B.

Pathophysiology a) Schematic Diagram (book – based)
Non – modifiable Risk Factors: -45 y/o and above -Glucokinase mutation -African American, Native -Familial history of DM type 2 Americans, Asian American -Familial history of hypertension Pacific Islander Modifiable Risk Factors: -Obesity -Sedentary lifestyle -Stress -gestational DM -Previously known Impaired - certain medication such as Fasting glucose Thiazides & corticosteroids. -↑consumption of fatty, salty - Smoking & sweet food - Alcoholism

Insulin resistance and desensitization ↓insulin production

↑glucagon Release

Fats and Proteins breaks down to glucose

↑blood glucose level ↑osmolalit y
Fluid shifts from IC to IV

Impaired glucose absorption

Cellular starvation

Wasting Weight loss / fatigue

Polyphagi a Chronic glucose elevation
Sluggish blood flow

Glycoprotein cell wall deposits
Narrowing of blood vessel

Cellular Thirst polydipsia

↑blood volume

↑GFR polyuri

Small vessel disease
Hypertensio n

Accelerated atherosclerosi s

↑LDL

Coronary Artery

Diabetic retinopath y
Alteration in vision/ blindness

Diabetic neuropathy

Plaque rupture

numbnes s Foot ulceratio n Diabetic nephropathy
Change in platelet shape

Exposure of subendohelial matrix

Platelet activation

Platelet degranulation

↑ Expression of Platelet GP IIb/IIIa

ESRD

Platelet adhesion to subendothelial matrix

Release of Thromboxane A2, Serotonin and other platelet aggregatory agent

Enhanced affinity to fibrinogen

Platelet aggregation

↓ Arterial lumen

Plasma Coagulation System activation

Formation of Converts fibrinogen to fibrin Enhances platelet aggregation

Stabilization Nidus of of fibrin clot rethrombosis
Backflow of Impaired blood in the repolarization of lungs the myocardium Lactic acid production Anaerobic glycolysis ECG changes Angina

Fatigue

Productive Adventitious cough Breath sounds ↓ oxygenation

DOB

Pulmonary congestion

Blood Release on pooling of ↓ with of Irregular Myocardial endothelium ventricular Hardening fibrotic lysosomal Vasospasm dislodges thrombus arteryvasocontriction2 needs beats enzymes tissue cell perfusion contractility Stimulation heart left ventricleImpaired cardiac ↓cardiacthe function ↑BP, HR, and O irritability the coronary by Ischemia of the ↑ CKMB Myocardial supplied Coronary occlusion SNS ↓ death

Re-establishment of the

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