Dm Advance Patho Report

8/2/2019 Dm Advance Patho Report

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The pancreas is veryimportant organ in thedigestion system and thecirculatory system becauseit helps to maintain ourblood sugar levels. The

pancreas is considered tobe part of thegastrointestinal system. Itproduces digestiveenzymes to be released intothe small intestine to aid inreducing food particles to

basic elements that can beabsorbed by the intestineand used by the body


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It has another very different function in thatit forms insulin, glucagon and otherhormones to be sent into the bloodstream toregulate blood sugar levels and other

activities throughout the body.


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The pancreas is unusual among the body'sglands in that it also has a very importantendocrine function. Small groups of specialcells called islet cells throughout the organmake the hormones of insulin and glucagon.


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The pancreas contains exocrine andendocrine cells. Groups of endocrine cells,the islets of Langerhans, secrete twohormones.

The Beta cells secrete insulin; The Alpha cells secrete glucagon. The level of sugar in the blood depends on

the opposing action of these two hormones.


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Insulin acts to lower blood sugar levels byallowing the sugar to flow into cells.

Glucagon acts to raise blood sugar levels bycausing glucose to be released into thecirculation from its storage site.

Insulin and glucagon act in an opposite butbalanced fashion to keep blood sugar levels

stable.


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Insulin deficiency leads to the developmentofdiabetes mellitus, specifically type I,juvenile diabetes.

In type II or maturity onset diabetes, thepancreas does produce enough insulin, butthe target cells do not respond to it.


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Epidemiology of Diabetes Mellitus in the PhilippinesThe prevalence of Diabetes in the Philippines fromthe past decade according to the National Nutrition

& Health Survey is as follows:

1998 2003 2008FBS>125 3.9 3.4 4.8

DM BASEDON

HISTORY---- 2.6 4.0

FBS/ OGTT/HISTORY

---- 4.6 7.2


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Adding on those who have Diabetes (impairedfasting glucose/ impaired glucose tolerance/both) which has a prevalence of 10.6% thisfigure balloons to 17.8% or nearly 20%. In

simple terms, 1 out of every 5 Filipino couldpotentially have Diabetes Mellitus / pre-diabetes.


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Diabetes = Hyperglycemia, which is definedas:

fasting plasma glucose >126 mg/dl

oral glucose tolerance test (OGTT) > 200mg/dl

Pre-Diabetes is defined as:

Impaired fasting glucose (IFG) of 100-125

mg/dlImpaired glucose tolerance (IGT) of 140-199mg/dl


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Type 1 Diabetes:results from the body's failure to produceinsulin, and presently requires the person toinject insulin.

Type 2 Diabetes:

results from insulin resistance, a condition inwhich cells fail to use insulin properly,

sometimes combined with an absolute insulindeficiency.


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Gestational Diabetes:is when pregnant women, who have neverhad diabetes before, have a high bloodglucose level during pregnancy. It mayprecede development oftype 2 DM.


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is characterized by loss of the insulin-producing Beta cells of the islets ofLangerhans in the pancreas leading to insulindeficiency.

This type of diabetes can be furtherclassified as immune-mediated or idiopathic.

Immune-mediated

where beta cell loss is a T-cell mediatedautoimmune attack.


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Type 1 diabetes can affect children or adultsbut was traditionally termed "juvenilediabetes" because it represents a majority ofthe diabetes cases in children.


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Is characterized by insulin resistance whichmay be combined with relatively reducedinsulin secretion.

The defective responsiveness of body tissuesto insulin is believed to involve the insulinreceptors.

Obesity is the main cause of insulin

resistance


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resembles type 2 diabetes in several respects,involving a combination of relativelyinadequate insulin secretion andresponsiveness.

It occurs in about 2%5% of allpregnancies and may improve or disappearafter delivery.

Is fully treatable but requires careful medical

supervision throughout the pregnancy. About 20%50% of affected women develop

type 2 diabetes later in life.


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classical symptoms of diabetes are polyuria (frequent urination)

polydipsia (increased thirst)

polyphagia (increased hunger)


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Type 1is partly inherited and then triggered bycertain infections, with some evidencepointing at Coxsackie B4 virus.

Type 2

is due primarily to lifestyle factors andgenetics


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Type 1 Diabetes Type 2 DiabetesEtiology Autoimmune Peripheral resistance

Formerly known as IDDM NIDDM or adult onsetdiabetes

Age of onset Younger Older

Obesity Rare Common

Family History/Twinconcordance

Rare Common

HLA association Yes No

Ketosis Yes No

Insulin resistance No Yes

Endogenous insulin No YesRespond to Oral Agents No Yes

Metabolic lability Labile Not labile


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Diabetes mellitus is characterized by recurrent orpersistent hyperglycemia, and is diagnosed bydemonstrating any one of the following:

Fasting plasma glucose level 7.0 mmol/L

(126 mg/dL). Plasma Glucose 11.1 mmol/L (200 mg/dL) two

hours after a 75 g oral glucose load as in aglucose tolerance test.

Symptoms of hyperglycemia and casual plasmaglucose 11.1 mmol/L (200 mg/dL).

Glycosylated hemoglobin (Hb A1C) 6.5%.


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MacrovascularAtherosclerosis:diabetics have ahigh incidence ofcoronary, cerebral,and peripheralartery diseases.


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Diabeticretinopathy

Nephropathy

Neuropathy


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a combination ofPeripheralNeuropathy (leadsto undetectedtrauma, blisters,ulcers) andPeripheral Vascular

Disease (impairshealing, allowsinfection).


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1. Diabetic Ketoacidosis results from completelack of insulin and reliance on fatty acids forenergy. There is unrestrained lipolysis andketone synthesis, causing acidosis andketonemia.

2. Non-Ketotic Hyperosmolarity is an extremehyperglycemia without acidosis. It is caused byinsufficient insulin resulting in poor glucoseuptake and increased hepatic glucose output.

There is just enough insulin to suppress ketonesynthesis. The extreme hyperglycemia leads toosmotic diuresis and vascular collapse.


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Keeping blood sugar levels as close to normal("euglycemia") This can usually be accomplished with diet, exercise,

and use of appropriate medications (insulin in thecase of type 1 diabetes, oral medications as well aspossibly insulin in type 2 diabetes).

Patient education, understanding, and participation isvital since the complications of diabetes are far lesscommon and less severe in people who have well-managed blood sugar levels. The goal of treatment isan HbA1C level of 6.5%, but should not be lower than

that, and may be set higher. Attention is also paid toother health problems that may accelerate thedeleterious effects of diabetes.

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