Pathophysiology (Book Based) Modifiable Factors: Environmental factors Viral infection Chemical Toxins Non - Modifiable Factors: Age

Age Race & Ethnicity Gender Family History Antibodies attack the pancreas, responding to it as a foreign body Insulinitis (chronic inflammatory process that occurs in response to autoimmune destruction of the islets of Langerhans)

Destruction of Alpha Cells Increase production of glucagons Stimulate gluconegenic and ketogenic pathways in liver of hydroxybutyrate and acetoacetic acids Hepatic overproduction of hydroxybutyrate and acetoacetic acids Increase ketone concentration Increase release of free fatty acids Loss of HCO3 Metabolic acidosis Kussmauls respiration Ketone breath odor Nausea & vomiting Plasma pH <7.3 Bicarbonate<15 meq/L (+) serum ketones (+) urine ketones and glucose

Slow destruction of Beta Cells Absolute insulin deficit Glucose cannot enter cell without insulin Decrease energy production Fatigue and malaise Stimulation of hunger POLYPHAGIA Breakdown of fats and protein in liver to produce glucose Diabetic ketoacidosis Weight loss

Increase glucose production and decrease glucose utilization Hyperglycemia (80-90% of Beta cell function is lost)

Increase serum osmolality Osmotic effect Swelling of eye lens Blurred vision Water shift from intracellular spaces to general circulation Increase blood volume Increase renal blood flow Increase GFR POLYURIA Blood glucose exceeds renal threshold 180mg/dl Glucosuria Decrease intracellular volume Dehydration Sensation of thirst POLYDYPSIA

Hypovolemia Shock Tissue hypoxia Lactic acidosis

Warm dry skin with poor turgor, rapid weak pulse hypotension, weight loss