PATHOPHYSIOLOGY OF TYPE 2 DIABETES MELLITUS

Predisposing factors - Race ( Filipino (1 out 0f 5 adults has DM T-2 as of 2008 - Developmental Stage: Late Adulthood Deterioration of organs and system - Genetic Predisposition (has a History) Precipitating Factors: - Diet: Increased intake of carbohydrates such as fruits and sweets - Lifestyle: Sedentary (no exercise) -Hypertension (> 140/80 mmHg

Increased Insulin levels in the blood

Increased cell resistance to insulin

Increased serum Glucose and insulin level

Pancreas decreases Insulin Production

Serum Glucose and Insulin Levels remains high

Reduced tissue uptake of glucose

INTRACELLULAR HYPOGLYCEMIA

EXTRACELLULAR HYPERGLYCEMIA

Increased hepatic Glucose Production

Hyperosmotic Plasma (Increased WBC and platelet Count) - Increased oncotic pressure)

Blood glucose is greater than renal threshold

Breakdown of fats

High levels of ketones

Decreased Protein (Albumin level: 2.4d/dl) Synthesis: -Cachexia -lethargy -polyphagia -Muscle weakness Decreased Gamma Globulins -Exposure to infection

Increased blood pressure : 160/90 -Increased Peripheral Resistance - At risk for CORONARY ARTERY DISEASE

Fluid shifting from cells to Extracellular compartments (transcellular compartments

Glucosuria (+3) urine urine output has increased. Specific gravity (2.035)

Diabetic ketoacidosis -Vomiting (10 cc/8 hrs) -Increased breathing (39cpm) -Hypercalcemia (10.50 mg/dl) -Body weakness

Increased ventricular pressure Community Acquired Pneumonia -presence of mucus secretions

Cardiomegaly

Cellular dehydration aznd third space fluid shift -Minimal Pleural Effusion

Osmotic diuresis -Polyuria (3220 cc/24 hrs) -Polydipsia -Hypokalemia (2.93-318 mmol/L) -Hyponatremia (127.5-131 mmg/d)

TYPE 2 DIABETES MELLITUS

NARRATIVE
Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike type 1 diabetes mellitus, insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with the production of insulin. Other important contributing factors:
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increased hepatic glucose production (e.g., from glycogen -> glucose conversion), especially at inappropriate times (typical cause is deranged insulin levels, as those levels control this function in liver cells) decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects) impaired beta-cell function loss of early phase of insulin release in response to hyperglycemic stimuli

This is a more complex problem than type 1, but is sometimes easier to treat, especially in the early years when insulin is often still being produced internally. Type 2 may go unnoticed for years before diagnosis, since symptoms are typically milder (eg, no ketoacidosis, coma, etc) and can be sporadic. However, severe complications can result from improperly managed type 2 diabetes, including renal failure, erectile dysfunction, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease. The onset of type 2 has been most common in middle age and later life, although it is being more frequently seen in adolescents and young adults due to an increase in child obesity and inactivity. A type of diabetes called MODY is increasingly seen in adolescents, but this is classified as a diabetes due to a specific cause and not as type 2 diabetes. Diabetes mellitus type 2 is of unknown etiology (i.e., origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause. Examples include diabetes mellitus such as MODY or those caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g., long-term steroid use). According to CDC, about 23.613 million people in the United States, or 8% of the population, have diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. It is thought that only 24% of diabetes is now undiagnosed, down from an estimated 30% in 2005 and from the previously estimated 50% in ca 1995. About 90 95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 has diabetes mellitus type 2. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. Diabetes affects over 150 million people worldwide and this number is expected to double by 2025.. About 55 percent of type 2 are obese chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue (especially that in the abdomen around internal organs) is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines). Other research shows that type 2 diabetes causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on insulin resistance. However, genetics play a relatively small role in the widespread occurrence of type 2 diabetes. This can be logically deduced from the huge increase in the occurrence of type 2 diabetes which has correlated with the significant change in western lifestyle.

Diabetes mellitus type 2 is often associated with obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan's syndrome, or CHAOS). Secondary causes of Diabetes mellitus type 2 are: acromegaly, Cushing's syndrome, thyrotoxicosis, pheochromocytoma, chronic pancreatitis, cancer and drugs. Additional factors found to increase risk of type 2 diabetes include aging, high-fat diets and a less active lifestyle.

Manifestations:
Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. SIGN AND SYMPTOMS Early symptoms may be nothing more than chronic fatigue, generalised weakness and malaise (feeling of unease) REMARKS Not experienced

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Excessive urine production Excessive thirst and increased fluid intake Blurred vision (typically from lens shape alterations, due to osmotic effects, e.g., high blood glucose levels) Unexplained weight loss Lethargy Itching of external genitalia

Experienced Not experienced

Experienced

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Not experienced Not experienced Not experienced

ANATOMY AND PHYSIOLOGY

Homeostasis depends on the precise regulation of the organ and organ systems of the body. The Nervous & Endocrine Systems are 2 major systems responsible for that regulation. Together they regulate and coordinate the activity of nearly all other body system. When these system fail to function properly. Homeostasis is not maintained. Failure of it results to Diabetes Mellitus/Addison s Disease. Pancreas is an elongated gland extending from the duodenum to the spleen; consist of head, body and tail. The endocrine part of the pancreatic islets, dispersed among the exocrine portion of the pancreas.The islets secretes: It is very important to maintain blood glucose level within normal values. A decline in the blood glucose level within normal range causes the Nervous System to malfunction because glucose is the Nervous System main source of energy. Insulin is released from the beta cells primarily in response to a blood glucose increased parasympathetic stimulation and is associated with digestion of meals. Glucagon from the alpha cells is released when blood glucose level is low. Glucagon binds to membrane bond receptors primarily in the liver and caused conversion of glycogen to glucose insulin and glucagon must work to function together to regulate blood glucose levels.