Figure 622

Role of insulin deficiency and the counter-regulatory hormones, and their respective sites of action, in the pathogenesis of hyper-glycemia and ketosis in diabetic ketoacido-sis (DKA).A, Metabolic processes affected by insulin deficiency, on the one hand, and excess of glucagon, cortisol, epinephrine, norepinephrine, and growth hormone, on the other. B, The roles of the adipose tissue, liver, skeletal muscle, and kidney in the pathogenesis of hyperglycemia and ketone-mia. Impairment of glucose oxidation in most tissues and excessive hepatic production of glucose are the main determinants of hyperglycemia. Excessive counterregula-tion and the prevailing hypertonicity, metabolic acidosis, and electrolyte imbalance superimpose a state of insulin resistance. Prerenal azotemia caused by volume depletion can contribute significantly to severe hyperglycemia. Increased hepatic production of ketones and their reduced utilization by peripheral tissues account for the ketonemia typically observed in DKA.

Feature

Pure DKA Mixed forms

Pure NKH

Incidence

5-10 times higher <=>

5-10 times lower

Mortality

5-10% <=>

10-60%

Onset

Rapid (<2 days) <=>

Slow (> 5 days)

Age of patient

Usually < 40 years <=>

Usually > 40 years

Type I diabetes

Common

Rare

Type II diabetes

Rare <==>

Common

First indication of diabetes

Often <==>

Often

Volume depletion

Mild/moderate <=>

Severe

Renal failure (most com-

Mild, inconstant <=>

Always present

monly of prerenal nature)

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

Get My Free Ebook


Post a comment