of diabetes
1. Polyuria .
2. Polydepsia .
3. Polyphagia .
4. Unexplained weight loss .
5. Tiredness and easy fatigability.
6. Increased liability to infection (vaginal infection).
7. Clinical presentation of complications .
3PS , Classical Symptoms Of D.M
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Complication of diabetes
A. Acute complication :
i. Hypoglycemia.
ii. DKA ( diabetic ketoacidosis).
iii. Hyperosmolar non-ketotic coma .
A. Chronic complication:
→ It affects all body system .
→ It either Microvascular ( affect small vessels) or
Macrovascular ( affect large vessels).
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Microvascular complication
1. Eye : diabetic retinopathy and cataract ( blurring of vision ).
2. Kidney : diabetic nephropathy ( acute and chronic renal
failure).
3. Diabetic neuropathy : ( tingling and numbness).
4. Foot complication : poor wound healing and increased liability
to infection.
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Macrovascular complication
1. Brain : stroke and altered mental status .
2. Heart : ischemic heart disease , cardiomyopathy and
hypertension.
3. Peripheral arterial disease and chronic ischemia.
4. Diabetic foot and gangrene .
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Types of diabetes
1. Type 1.
2. Type 2.
3. Gestational diabetes.
4. Others e.g. secondary diabetes ( chronic pancreatitis , cancer
head of pancreas and pancreatectomy).
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Type 1diabetes mellitus
Also known as Juvenile or insulin-dependent diabetes mellitus
(IDDM).
Result from Inadequate Production of insulin by pancreas.
Usually occurs in teenagers and young adults.
Characterized by sever hyperglycemia , so more sever symptoms and
more fat metabolism.
Cause : autoimmune disease that results from genetic abnormality
that causes body to destroy its own insulin producing cells.
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Type 1diabetes mellitus
Onset is usually sudden and may be with DKA.
Treatment : insulin is essential ( main line ), exercise, diet
regulation.
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Type 2 diabetes
Adult-onset or non-insulin-dependent diabetes mellitus (NIDDM).
Results from decreased binding of insulin to cells (insulin resistance).
Less sever hyperglycemia so less sever symptoms and less fat
metabolism.
Predisposing factor :
1. Obesity and bad eating habits
2. Sedentary life .
3. Family history ( hereditary ) .
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Type 2 diabetes
Treatment :
1. Mainly diet control and exercise
2. Oral hypoglycemic drugs ( to increase insulin
sensitivity and production) .
3. Only small number requires insulin.
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Gestational diabetes
Develops in some women during late pregnancy and Usually
resolves with childbirth.
It may progress to D.M type 2.
Etiology :
1. The effect of pregnancy hormones which antagonize
the effect of insulin
2. increased insulin requirement during pregnancy.
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Gestational diabetes
Commonest complication is Macrosomia
Treatment : Diet is first and the most important line of
treatment , insulin is given last.
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Metabolic syndrome
Cluster of characteristics :
a. Excessive fat in the abdominal area.
b. Elevated blood pressure.
c. High levels of blood lipids.
People with metabolic syndrome are at increased risk of
D.M.
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Diagnosis of diabetes
If you suspect diabetes (in any persons showing symptoms
and signs of diabetes) diagnosis is confirmed by following
blood tests :
1. Fasting blood glucose .
2. 2hrs post prandial blood glucose.
3. Random blood glucose.
4. Glycoselated hemoglobin.
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Diagnosis of diabetes
≥ 126mg/dl. ≥ 200mg/dl
˃ 200mg/dl +
polysymptoms
100-125mg/dl 140 - 199 mg/dl.
< 100 mg/dl.
< 140mg/dl
Fasting 2hr PP Random HBA1C
Normal
prediabetic
Diabetic
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Diabetic Emergencies
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Hypoglycemia
Definition : blood glucose level Lower Than 60mg/dl.
It occurs in both diabetics and non diabetics .
Characteristic :
1. Sudden onset .
2. Rapidly progressive course .
That is why hypoglycemia is Very Dangerous especially in
diabetics because they are usually unable or unaware of
symptoms.
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Causes of hypoglycemia
A. Causes And Predisposing Factors Of Hypoglycemia In
Diabetics:
1. Overdose of oral hypoglycemic drugs or insulin
2. Missed meals.
3. Stress e.g. physical or emotional.
4. Surgery and trauma
5. Infection.
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Causes of hypoglycemia
B. Causes of hypoglycemia in non diabetics :
1. Starvation .
2. Renal failure .
3. Liver cell failure .
4. Malignancy .
5. Chronic debilitating illness.
6. Endocrinal disorders e.g. adrenal and growth hormone
deficiency.
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Clinical presentation
It present with two sets of symptoms :
1. Autonomic : caused by stimulation of autonomic nervous
system.
2. Neuroglycopenic : caused by lack of glucose supply to
the brain ( glucose is the main source of energy to the
brain).
Complication : prolonged hypoglycemia leads to irreversible
brain damage.
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Signs and symptoms of hypoglycemia
Autonomic
1. Anxiety.
2. Palpitation.
3. Sweating.
4. Tingling.
5. Tremors.
6. Tachycardia.
Neuroglycopenic
1. Irritability
2. Blurring of vision.
3. Difficulty of speech
4. Dizziness
5. Drowsiness
6. Feeling faint
7. Confusion.
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Management of hypoglycemia
Diagnosis : Should be suspected in any diabetic patient with
:
1. Behavioral changes
2. Confusion
3. Abnormal neurological signs
4. Unconsciousness
Rapid diagnosis and administration of glucose is essential to
prevent permanent brain damage or death.
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Treatment of hypoglycemia
1. Address the ABCs.
2. If patient is fully conscious and alert : give oral sugars.
3. If patient is Confused :
Secure an I.V access and give D50 12.5 to 25 gm over 3
minutes followed by Saline Flush .
No I.V access available , give I.M glucagon .
4. Do not use an advanced airway until you have given the
patient D50.
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Home Work
In table compare between :
1. Insulin and glucagon.
2. Type 1 and Type 2 diabetes .
The home work should be sent to the email in ward
document , before the next lecture .
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Any questions ??