Diabetes and Its Complication Dr. Miada Mahmoud Rady EMS / 474 Endocrinal Emergencies lecture II

Lecture Topics Definition. Hormones That Affect Glucose Metabolism. Regulation of Blood Glucose. Pathophysiology and clinical presentation of diabetes. Complication of diabetes Types of diabetes. Diagnosis of diabetes. Diabetic emergencies.

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

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 .

What are the hormones that affect blood glucose level Glucagon Thyroid hormone Growth hormone Corticosteroids Insulin

Insulin The only Hypoglycemic hormone in the body. Secreted from Beta Cells of islet of Langerhans. Main functions of insulin : Increase glucose transport into cells. Increase glucose metabolism by cells. Increase liver glycogen levels. Insulin antagonize effects of glucagon. So It Decrease Blood Glucose Concentration Toward Normal

Glucose movement into the cell with insulin and the inability of glucose to get into the cell without insulin.

Glucagon It is secreted from alpha cells of the pancreas. It increases blood glucose level through : Glycogenolysis : break down of stored glycogen in liver and other storage sites into glucose. Gluconeogensis : glucose formation through breakdown of fats and fatty acids.

Pancreatic secretions in changes in blood glucose level. response to changes in blood glucose level.

Regulation of Blood Glucose Hypoglycaemia: Low blood sugar. Stimulates α cells. Release glucagon. Hyperglycaemia: High blood sugar. Stimulates β cells. Release insulin. Also lost in urine (osmotic diuresis) .

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

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: Kidney : excess sugar produces osmotic diuresis, which leads to polyuria , which causes the polydepsia. Tissues saturated with sugars are more liable to trauma , infection and also heals badly , that’s why diabetic patient is more liable to infection.

Clinical presentation of diabetes Polyuria . Polydepsia . Polyphagia . Unexplained weight loss . Tiredness and easy fatigability. Increased liability to infection (vaginal infection). Clinical presentation of complications . 3PS , Classical Symptoms Of D.M

Complication of diabetes Acute complication : Hypoglycemia. DKA ( diabetic ketoacidosis). Hyperosmolar non-ketotic coma . Chronic complication: It affects all body system . It either Microvascular ( affect small vessels) or Macrovascular ( affect large vessels).

Microvascular complication Eye : diabetic retinopathy and cataract ( blurring of vision ). Kidney : diabetic nephropathy ( acute and chronic renal failure). Diabetic neuropathy : ( tingling and numbness). Foot complication : poor wound healing and increased liability to infection.

Macrovascular complication Brain : stroke and altered mental status . Heart : ischemic heart disease , cardiomyopathy and hypertension. Peripheral arterial disease and chronic ischemia. Diabetic foot and gangrene .

Types of diabetes Type 1. Type 2. Gestational diabetes. Others e.g. secondary diabetes ( chronic pancreatitis , cancer head of pancreas and pancreatectomy).

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.

Type 1diabetes mellitus Onset is usually sudden and may be with DKA. Treatment : insulin is essential ( main line ), exercise, diet regulation.

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 : Obesity and bad eating habits Sedentary life . Family history ( hereditary ) .

Type 2 diabetes Treatment : Mainly diet control and exercise Oral hypoglycemic drugs ( to increase insulin sensitivity and production) . Only small number requires insulin.

Gestational diabetes Develops in some women during late pregnancy and Usually resolves with childbirth. It may progress to D.M type 2. Etiology : The effect of pregnancy hormones which antagonize the effect of insulin increased insulin requirement during pregnancy.

Gestational diabetes Commonest complication is Macrosomia Treatment : Diet is first and the most important line of treatment , insulin is given last.

Metabolic syndrome Cluster of characteristics : Excessive fat in the abdominal area. Elevated blood pressure. High levels of blood lipids. People with metabolic syndrome are at increased risk of D.M.

Diagnosis of diabetes If you suspect diabetes (in any persons showing symptoms and signs of diabetes) diagnosis is confirmed by following blood tests : Fasting blood glucose . 2hrs post prandial blood glucose. Random blood glucose. Glycoselated hemoglobin.

Diagnosis of diabetes Diabetic Fasting 2hr PP Random HBA1C prediabetic ≥ 126mg/dl. ≥ 200mg/dl ˃ 200mg/dl + polysymptoms 100-125mg/dl 140 - 199 mg/dl. ＜ 100 mg/dl. ＜ 140mg/dl Fasting 2hr PP Random HBA1C prediabetic Normal

Diabetic Emergencies

Hypoglycemia Definition : blood glucose level Lower Than 60mg/dl. It occurs in both diabetics and non diabetics . Characteristic : Sudden onset . Rapidly progressive course . That is why hypoglycemia is Very Dangerous especially in diabetics because they are usually unable or unaware of symptoms.

Causes of hypoglycemia Causes And Predisposing Factors Of Hypoglycemia In Diabetics: Overdose of oral hypoglycemic drugs or insulin Missed meals. Stress e.g. physical or emotional. Surgery and trauma Infection.

Causes of hypoglycemia Causes of hypoglycemia in non diabetics : Starvation . Renal failure . Liver cell failure . Malignancy . Chronic debilitating illness. Endocrinal disorders e.g. adrenal and growth hormone deficiency.

Clinical presentation It present with two sets of symptoms : Autonomic : caused by stimulation of autonomic nervous system. 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.

Signs and symptoms of hypoglycemia Autonomic Neuroglycopenic Anxiety. Palpitation. Sweating. Tingling. Tremors. Tachycardia. Irritability Blurring of vision. Difficulty of speech Dizziness Drowsiness Feeling faint Confusion.

Management of hypoglycemia Diagnosis : Should be suspected in any diabetic patient with : Behavioral changes Confusion Abnormal neurological signs Unconsciousness Rapid diagnosis and administration of glucose is essential to prevent permanent brain damage or death.

Treatment of hypoglycemia Address the ABCs. If patient is fully conscious and alert : give oral sugars. 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 . Do not use an advanced airway until you have given the patient D50.

Home Work In table compare between : Insulin and glucagon. Type 1 and Type 2 diabetes . The home work should be sent to the email in ward document , before the next lecture .

Any questions ??