Diabetes

Type 1 Pathophysiology

Stage 1: genetic predisposition

Stage 2: environmental triggers

Spring and fall

Epidemics of various viral diseases

Stage 3: active autoimmunity

ICA's and insulin antibodies progressively decrease the effective circulating insulin level

Stage 4: progressive beta cell destruction

Stage 5: overt diabetes mellitus

Type 2 Pathophysiology

Insulin is a building (anabolic) hormone. w/o 3 metabolic problems occur

Decreased glucose utilization

Increased fat mobilization

Increased protein utilization

Decreased Glucose Utilization

Cells that require insulin as a carrier for glucose can take in only 25% of the glucose they require for fuel

Do Not Require Insulin for Glucose Transport Require Insulin

Nerve tissue Adipose tissue

Erythrocytes Skeletal muscle

Cells of intestines Cardiac muscle

Liver

Kidney tubules

Inadequate amounts of insulin = levels of glucose rise

Elevation continues to rise b/c liver cannot store glucose as glycogen w/o sufficient insulin levels

Return to homeostasis = kidney excretes excess glucose = urine acting as osmotic diuretic = increased water loss aka fluid volume deficit.

Increased Fat Mobilization

Body turns to fat stores for energy production when glucose unavailable

Type 1

Type 2 w/severe stress

Fat metabolism causes breakdown products called ketones

Ketones