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Diabetes, Acute complication, Pathogenesis, Metabolic abnormalities =>…

- - - - Acini (exocrine)
        
        Excrete digestives juices (enzymes) into duodenum
      - Islets of langherhans (endocrine)
        
        Secrete glucose regulating hormones into the blood
        
        Beta cells = secrete insulin
        
        Lower blood glucose (facilitating the mvt of glc into body tissues
        
        Alpha cells = Secrete glucagon
        
        Maintains blood glucose (increasing release of glc from liver into blood)
        
        Delta cells = Secrete somatostatin
        
        Inhibits the release of insulin and glucagon
        
        Decrease gastrointestinal activity after ingestion of food
  - - - Prevents fat and glycogen breakdown
      - Promotes glucose uptake = Glucose storage as glycogen (liver&muscle)
      - Inhibits gluconeogenesis
      - Increases protein synthesis
    - - Exposure to Glc = 1st phase release -> 2nd phase release (new)
      - Serum insulin reach a peak = 3 to 5min after a meal and return to baseline after 2-3 hours
      - Release from pancreatic Beta cells and regulated by blood glucose levels
      - Insulin enters portal circulation and travels directly to = liver
      - Half-life = 15 min
    - - 𝛼 subunit (large)
        
        Insulin binding
      - 𝛽 subunit (small)
        
        Kinase enzyme
  - - - Travel through portal vein to the liver = main action
      - Increase in blood glucose = initiating glycogenolysis
      - Produced by 𝛼 cells = maintains blood glucose between meals and period of fasting
      - Increase the transport of AA into the liver and stimulates their conversion into glucose = Gluconeogenesis
    - - Rich protein meal = stimulate glucagon secretion and the conversion of AA to glucose = maintain body's glucose levels
      - Glucogon level increase in heavy exercise = to prevent a decrease in blood glucose
      - Hypoglycemia VS Hyperglycemia
    - - Counteract the storage functions of insulin
  - - - Counteract the storage functions of insulin in regulating blood glucose levels during periods of fasting or exercise
    - - Inhibit insulin release and promotes glycogenolysis
        
        Stimulate the conversion of muscle and liver glycogen to glucose
    - - Decreases cellular uptake and use of glucose
        
        Chronic hyper secretion of GH = Acromegaly
        
        Lead to glucose intolerance and diabetes mellitus
    - - Stimulate gluconeogenesis by the liver and moderately decrease tissue use of glucose
        
        Prolonged elevation of Glucocorticoids = Hyperglycemia and diabetes mellitus
- - - - Pancreatic 𝛽 cells destruction by an autoimmune process
        
        Insulin deficiency
        
        Immune-mediated (type 1A) in more than 90%
        
        Idiopathic (Type 1B) in less than 10%
    - - More prevalent type
        
        Insulin resistance (impaired ability to the tissue to use insulin)
        
        Lack of insulin or impaired release of insulin
- - - - Thickening of the walls of the nutrient vessels that supply the nerve
      - Segmental demyelinization
    - - diminished perception of vibration, pain, and temperature, particularly in the lower extremities
    - - ✦ Defects in vasomotor responses: can lead to dizziness and syncope when the person moves from the supine to the standing position.
        
        ✦ Decreased cardiac responses.
        
        ✦ Gastroparesis (impaired emptying of the stomach): can lead to alternating bouts of
        
        diarrhea, particularly at night, and constipation.
        
        ✦ Inability to empty the bladder: predisposes to urinary stasis and bladder infection and
        
        increases the risk of renal complications.
        
        ✦ Sexual dysfunction.
  - - - ✦ Genetic and familial predisposition
      - ✦ Poor glycemic control
      - ✦ Smoking
      - ✦ Hyperlipidemia
      - ✦ Microalbuminemia
      - ✦ Elevated blood pressure
  - - - ✦ Abnormal retinal vascular permeability
      - ✦ Microaneurysm formation,
      - ✦ Neovascularization and associated hemorrhage
      - ✦ Retinal detachment
      - ✦ Scarring
  - - - ✦ Soft tissue infections of the extremities,
      - ✦ Osteomyelitis
      - ✦ Urinary tract infections and pyelonephritis
      - ✦ Candidal infections of the skin and mucous surfaces
      - ✦ Tuberculosis.
      - ✦ Dental caries and infections