Host:
- 19 years old
Predisposing Factors:
- Age (4 – 14 years old)
- Hereditary
- Race (Hispanic Americans,
Caucasians)
- Gender (Male)
- Autoimmune disorder
- Geography (Europe, South
America)
Failure of maturing T-cells in
the thymus
- Male
- Symptoms: severe weakness, dizziness, and
sleepiness during the preceding 6 weeks of Precipitating Factors:
boot camp.
- drowsiness and generalized tiredness, - Bacterial or viral infection
unquenchable thirst and lost 20 pounds - Environmental factors
- Ill-defined generalized abdominal tenderness, (Pollutants)
generalized muscular hypotonia
- urine sample was 4+ for glucose and had
"large" acetone
- manifested hypoglycemia after insulin
therapy
UNKNOWN ETIOLOGY
Mutations in the HLA(MHC) Molecular mimicry of beta Direct destruction of beta
gene cells cells
Breakdown of pancreatic
beta cells
Auto-immune attack of beta
cells
Loss of Beta-cell mass
A
 A

DECREASED INSULIN PRODUCTION

FAT METABOLISM GLUCOSE METABOLISM PROTEIN METABOLISM

↓ Glucose uptake ↓ Amino acid ↑ Protein

↑ Fat breakdown ↓ Fat Storage (muscle and ↓ Glucose
uptake by most breakdown,
adipose) utilization
cells especially muscle

↑ Plasma fatty ↑ Plasma amino

acids LIVER: acids
↑ Ketone production

Substrate for ATP

F ↑ Glycogenolysis
Brain interprets as
↑Gluconeogenesis Substrate for ATP
production starvation production

↑ Serum glucose level

Hyperglycemia
Tissue loss Polyphagia
Tissue loss

Insulin Therapy B
started

G
 B

Sluggish flow of blood ↑ Serum osmolarity ↓ Tissue perfusion of kidney ↓ Osmotic pressure in
blood

Impaired delivery ↑ Blood viscosity Impaired removal Failure to initiate ↓ H2O from cell
of blood of waste erythropoietin towards the blood
components
↓ Blood flow to the
organs and extremities Impaired removal Failure stimulation
Inadequate of waste from of the bone Dehydration
inflammatory blood marrow
response ↓ Tissue perfusion in
nerves
Glucose level ↓RBC production Stimulation of
Microorganism exceeds renal osmoreceptors
would enter the Nerve hypoxia threshold
body at any route

Thirst
↑ risk of infection Impaired renal
Nerve damaged
function

↑ Permeability of Poor skin

Weak deep Excessive glucose is Polydipsia
the renal cell wall turgor
tendon reflexes converted into sorbitol

Paresthesia, Filtration of macro

Motor nerve conduction
Numbness cells & particles
impairment
C
E D
 C D E

- Na = 156 mEq/L (135-145 ↑ Glucose concentration - BUN = 32mg/dl (7-20

mEq/L) in urine mg/dl)
- K = 7.0 mEq/L (3.5-
- Creatinine = 2.8mg/dl (0.9-
5.5mEq/L)
1.3mg/dl (Adult men))
- HCO3- = 8 mEq/L (23-
↓Reabsorption of glucose - pH = 7.0 (4.5-8.0)
30mEq/L)
- Chloride = 92mEq/L (98- and other particles in the
107mEq/L) renal tubule

↓ Osmotic
pressure

↓ H2O
reabsorption

↑ Urine Output

Polyuria Glucosuria

+4 Glucose in
urine (negative)
 DIABETIC KETOACIDOSIS

+4 Acetone in
urine (negative) Ketonuria F

Metabolic acidosis (↑
anion gap)

Disrupts enteric nervous Blowing off CO2 to try to Breathing off ketones Disruption of electrical ↓ perfusion to brain,
system offset acidosis signaling in brain, spinal spinal cord, and nerves
cord and nerves

↓ Gastric emptying
Kussmaul
respiration Ketone breath
(deep, laborious (fruity odor) Weakness,
breathing) confusion, +/- coma
Abdominal
pain, Vomiting
 G
DIABETIC HYPOGLYCEMIA

Excess subcutaneous Insulin dependent Consistent ↑

insulin insulin

↓ Plasma glucose Inhibited glucagon Reinforce

release hypoglycemia
↑ insulin
↑ Glycogenolysis
transports plasma ↓ Plasma glucose
↑ Gluconeogenesis
glucose into cells

Peripheral ↓ Peripheral
↑ Epinephrine
Vasoconstriction glucose delivery
and uptake
Euglycemic brain ↓ Glucose in the
cells due to GLUT1 brain
↑ Growth Activation of receptor over-
hormone and sympathetic expression
cortisol (adrenergic)
receptors
↓ Autonomic
epinephrine
secretion

↑ systolic BP,
Anxiety
tachycardia
irritability
- Confusion
- Lack of
concentration
- Weakness
- Slurred speech
- Seizures

G
 G

Medical Management:

 Regular Insulin (Humulin R)

 Insulin zinc suspension (Lente)

Surgical Management:

 Pancreas transplant
 Pancreatic islet transplantation 

TEXT
- Lab results (Lower than normal range)
TEXT - Lab results (Higher than normal range)