Precipitating Factors: Genetic (HLAs= DR3 & DRA) Autoimmune response (destruction of islet cells and endogenous insulin)

n) Viruses or toxins (destruction of bata cells

Decrease insulin production /lack of insulin. Increased fat breakdown for energy (lipolysis) Destruction Beta cells fatty acids insulin and and = endogenous glycerol unchecked glucose production by the of liver utilization of glucose by muscle, fat and liver.

PATHOPHYSIOLOGY OF DM TYPE 2

Shock Coma Death

Liver conversion into Ketone Bodies

Fasting hyperglycemia

Acidosis *acidic blood Acetone concentration Increased blood osmolarity Amb: increased RR

Increased ketone bodies amb: Acetone breath Poor apetite Nausea

Polyuria ( osmotic diorosis )

Loss of fluids and electrolytes in the urine.