PATHOPHYSIOLOGY

Predisposing factor Age > 40 year old Ethnicity (African-American, Hispanic /Latin, Asian- American) Family history of diabetes Male

Precipitating factor Obesity Inactive lifestyle Drugs (corticosteroids, beta blockers, and phenytoin) Faulty eating habit Viral infections Emotional stress Smoking, alcohol drinking HDL <35mg/dl Triglyceride-250 mg/dl or higher Impaired glucose tolerance

Decreased sensitivity to insulin or insulin resistance

impaired function of B cells and insulin production

Decreased glucose uptake of cells

Inability of glucose to enter muscle cells and adipose cells

Decrease Glucose utilization Cell starvation Liver responds to demand of stained cells Stimulation of hunger mechanism

Impaired protein metabolism Increase CHON metabolism Decrease protein synthesis

Impaired fat metabolism

Lipid catabolism Increase ketone bodies

Weight loss

Hyperlipidemia

Glycogenolysis

Hunger Gluconeogenesis polyphagia Increase glucose level Weight loss Weakness and fatigue

Fats deposition in the blood vessel

Atherosclerosis

Changes in the vessel of lower extremities Intermittent claudication Decreased peripheral pulse

Formation of embolus in cerebral vessel Cerebrovascul ar disease /stroke

Occlusive changes in coronary artery Myocardial ischemia Myocardial infarction

HYPERGLYCEMIA

Incomplete reabsorption of glucose in KIDNEYS

Increased serum osmolarity

Prolonged glucose level elevation

Increased blood viscosity Increased osmotic pressure Decreased tissue perfusion Alters reabsorption of water in kidneys Kidney filtration mechanism is stressed Fluid loss

Increased urine output with glucose

Allows blood protein to leak

Polyuria

Glucosuria

Stimulation of thirst center polydipsia

Dehydration

Pressure in blood vessels of the kidneys increases

Damage to vessels of kidneys

NEPHROPATHY

Further leakage of protein

Microalbuminuria Impaired delivered of blood component Heart Eyes CRF/ESRD Inadequate inflammation response Delayed wound healing Diminished myocardial oxygenation Blurring of vision Alters oncotic pressure

Capillary baseline membrane thickening

Fluid shift Anaerobic respiration Infection Lactic acid EDEMA

Chest pain

Changes in small vessels of retina

Aberration of myelin sheaths

DIABETIC RETINOPATHY

Disrupted nerve conduction

PERIPHERAL NEUROPATHY

Nonproliferative

Prepoliferative

Proliferative

Burning sensation

Paresthesia

Microaneurysm

Destruction of blood vessels

New blood vessel growth

Numbness of extremities

Distorted vission

Loss of vision or blindness

Decreases sensitivity

Decreased position and posture

Increased for infected undetected foot ulcers

Unsteady gait

Diabetic ketoaciidosis

Positive ketone bodies in urine

Acetone breath Metabolic acidosis

Nausea and vomiting

Abdominal pain

Poor appetite

Decreased cellular potassium

Body attempts to prevent further decrease in pH

Depressed central nervous system

Cardiac arrhythmia

Kussmauls respiration

Headache