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Unformatted text preview: ENDOCRINE DISEASES
BY CYNTHIA L. DIETRICH, D.O.
November 23, 2004 DIABETES MELLITUS
DIABETES MELLITUS Problem in glucose metabolism, accompanied by predictable longterm vascular and neurologic complications Chronic disease Significant morbidity and mortality COMPLICATIONS
COMPLICATIONS Hyperglycemia +/ ketoacidosis Hypoglycemia: activation of the sympathetic nervous system (diaphoresis, tremulousness and tachycardia) and insufficient delivery of oxygen to the brain (confusion, seizures and unconsciousness Retinopathy microaneurysms cluster at macula >terminal vessels obstructed>ischemia>new vessel proliferation Nephropathyleads to hypertension. Assoc with the highest mortality. Cardiovascular disease “silent ischemia” Peripheral neuropathy numbness and tingling progressing to total insensitivity Stiff joint syndrome “prayer sign” and atlanto
occipital joint involvement Autonomic nervous system dysfunction orthostatic hypotension, resting tachycardia, absent beattobeat variation hypogylcemic unawareness gastroparesis occurs in 2030% IDDM
IDDM Prevalence 0.4%
Onset most often prior to age 20
Environmental influences are superimposed on a genetic component located on chromosome 6
Absolute insulin deficiency
Pancreatic beta islet cells are destroyed and antiislet cell antibodies appear
Clinical symptoms when 90% of the beta cells destroyed
Associated with other autoimmune diseases: rhuematoid arthritis and thyroid disease Clinical presentation is unmistakable: hypergylcemia, polyuria, polydipsia, weight loss, blurred vision and ketoacidosis
Long term management requires exogenous insulin, self monitoring, lifestyle adaptations including diet and exercise
Insulin formulations rapid (regular), intermediate (Lente, NPH) or longacting (Ultralente)
Goal HbA1c less than 7.5% DKA
DKA Insulin transfers glucose and amino acids into the cells. Hyperglycemia>osmotic diuresis>dehydration
>acidosis. Also, a build up of amino acids in the blood>lipolysis>free fatty acids>converted to ketone bodies in the liver
Results in a intravascular fluid volume deficit of 58 liters, potassium...
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