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Diabetes, PATHOPHYSIOLOGY - Coggle Diagram

- - - - Age 30
        
        Type 1 or type 2 diabetes of 10 years’ duration
        
        Hypertension
        
        Cigarette smoking
        
        Dyslipidemia
        
        Retinopathy
        
        Nephropathy
  - - - Known or suspected CAD, cerebrovascular disease, and/or peripheral vascular disease
      - Autonomic neuropathy
      - Advanced nephropathy with renal failure
  - - - Serious dysrhytmias
      - 2mm ST-segment depression or elevation
      - Ischemic threshold
      - Significant T-wave change
      - SBP >220mmHg
      - DBP >110mmHG
      - Onset of peripheral pain
- - - - may develop during pregnancy & disappear after
        
        24-28 weeks of gestation
        
        Diagnosed by oral glucose tolerance test
        
        Risk Factors
        
        Family history, obesity
        
        Delivery of previous large-birth-weight baby
      - Resolves postpartum
    - - Impairment in pancreatic beta cell insulin secretion in response to a glucose stimulus
      - Reduced sensitivity to the action of insulin in muscle, liver & adipose tissue
      - Excessive hepatic glucose production in the basal state
    - - Genetics
      - Environment
      - Insulin abnormalities
      - ↑ Glucose production in liver
      - ↑ Fat breakdown
      - Defective hormonal secretions
      - Obesity contribute insulin resistance
- - - - Exercise very NB & very beneficial: ↓ glucose
      - ↑ Blood glucose control
      - ↑ Insulin sensitivity (12-16 hours after exercise)
      - ↓ Medication required
      - ↓ Body fat → increases insulin sensitivity
      - ↓ Risk for CVD
      - Stress reduction
      - Prevention of type 2 diabetes
      - Improved blood lipid profiles
      - ↓ HR & BP at rest
- - - - If 4-5mmol/L → something to eat?
  - - - Dosage & type of medication
      - Timing of medication
      - Blood glucose level prior to exercise/testing
      - Timing, amount & type of previous food eaten
      - Presence & severity of diabetic complications
      - Usage of other medication secondary to diabetic complications
      - FIT of exercise
      - Environmental conditions
      - Presence of infection
      - Foot care
      - Abdominal/thigh injections
      - Adequate fluids
    - - Concentrate on low GI foods leading up to exercise
      - Intermediate GI foods prior and during exercise
      - Snack/Insulin 30-60min prior exercise
      - Monitor glucose before & after exercise
      - Have a rapidly acting carbohydrate present (250ml fruit juice)
      - Exercise late evening - nocturnal hypoglycemia
      - Hypoglycemia can develop up to 48 hours after exercise
      - Good idea to have evening snack – low GI if had intense day of exercise
      - Must train to predict response (for competition events)
      - Do not perform exercise testing if blood glucose levels 3.9mmol/L, or > 15mmol/L
- - - - Extracellular hyperglycemia
        
        Blood glucose > renal threshold
        
        Hyperosmotic plasma
        
        Dehydration of cells
        
        Polyuria (excessive urine output)
        Polydipsia (great thirst)
        
        Glucosuria (glucose in urine)
        
        Polyphagia (excessive appetite)
  - - - Glucogenesis & gluconeogenesis
        
        Breakdown of fats
        
        High levels of ketones
        
        Diabetic ketoacidosis
        
        Ketonuria (ketone in urine – body using other sources of energy)
        
        Decreased protein synthesis:
        
        Cachexia (wasting)
        
        Lethargy
        
        Polyphagia
        
        Susceptibility to infections
        
        Impaired wound healing