DIABETES MELLITUS TYPE 2 Predisposing Factors Age: >40y.

o Race: African, Hispanics Destruction of Beta-Cells in the Pancreas Precipitating Factors Obesity Lifestyle Diet Environmental Stress

Decrease Production of Insulin

Increase Insulin Resistance

Hyperglycemia

Hyperosmolarity of Serum

Insufficient Intracellular Glucose Supply

Chornic Elevation of Blodd Glucose

Renal Threshold of Glucose Reabsorption Decrease d Energy Productio n Satiety Center responds by Increasing Appetite

Accelerated Atherosclerosis in the Blood Vessel Walls Blood Flow is Blocked

Supressed Kidneys Ability to Absorb

Glucose become Glycoprotei ns

Excess Glucose Secreted in the Urine Excess Glucose Secreted in the Urine

Weaknes s/ Fatigue

Polyphag ia

Increased Pressure Against the

Capillary basement membrane thickening and capillary closure

Hypertensio Damaged tiny n vessels in the retina

Leakage of Protein of Small Blood Vessels in the Kidneys

Glucose acts Osmotic Leakage of Protein onto the Macula Dec. Blood Blindnes Nerve Increased Neuropathy Polydips Blindne Decreased Blood Supply in the Kidneys Decreased Ecretion of Metabolic Waste Blurring of

Diabetic

Forms deposit on Kidney Tissues and Blood Vessels

Autonomicneurop

HEART: -Orthostatic Hypotension and Fainting

GASTROINTESTINAL: Gastroparesi s GENITOURINARY: -Neurogenic

-Symmetrical loss of protective sensation -Numbness and tingling sensation of lower extremities -Wasting of Intrinsic Muscles -Changes in the Joints

Acidosi s

Kidney Impairment

Nausea/ Vomitting

Dec. Production of

Pale

Diabetes Mellitus
Diabetes Mellitus Type 2 is the most common form of Diabetes. Formerly known as adult-onset diabetes, it usually affects people aged over 40 and progresses gradually. In this type the

pancreas has not ceased to produce insulin, but the quantity is insufficient, or the hormone is not stimulating the glucose uptake in muscles and tissues required for energy. The result is a build-up of glucose in blood and urine. Although the cause of this malfunctioning is unclear, non-insulin dependent diabetes mellitus tends to run in families. Other risk factors, such as increasing age, obesity, and a sedentary lifestyle, probably contribute to its increased incidence in developed countries. Non-insulin dependent diabetes mellitus can often be controlled initially by diet alone, or in combination with tablets that reduce the amount of blood glucose. There are two main types of blood glucose-reducing drugs: sulphonylureas work mainly by stimulating the pancreass islet cells (known as the Islets of Langerhans) to produce more insulin and biguanides increase the effectiveness of insulin on cells. Eventually, however, patients may need insulin injections.

Prerenal Acute Renal Failure

It is categorized as an acute renal failure which is characterized by inadequate blood circulation (perfusion) to the kidneys, which leaves them unable to clean the blood properly. Many patients with prerenal ARF are critically ill and experience shock (very low blood pressure).There often is poor perfusion within many organs, which may lead to multiple organ failure. Prerenal ARF is associated with a number of preexisting medical conditions, such as atherosclerosis ("hardening" of the arteries with fatty deposits), which reduces blood flow. Dehydration caused by drastically reduced fluid intake or excessive use of diuretics (water pills) is a major cause of prerenal ARF. Many people with severe heart conditions are kept slightly dehydrated by the diuretics they take to prevent fluid buildup in their lungs, and they often have reduced blood flow (underperfusion) to the kidneys

Predisposing Factors
Age - Type 2 DM usually occurs at the age 40 years old and above. Type 2 DM occurs most commonly in people older than 30 years who are obese. Family history of DM - Type 2 DM has a strong genetic component. Although the major gene that places the patient at risk is not yet identified, it is clear that the disease is polygenic and multifactorial. Individuals with a parent with type 2 DM have an increased risk for diabetes. Genetic factors are thought to play a role in insulin rsistance and impaired insulin secretion in type 2 DM.

Race (African-Americans, Hispanic-Americans) - The risk for type 2 diabetes varies among population groups. Diabetes also seems to pose higher or lower risks for specific complications among racial groups.

Precipitating Factors
Obesity Elevated levels of free fatty acids, a common feature of obesity, may contribute to the pathogenesis of type 2 DM. It can impair glucose utilization in skeletal muscles, promote glucose production by the liver and impair beta cell function. Environmental Factors/Stress An increase in stress hormone triggers the release of epinephrine and norepinephrine which will promote the secretion of glucose leading to hyperglycemia. Inactive Lifestyle A risk factor that had contributed in the occurrence of DM due to the fact that lack of muscle activities decreases the need for the body to utilize glucose as a form of energy. Diet Foods rich in carbohydrates can easily promote the increasing level of glucose along the bloodstream.

Prerenal Risk Factors

Atherosclerosis cause obstruction to the flow of blood reaching the kidneys Blood loss can lead to the constriction of the arteries carrying blood throughout the body, reducing the volume of blood reaching various organs including the kidney Heart disease can lead to a reduction in the pumping effect of the heart, reducing the amount of blood reaching the kidneys and other organs.

Signs and Symptoms with Rationale

Diabetes Mellitus HYPERGLYCEMIA (INCREASED BLOOD SUGAR LEVEL) May be due to lack of physiologically active insulin that transports glucose from extracellular to intracellular leading to accumulation of glucose in the intravascular space. The glucose is not utilized by the body and it remains in the blood streams. POLYURIA Increased frequency of urination. This may be due to the osmotic diuretic effect of the glucose, wherein it attracts water during urination.

POLYDIPSIA

Increased thirst and fluid intake. This may be due to the activation of the thirst center in the hypothalamus resulting form the intracellular dehydration or volume depletion. POLYPHAGIA Increased hunger and food intake. This may be due to the decrease glucose uptake by the cells leading the stimulation of the satiety center in the hypothalamus resulting to the hunger sensation. WEAKNESS/ FATIGUE This is due to the decreased glucose uptake by the cells leading to decreased energy production. GLYCOSURIA The kidney filters the blood, making it to its normal state. Glucose was filtered out and excreted in the urine. Due to the excess glucose ad compared to the kidney threshold, which results to the excretion of glucose in the urine. GASTROPARESIS (Stomach fullness) ,CONSTIPATION and BLOATING This is due to changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Over time, high blood glucose can damage the vagus nerve. The stomach fails to empty properly and is likely due to the generalized neuropathy. NAUSEA/ VOMITING Due to stomach fullness, there will be an involuntary emptying of stomach contents that are forcefully expelled by the mouth. A compensatory mechanism due to acidity of body because of decrease excretion of metabolic waste. PALE Due to decreased production of erythropoietin.