Diabetes Mellitus

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Diabetes mellitus27 (DM) warrants special consideration. This is the world's most prevalent metabolic disease, and is the leading cause of adult blindness, renal failure, gangrene, and the necessity for limb amputations.

Diabetes mellitus can be defined as a disruption of carbohydrate, fat, and protein metabolism resulting from the hyposecretion or inaction of insulin. Its classic signs and symptoms are "the three polys": polyuria28 (excessive urine output), polydipsia29 (intense thirst), and polyphagia30 (ravenous hunger). We can add to this list three clinical signs revealed by blood and urine tests: hyper-glycemia31 (elevated blood glucose), glycosuria32 (glucose in the urine), and ketonuria (ketones in the urine).

!6Harvey Cushing (1869-1939), American physician 'Jdiabet = to flow through + melli = honey

8poly = much, excessive + uri = urine

'9dipsia = drinking

,0phagia = eating

A hyper = excess + glyc = sugar, glucose + emia = blood condition l2glyco = glucose, sugar + uria = urine condition

Ketonuria Symptom Sign
(a)
Cushing Syndrom
Figure 17.26 Cushing Syndrome. (a) Patient before the onset of the syndrome. (b) The same boy, only 4 months later, showing the "moon face" characteristic of Cushing syndrome.

A little knowledge of kidney physiology is necessary to understand why glycosuria and polyuria occur. The kidneys filter blood plasma and convert the filtrate to urine. Normally, the kidney tubules remove all glucose from the filtrate and return it to the blood, so there is little or no glucose in the urine of a healthy person. Water follows the glucose and other solutes by osmosis, so the tubules also reclaim most of the water in the filtrate.

But like any other carrier-mediated transport system, there is a limit to how fast the glucose transporters of the kidney can reabsorb glucose. The maximum rate of reabsorption is called the transport maximum, Tm (see p. 109).

Saladin: Anatomy & 17. The Endocrine System Text © The McGraw-Hill

Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Chapter 17 The Endocrine System 669

Ags Syndrom

Figure 17.27 Adrenogenital Syndrome (AGS). These are the genitals of a baby girl with AGS, masculinized by prenatal hypersecretion of adrenal androgens. Note the fusion of the labia majora to resemble a scrotum and enlargement of the clitoris to resemble a penis. Such infants are easily mistaken for boys and raised as such.

Figure 17.27 Adrenogenital Syndrome (AGS). These are the genitals of a baby girl with AGS, masculinized by prenatal hypersecretion of adrenal androgens. Note the fusion of the labia majora to resemble a scrotum and enlargement of the clitoris to resemble a penis. Such infants are easily mistaken for boys and raised as such.

In diabetes mellitus, glucose enters the tubules so rapidly that it exceeds the Tm and the tubules cannot reabsorb it fast enough. The excess passes through into the urine. Glucose and ketones in the tubules also raise the osmolarity of the tubular fluid and cause osmotic diuresis—water remains in the tubules with these solutes, so large amounts of water are passed in the urine. This accounts for the polyuria, dehydration, and thirst of diabetes. Diabetics often pass 10 to 15 L of urine per day, compared with 1 or 2 L in a healthy person.

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Responses

  • celio
    What is adrenogenital syndrome?
    8 years ago
  • lempi
    What does moon face syndrome look like?
    3 years ago

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