Diabetic ketoacidosis
In a diabetic person ketogenesis occur leading to acidosis.
Dka is more associated with type 1 diabetes rather than type 2, but it can occur in
type 2 too.
Diabetes Type 1 patients are at higher risk to develop dka more than type 2
Because for dka to develop an absolute or very severe insulin deficiency is required. We are
going to see how absolute severe deficiency of insulin then we will deep into details about dka
genesis.
In type 1 diabetes
1 - dka can be the first is impatient in undiagnosed patient
2 - increased insulin demands in the following situations
- infections (severe infections pneumonia, gastrointestinal, infections UTI)
- trauma
- surgery
- myocardial infarction stroke mesenteric infarction
3 - compliance : Insulin is not taken properly
- for example a patient who is not taking food for some reason and who might think thought no
food no insulin is required, a doctor must well educate his patient
Insulin is not only required to make our cells use glucose but is also required to prevent
ketogenesis. patients must be informed if they are insulin-dependent they must not stop insulin
under any circumstance.
Failure to take insulin is a preventable cause
In type 2 diabetes
Dka is possible
But it is less frequent and less severe The underlying situation maybe Increased demands for
insulin Failure to take insulin
Severe insulin deficiency, decreased insulin-dependent uptake and utilization of glucose within
insulin-dependent cells which are muscular cell and adipose cells which contain glut4 glucose
transporters which are very sensitive to insulin.
Note cNS utilisation of glucose it's not insulin-dependent same thing for testis
We are going to see what will happen within the liver muscles and adipose tissue
In the absence of insulin there will be production counter regulatory hormones Glucagon cortisol
epinephrine growth hormone
No insulin no glucose utilization, the body will think that there is no, glucose even though it's a
hyperglycemic state the system is fooled and this is why counter regulatory hormones will be
produced leading to further hyperglycemia
Insulin is down counter regulatory hormones are up resulting in
In the liver there is a glucose production by glycogenolysis and neoglucogenesis
In the muscle there is a breakdown of proteins providing a the presence of insulin and headed
to the insidemino acids for hepatic neoG
And glycogen breakdown into g6p which enters glycolysis producing lactate because it lacks the
last enzyme so it can't release glucose to the blood this is hepatic speciality, the lactate will be
used in the liver in neoG apprentice off in Salinas
In a diabetic person ketogenesis occur leading to acidosis.
Dka is more associated with type 1 diabetes rather than type 2, but it can occur in
type 2 too.
Diabetes Type 1 patients are at higher risk to develop dka more than type 2
Because for dka to develop an absolute or very severe insulin deficiency is required. We are
going to see how absolute severe deficiency of insulin then we will deep into details about dka
genesis.
In type 1 diabetes
1 - dka can be the first is impatient in undiagnosed patient
2 - increased insulin demands in the following situations
- infections (severe infections pneumonia, gastrointestinal, infections UTI)
- trauma
- surgery
- myocardial infarction stroke mesenteric infarction
3 - compliance : Insulin is not taken properly
- for example a patient who is not taking food for some reason and who might think thought no
food no insulin is required, a doctor must well educate his patient
Insulin is not only required to make our cells use glucose but is also required to prevent
ketogenesis. patients must be informed if they are insulin-dependent they must not stop insulin
under any circumstance.
Failure to take insulin is a preventable cause
In type 2 diabetes
Dka is possible
But it is less frequent and less severe The underlying situation maybe Increased demands for
insulin Failure to take insulin
Severe insulin deficiency, decreased insulin-dependent uptake and utilization of glucose within
insulin-dependent cells which are muscular cell and adipose cells which contain glut4 glucose
transporters which are very sensitive to insulin.
Note cNS utilisation of glucose it's not insulin-dependent same thing for testis
We are going to see what will happen within the liver muscles and adipose tissue
In the absence of insulin there will be production counter regulatory hormones Glucagon cortisol
epinephrine growth hormone
No insulin no glucose utilization, the body will think that there is no, glucose even though it's a
hyperglycemic state the system is fooled and this is why counter regulatory hormones will be
produced leading to further hyperglycemia
Insulin is down counter regulatory hormones are up resulting in
In the liver there is a glucose production by glycogenolysis and neoglucogenesis
In the muscle there is a breakdown of proteins providing a the presence of insulin and headed
to the insidemino acids for hepatic neoG
And glycogen breakdown into g6p which enters glycolysis producing lactate because it lacks the
last enzyme so it can't release glucose to the blood this is hepatic speciality, the lactate will be
used in the liver in neoG apprentice off in Salinas
