Diabetes and Its Complication

Dr. Miada Mahmoud Rady

EMS / 474

Endocrinal Emergencies lecture II

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.

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 .

GlucagonThyroid hormone Growth hormone Corticosteroids

What are the hormones that affect blood glucose level

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

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 :

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.

Pancreatic secretions

in response

to changes in

blood glucose level.

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) .

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:

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.

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

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).

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.

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 .

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).

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 :

1. Obesity and bad eating habits

2. Sedentary life .

3. Family history ( hereditary ) .

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.

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.

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 :

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.

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.

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

Diabetic Emergencies

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.

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.

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.

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.

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.

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.

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.

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 .

Any questions ??