Medical Emergencies

1
Medical Emergencies

• Diabetes

2
Topics

• AP Review
• Regulation of glucose metabolism
• Pathophysiology
• Diabetic Emergencies

3
AP Review
4
Pancreas Hormones

• Alpha cells (20) glucagon
• Beta cells(75) insulin

5
Pancreas Hormone Action
6
Glucose Regulation
7
Insulin Mechanism

• Increase glucose transport
• Increase glucose metabolism
• Increase liver glycogen levels
• Decrease blood glucose

8
Glucagon Mechanism

• Release glycogen reserves
• Gluconeogenesis from fat

9
Regulation of Glucose Metabolism

• Normal Range 60 - 120 mg/dl
• Sources
• Carbohydrates
• Fats
• Proteins
• Digestion

10
Carbohydrate Metabolism

• Carbohydrate ingestion prompts insulin release
• Glucose used by body cells, excess stored by
  liver (glycogen)
• Glycogen released when blood glucose drops
• Insulin has little effect on brain glucose

11
Fat Metabolism

• Glucose converted to fatty acids in liver
• Insulin allows storage of fatty acids
• ? insulin ? ? fatty acid metabolism
• Ketones are a result
• ? ketones ? acidosis

12
Glucagon Action

• Opposes insulin
• Promotes glycogen release breakdown
• Increases gluconeogenesis
• Released as blood glucose levels drop

13
Review of Glucose Regulation

• Liver is a glucose buffer
• Insulin and glucagon make up feedback loop
• ? blood glucose ? sympathetic stimulation

14
Pathophysiology

• Too little insulin or,
• Ineffective insulin

15
Type I Diabetes Mellitus

• Too little insulin produced
• Onset at any age
• Treatment insulin injections, exercise and diet
  modifications
• May lead to hypo- or hyperglycemia

16
Type II Diabetes Mellitus

• ? insulin production ? tissue sensitivity
• Usually adult overweight onset
• Treatment diet, exercise, oral hypoglycemic
  meds.
• May lead to hypo- or hyperglycemia

17
Effects of Diabetes Mellitus

• ? blood glucose, ketoacidosis
• Glucose in urine, dehydration
• Acidosis
• Blindness
• Kidney disease dialysis
• Neuropathy
• Heart disease and stroke

18
Diabetic Emergencies

• Hypoglycemia (insulin shock)
• Hyperglycemia (DKA)
• Hyperosmolar Hyperglycemic Nonketotic Coma

19
Hypoglycemia

• Caused by an imbalance between insulin and
  glucose
• Rapid onset
• Signs Symptoms
• Management

20
Diabetic Ketoacidosis (DKA)

• Inadequate insulin
• Cells use fat for energy
• Hyperglycemia causes osmotic diuresis
• Slower onset (12 - 48 hours)
• Signs Symptoms
• Management

21
Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)

• Enough insulin present to prevent ketoacidosis
• Not enough to lower glucose levels
• Osmotic diuresis causes dehydration
• Signs Symptoms
• Management