Diabetes & Metabolic Syndrome

• where is glucagon produced, what triggers its release, & what does it do?

  produced and released by alpha cells of the pancreas to maintain blood glucose between meals

  main action - increase blood glucose through glycogenolysis and gluconeogenesis, increases free fatty acids through lipolysis

  release triggered by low blood glucose, strenuous exercise, stress response
• what are the risk factors/causes of type I vs type II diabetes mellitus?

  type I - genetic or environmental, autoimmune or idiopathic

  type II - combination of genetic and environmental factors (obesity, physical inactivity, metabolic syndrome, age)
• s/s of type I vs type II diabetes mellitus

  type I - weight loss, polyphagia, blurred vision, fatigue, weakness, hunger, thirst

  type II - polyuria, polydipsia, fatigue, recurrent infections, visual changes, neuropathy, paresthesia
• causes of type I & type II diabetes mellitus

  type I - absolute lack of insulin

  type II - insulin present, but receptors are resistant or problems with secretion
• s/s of hyperglycemia & what happens to cells?

  thirst, dry mouth, polyuria, blurred vision, weight loss, recurrent infections, fatigue

  cells must use other fuel, causing protein and fat breakdown
• how does diabetes mellitus cause polyuria & polydipsia?

  polyuria - excessive fluid loss through urine from decreased absorption into blood

  polydipsia - increased blood osmolality, pulls water from intracellular space
• what are ketones, & what causes ketoacidosis?

  acids present in urine and blood

  DKA - diabetic emergency occurring in type I

  lack of insulin -> hyperglycemia -> increased breakdown of fats and proteins for fuel -> increased gluconeogenesis and glycogenolysis -> increased ketones (from excess fatty acids) -> ketoacidosis

  increased metabolism of fatty acids in type I leads to higher likelihood
• s/s & tx of diabetic ketoacidosis

  s/s - confusion, unconscious, pink, flushed, or warm skin (vasodilation), nausea/vomiting, abdominal pain, arrhythmias, fruity breath, Kussmaul respirations, polyuria, tachycardia

  tx - isotonic IV fluids, insulin, electrolytes
• what is HHS, s/s, & tx?

  emergency problem of type II

  patho - severe hyperglycemia, severe water loss (high serum osmolality)

  s/s - thirst, polyuria, stroke-like symptoms (decreased consciousness, seizures, aphasia, hemiparesis)

  tx - fluid replacement, IV insulin, electrolytes
• s/s & tx of hypoglycemia

  s/s - irritability, personality changes, headache, confusion, slurred speech, ataxia, coma, hunger, anxiety, diaphoresis, tremors

  tx - carbs, glucose tablets, juice
• characteristics & diagnosis of metabolic syndrome

  must have 3: abdominal obesity, dyslipidemia, BP greater than 130/85, fasting plasma glucose greater than 100 mg/dL

  diagnosis - check BP, blood glucose, cholesterol, triglycerides