Lecture 2/5

• Gestational Diabetes - resembles type II DM

  • presentation - symptoms of hyperglycemia occurs during pregnancy
  • onset - diagnosed during pregnancy
  • resolution - disappears after birth; however, mother is more prone to developing type II DM later in life
• babies of mothers with gestational diabetes that are not treated are more likely to develop

  • hypoglycemia, hypocalcemia
  • respiratory distress syndrome
• pathophysiology of DM

  • common
  • hyperglycemia
  • spillover of 180 mg/dl
  • plateaus at 300-500 mg/dL because spillover occurs at 180 mg/dL
• pathophysiology of DM

  • type 1
  • tendency to generate ketones - metabolism of triglycerides results in _____
  • low insulin/high glucagon promotes lipolysis
  • low or absent C-peptide (proinsulin by pancreas is not being cleaved)
  • acidosis and hyperosmolality due to hyperventilation and ketosis
  • ketosis puts patient in metabolic acidosis; body tries to resolve this by getting rid of CO2 to drive buffer to neutral side
• Pathophysiology of DM type II

  • rarely generates ketones - some glucose is being utilized
  • normal insulin levels suppress glycogenolysis and lypolysis
  • normal C-peptide levels as insulin is being secreted
  • hyperosmolality without ketosis (from elevated glucose and insulin increases concentration)
• hypoglycemia

  • decreased plasma glucose levels
  • true hypoglycemia is rare
  • islet hyperplasia or insulinoma (beta cell tumor) - secrete too much insulin and cause glucose level to lower too much
  • usually drug induced - if transient
• hyperplasia - growth in number of cells
• hypertrophy - growth in cell size
• Hypoglycemia

  • symptoms appear at 50-55 mg/dL
• symptoms of early hypoglycemia - hunger, diaphoresis, nausea/vomiting, dizziness
• symptoms of hypoglycemia: mental confusion, blurred vision, slurred speech, nervousness and shaking
• hypoglycemia

  • see secretion of glucagon, epinephrine, cortison, and GH (growth hormone)
• hypoglycemia can be induced by alcohol, as it mimics insulin
• if hypoglycemia continues and gets too low, patient can die
• Carbohydrate intolerance

  • enzyme deficiency - lactose not manufactured
  • lactose is the most common
• • lactose intolerance test -
  • pt comes in fasting; lactose solution given, blood drawn every 30 minutes; if glucose doesn't increase above 25 mg/dL, patient is lactose intolerant
  • patient is not metabolizing lactose to glucose and galactose
  • patient blows balloon; H2 gas produced by bacteria metabolizing glucose will be present
  • blows up balloon every 15 minutes for 2 hours
• galactosemia

  • galactose accumulates in the body when patient lacks enzyme to convert it to glucose
  • if galactose not removed from diet, patient can get cataracts, CNS dysfunction, short lifespan
  • inherited condition, occurs in 1 out of 62,000 people
  • increased liver enzymes in blood, as well as bilirubin
  • urine will be positive for reducing sugars
• G6PD - glucose 6 phosphate dehydrogenase (takes H)
• phosphogluconolactone or phosphogluconate
• monitoring

  • self-monitoring - most common; record on notebook
  • serum glucose - drawn at checkups
  • urinalysis - way to alert doctor something isn't right; patient isn't compliant with dietary restrictions
• Glycosylated hemoglobin

  • normal is 4-7%; some texts say up to 8% is normal
• Some type II diabetics, if they do not follow doctor orders, pancreas stops secreting insulin, becoming type I