Objectives Understand the role of the endocrine system in the regulation of blood glucose Distinguish between Type I and Type II Diabetes Mellitus Define the criteria used in the diagnosis of diabetes Discuss the epidemiology of diabetes Summarize the complications associated with diabetes Apply knowledge to a case study
Case Study – Part 1a A 14-year-old male is brought to the Emergency Department via ambulance with a report of the patient being found unresponsive. The report given by the paramedics is that the patients mother, who had not seen the child for over 24 hours, came home to find her son lying on the sofa unresponsive. Vitals: BP: 101/72 Pulse: 123bpm Respirations: 32, deep Temperature:94.6°F Are these vital signs normal?
Case Study – Part 1b BP: 101/72 – decreased (normal = 120/80) Pulse: 123bpm – increased (normal = 60-100 bpm) Respirations: 32, deep – “Kussmaul” breathing (rapid and deep) Temperature:94.6°F- low What other vital signs or information would you like to see from this patient? Are there any questions you would like to ask about the patient’s history?
The Endocrine System The endocrine system consists of glands that secrete regulatory hormones directly into the blood stream To understand diabetes, it is crucial to understand the role of the endocrine system in harnessing energy from food Carbohydrates and complex sugars from food are broken down into glucose Glucose circulates through the blood stream and is taken up by cells The pancreas is an important organ that has a role in both the digestive and endocrine systems
The Pancreas As an exocrine gland it secretes pancreatic juices that aid in digestion As an endocrine gland, it secretes hormones (insulin, glucagon, and somatostatin) into the bloodstream that regulate blood glucose levels
Insulin Insulin is made in the βcells of the pancreas When a meal rich in carbohydrates is consumed, blood glucose levels increase and insulin secretion is triggered, which helps to regulate carbohydrate metabolism in the body by stimulating cells to take up glucose Excess glucose is taken up by the liver and muscle and stored as glycogen to be used as energy when needed (for example, during a long fast) The actions of insulin are opposed by glucagon (think: “glucose is gone”)
Diabetes Mellitus “Sweet Urine” – originally diagnosed by tasting the patient’s urine for the presence of sugar The 7th leading cause of death in the US Can be caused by too little insulin, resistance to insulin, or both Can be Type I (insulin-dependent) or Type II (non- insulin-dependent) Inability to use glucose makes the body think it is “starving”
Type I Diabetes Occurs when the body’s immune system wrongly targets the βcells of the pancreas As a result, people with Type I Diabetes are unable to produce enough insulin to reduce blood sugar levels Patients with Type I Diabetes depend on insulin injections (or a pump) for control of their blood sugar Usually affects children and young adults, but the disease may begin at any age Symptoms include polyuria, polydypsia, extreme hunger, weight loss, fatigue, and irritability
Type II Diabetes Occurs when the body’s cells are resistant to insulin, and therefore do not take up glucose from the blood People with Type II Diabetes are able to produce insulin, but the body cannot use it Patients with Type II Diabetes must control their diet and exercise to avoid blood sugar increases Usually affects adults, but with the increase in obesity it is also found in children. Some ethnic groups are at higher risk (Native Americans, African Americans, Hispanic Americans, Asian/Pacific Islanders) Symptoms are similar to those found in Type I Diabetes
Complications Diabetic ketoacidosis (DKA): a condition in which the body becomes too acidic due to the production of ketones, which results from improper glucose utilization Heart disease, stroke, and hypertension Nerve damage Complications during pregnancy Diabetes affects EVERY organ system in the body!
Diagnosis Diagnosis is made by blood glucose measurements A good indicator of long- term blood glucose control is measuring HbA1c
Case Study – Part 2a The boy’s mother reports to the doctor that her son is a diabetic and takes his own “medication”. She does not know the last time he took his medication, and the boy is still unconscious. He is started on IV fluids, and lab tests are done: Lab results: Blood glucose 1582 mg/dL pH: 6.92 Urinary ketones: positive Are these lab results normal? What condition might they indicate?
Case Study – Part 2b Blood glucose: 1582 mg/dL – EXTREMELY high (normal = 70-100 mg/dL fasting, <125 mg/dL random) pH: 6.92 - low (acidic) (normal = 7.35-7.45) Urine ketones: positive – abnormal What do you think might be going on with this patient? What do you think is the best initial treatment?
Diabetic Ketoacidosis When the body can’t use glucose for energy, it resorts to other sources, mainly fats and amino acids (muscle proteins) Using fats for energy leads to the production of ketones, which make the blood more acidic This is actually an inefficient means of getting energy, so the body continues to do it, making the problem worse! Excess ketones are excreted in the urine as well as exhaled (ketones on the breath have a characteristic “fruity” odor)
Case Study – Conclusion The patient was given insulin and fluids and regained consciousness a few hours later. He told the ER doctor that he hadn’t been taking his insulin for the last few days. After recovering in the hospital for a few days, he was on his way out of the hospital when he ran into a group of Pre-Medical Honors Program students in the lobby. They promptly informed him about the risks of leaving his Type I Diabetes untreated, and reminded him to be more careful about taking his insulin.