Pathophysiology of diabetes mellitus | Signs and symptoms of diabetes | Endocrine system physiology
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- เผยแพร่เมื่อ 8 ส.ค. 2020
- Physiology lecture on endocrine system physiology details Pathophysiology of diabetes mellitus with physiological basis of signs and symptoms
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In diabetes, storage and utilisation of glucose decreases in fed state leading to increase in blood glucose concentration after food i.e post-prandial hyperglycemia. Due to continuing glycogenolysis and gluconeogenesis, glucose concentration in blood rises in between meals too i. e fasting hyperglycemia
Due to excess blood glucose concentration, the glucose filtered through nephron is also high. This exceeds the capacity of nephrons of absorbing glucose i.e transport maximum is reached, above which the nephrons are not able to reabsorb further glucose and hence glucose starts appearing in urine i.e glucosuria occurs. The presence of glucose in nephron acts as an osmotic pull for water preventing the reabsorption of water also from the nephron. So water loss also increases causing increase in the volume of urine i.e polyuria. Due to increase in water loss from the body, and hyperosmolarity of blood due to increased blood glucose concentration, water moves out of cells. This when happens in osmoreceptors…thirst centres are activated causing increase in the intake of water i.e polydipsia.
Hyperphagia: When insulin is deficient, the satiety centre neurons are not able to utilise glucose and become inactive. Thus they do not inhibit feeding centre. Since feeding centre is not inhibited, the person feels hungry and eats often i.e polyphagia occurs.
In insulin deficiency lipolysis starts in adipose tissue causing release of free fatty acids in circulation .proteolysis also starts. So with increased lipolysis and proteolysis , there is weight loss. The free fatty acids enter liver and undergo beta oxidation leading ultimately to formation of acetyl COA. In diabetes, most of the acetyl coA is channeled away from Krebs cycle and is utilised for production of ketone bodies (ketosis). When rate of productions of ketone bodies is too high which occurs when insulin levels are very low or virtually absent as seen in type 1 diabetes mellitus, ketone bodies decrease blood pH (ketocacidosis) . Since blood pH decreases, body starts compensatory mechanisms for excretion of excess acids by increasing respiratory rate and depth. This is known as Kussmaul’s breathing or air hunger Some ketone bodies i.e acetone is also excreted by breath causing fruity smell of breath. Ketoacidosis is always accompanied by dehydration. This lead sto activation of renin-angiotension-aldosterone system. Thus causing hyperaldsteronism causing potassium loss from the body.
In type 2 DM, ketocacidosis is not that common, since insulin receptor defect starts slowly, i.e some actions of insulin are preserved so lipolysis and proteolysis are not that severe. Since lipolysis is not severe, formation of ketone bodies is also not excessive. In contrast, another problem may occur in type 2 diabetes i.e hyperglycemia hyperosmolar state. In this also, there is hyperglycemia, causing high serum osmolarity , also causing glucosuria and poyluria and hence depletion of watre. However, ketoacidosis is not present.
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The flow of topics in the video is such an amazing that it clears all the concepts like a story
😊
Love your videos. I appreciate you so much for covering all the details and explaining everything so easily. Thank you so much!!!
Yeah I strive to achieve exactly this. Feel very happy that you understood the concepts. Thanks
Thank you for the wonderful video Ma'am! 😊
My pleasure
These videos are so easy to understand that I don't feel the need to make notes!!!!
Thanks once again 😊
Nicely explained. Thank you so much mam
It’s my pleasure 😊
🙏🙏 amazing explanation mam thank you so much 👍👍
As always. Pleasure is all mine
The video was good with full clearence of concept
But ma'am i have one doubt
You wrote in your description that
In contrast to type 1 dm there occur hyperglycemic hyperosmolar state in type 2 dm
Is that not common to both?
Yes. But more common in type 2 DM
@@PhysiologyOpen ok, thank you ma'am
😃😃😃😃😃
Because In hyperosmolar Hyperglycaemic state there is relative insulin def due to presence of some sort of insulin there is no acidosis whereas in T1D there is no insulin so Acidosis will be present that's why hope it clears
Ma'am
I Have one doubt
That why diabetic patient should be warned against hypoglycemic symptoms ?
Cells not using glucose due to lack of insulin. Also if on insulin excessive dose, sudden influx of glucose
Siddanagouda,
??
A 40 year old female presented with 2 months history of polyuria,weakness,fatigability and pruritus vulvae. During her last pregnancy 2 years ago she was found to have raised blood sugar for which she was put on insulin which was discontinued after delivery as followup blood glucose levels remained normal.on examination her BMI is 36,pulse 80/min,BP 150/96mmhg rest of examination is normal what is the diagnosis for this condition
GDM