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| Pathophysiology: An insulin deficit leads to the following sequence of events: Initial Stage. 1. |
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| Insulin deficit results in decreased transportation and use of glucose in many cells of the body. |
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| Blood glucose (BG) levels rise (hyperglycemia). |
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| Excess glucose spills into the urine (glucosuria) as the level of glucose in the filtrate exceeds the capacity of the renal tubular transport limits to reabsorb it. |
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| Glucose in the urine exerts osmotic pressure in the filtrate, resulting in a large volume of urine to be excreted (polyuria), with the loss of fluid & electrolytes, like sodium & potassium, from the body tissues. |
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| Fluid loss through the urine and high BG levels draw water from the cells, resulting in dehydration. |
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| Dehydration causes thirst (polydipsia). |
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| Lack of nutrients entering the cells stimulates appetite (polyphagia). |
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| Progressive Effects: If the insulin deficit is severe or prolonged, the process continues to develop, resulting in additional consequences, ultimately, diabetic ketoacidosis. This occurs more frequently in persons with Type... |
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| Lack of glucose in cells results in catabolism of fats and proteins, leading to excessive amounts of fatty acids and their metabolites, known as ketones or ketoacids, in the blood. |
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| Ketones consist of acetone and two organic acids -- beta-hydroxybutyric acid and acetoacetic acid. Because the liver and other cells are limited in the amount of lipids, fatty acids, or ketones they can process completely within a given time, excessive amounts of ketones in the blood cause... |
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| The ketoacids bind with bicarbonate buffer in the blood, leading to decreased serum bicarbonate and eventually to a decrease in the pH of body fluids. (Note that ketones can also accumulate in people... |
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| Ketoacids are excreted in the urine (ketonuria). Some diabetic pts test their urine for ketones. |
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| However, as dehydration develops, the glomerular filtration rate in the kidney is decreased, and excretion of acids becomes more limited, resulting in decompensated metabolic acidosis, which has life-threatening potential (diabetic ketoacidosis [DKA] or diabetic coma). |
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| Insulin deficit results in decreased transportation and use of glucose in many cells of the body. |
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| decompensated metabolic acidosis |
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