Type 1: AI destruction of Bcells, insulin always needed, < 30 years, no obesity, weak genetic predisposition, associated with HLADR3/DR4, glucose intolerance severe, insulin sensitivity high, ketoacidosis common, decreased b-cell # in islets, decreased serum insulin level. Classic symptoms of polyuria, polydipsia, polyphagia weight loss is common. Histology = islet leukocytic infiltrate.
Diabetic ketoacidosis: Feared complications of diabetes. Due to insulin noncompliance or increased insulin requirements from stress. Excess fat breakdown and increased ketogenesis from free fatty acids, which are then made into ketone bodies. Occurs in T1D and endogenous insulin in type 2 diabetes usually prevents lipolysis.
Signs/symptoms: Delirium, kussmaul respirations, abdominal pain/nausea/vomiting, dehydration, fruity breath odor.
Labs: Hyperglycemia, increased H+, decreased HCo3-, increased blood ketone levels, leukocytosis. Hyperkalemia but depleted intracellular K+ due to transcellular shift from decreased insulin and acidosis.
Complications: Life-threatening mucormycosis , cerebral edema, cardiac arrythmias, heart failure.
Treatment: IV fluids, IV insulin and K+ - glucose if needed to prevent hypoglycemia.