Diabetes Mellitus (Hyperglycemic Hyperosmolar Coma)

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Diabetes mellitus (hyperglycemic hyperosmolar coma)

Diabetes is a union of very chronic diseases characterized by a high concentration of blood glucose as resulting from a defect in insulin secretion in the pancreas. (Gonzalez, 2005) Insulin is one of the hormones produced by the beta cells of the pancreas, which are necessary for the use of energy deposits such as carbohydrates, proteins, lipids, where it makes glucose between the body and betransferred to the interior of the cells that are then transformed into energy, so that both muscles and tissues have proper functioning in our body. People with diabetes do not produce enough insulin;Insulin deficiency results in hyperglycemia (glycemia elevation). Not having adequate, long -term control, the continuous presence of high glucose in the blood can cause alterations in the function of different organs, specifically in the eyes, kidneys, nerves, heart and blood vessels.

The main function of insulin is to maintain the correct and/or adequate values of glucose in the bloodstream. Also add that insulin helps cells store glucose until their use is required.

Fortunately, people with diabetes can take steps to control the disease and reduce the level of mobility and premature mortality. (Insulclock, 2018)

Pathophysiology

Type 1 diabetes pathophysiology.

Type one diabetes mellitus, is commonly given from childhood and is considered a chronic inflammatory disease that is caused by the destruction of beta cells in Langerhans islets that are located in the pancreas. As mentioned above, these cells have as the main function insulin secretion in response to the increase in blood glucose. There are different causes for which islet destruction can occur: viruses, chemical agents, cross -autoimmunity or a gene predisposition. (EITHER., 1999) During the stage prior to the start of type 1 diabetes, a percentage of 80% of individuals detect antibodies against cytoplasmic antigens or membrane les of pancreatic β cells such as decarboxylase of glutamic acid 65 and 67, shock proteinThermal 65, and against insulin. However, the greatest susceptibility to develop type 1 diabetes is found in the genes of the human leukocyte antigen of chromosome number 6, which contribute 50% risk, and some genetic polymorphisms are associated in the peptide binding sites. By identifying these antibodies in healthy people, the risk of developing the disease is indicated;For example, the presence of antibodies against insulin confers a lower risk, while the combination of antibodies against islet cells and against GAD or insulin represents a much greater risk to develop type 1 diabetes. (Association, 1998)

Amiline is a glucorregulator hormone that also occurs in pancreatic β cells and is segregated along with insulin. Amiline complements the effects of insulin regulating postprandial blood glucose and suppressing glucagon secretion. DMT1 is also an amiline deficit state. Individuals with DMT1 are prone to other self-immune disorders such as Graves’ disease, hashimoto’s so -called Addison, vitiligo disease, celiac disease, auto -immune hepatitis, myasthenia serious and pernicious anemia. (UCSF, 2012)

Type 2 diabetes pathophysiology

Morbid obesity is associated with the development of different diseases, including diabetes and hypertension. (Sanamé, 2016) Obesity is a consequence of the continuous and deregulated intake of food rich in energy content that is not used as a consequence of a low metabolic activity and/or sedentary lifestyle, therefore, it is stored and accumulated in fatty tissue. During this situation, the pancreas has hyperactivity due to the high and constant blood glucose concentration, with a high insulin secretion to preserve blood glucose at normal levels. The causes that trigger type 2 diabetes are unknown in 70-85% of patients;Apparently, various factors influence polygenic inheritance (in which an undetermined number of genes participates), along with risk factors that include obesity, dyslipidemia, arterial hypertension, family history of diabetes, diet rich in carbohydrates, hormonal factors andA sedentary life. (Baquero, 2010) Patients have high levels of glucose and resistance to insulin action in peripheral tissues. More than 80 – 90% of people have healthy β cells with the ability to attach to high insulin demands in obesity, pregnancy and cortisol by increasing their secretory function and in cell mass. (A, 2014) However, in 10 to 20% of people there is a deficiency of β cells in adapting, which produces cell exhaustion, with reduction in insulin release and storage. (E, 2017) Type 2 diabetes is associated with a lack of adaptation to the increase in insulin demand, in addition to loss of cell mass due to glycotoxicity. However, the insulin receiver presents alterations in its function. When insulin binds to its receiver in muscle cells, it starts complex signaling routes that allow the translocation of the glut4 transporter located in vesicles to the plasma membrane to carry out its function of transporting the glucose of the blood into the interior of thecell. (Bautista Rodríguez LM, 2015)

The different risk factors both known and additional for diabetes are:

• Physical inactivity.
• In the first -degree family nucleus with diabetes.
• The members of a high -risk population (African -American, Latinos, native Americans, American and native Americans of the Pacific Islands).
• Hypertensive (blood pressure ≥ 140/90 mmHg or that they take medication for hypertension).
• High density lipoprotein cholesterol concentration (HDL) < 35 mg/dl (0,9 mmol/l) y/o concentración de triglicéridos > 250 mg/dl (2.82 mmol/l).
• Women with polycystic ovary syndrome (SOPQ).
• A1C ≥ 5.7%, ATG or AGA in previous tests.
• Other clinical disorders associated with insulin resistance (severe obesity, acanthosis nigricans [brown gray skin pigmentations])).
• ECV history.

Children and young people with increased risk for DMT2 should be valued with the same systematic detection recommendations as adults. The age of onset of systematic detection is 10 years or at the beginning of puberty, and frequency, every 3 years. Overweight young people (BMI> percentile 85 for age and sex, weight above the 85 percentile for height, or weight greater than 120% of the ideal for height) and who have two of the following risk factors must undergo detectionsystematic:

• DMT2 family history in a first or second degree relative.
• Race/Ethnicity (Native Americans, African -American, Latinos, Americans of Asian origin, natives of Pacific Islands).
• Signs of insulin resistance (hypertension, dyslipidemia, SOPQ or small for gestational age at birth).
• Maternal background of diabetes or DMG during child pregnancy. (NIH: Niddk, 2016)

Causes of type 1 diabetes

The exact cause of type 1 diabetes is still unknown. What is known is that your immune system, which normally fights harmful bacteria or viruses, attacks and destroys cells that produce insulin in the pancreas. This leaves you with a low level of insulin, or without insulin. Instead of being transported to your cells, sugar accumulates in the bloodstream.

It is believed that type 1 diabetes is caused by a combination of genetic susceptibility and some environmental factors, although it is still not clear what these factors are. It is not believed that the weight is a factor in type 1 diabetes. (MSAL, 2005)

Causes of prediabetes and type 2 diabetes

In prediabetes – which can eventually cause type 2 diabetes – and in type 2 diabetes, cells become very resistant to insulin action, and the pancreas cannot produce the appropriate amount of insulin to overcome the resistance. Instead of moving to your cells where it is needed as a source of energy, sugar accumulates in your bloodstream.

It is not known with certainty why it occurs exactly, although it is believed that genetic and environmental factors play a definitive role in the development of type 2 diabetes. The overweight is closely related to the development of type 2 diabetes but not all people with type 2 diabetes are overweight. (KS, 2016)

Clinical manifestations: symptoms and signs.

The symptoms of diabetes can vary according to the amount of sugar in the body, to be clear in the bloodstream since some people, especially those with prediabetes or diabetes type 2, do not usually experience symptoms at the beginning. In type 1 diabetes, symptoms tend to appear quickly and be more serious.

These are some of the signs and symptoms of type 1 diabetes and type 2 diabetes:

• Increased thirst
• Desire to urinate (more frequent).
• Extreme hunger.
• Weight loss for no reason.
• The presence of ketones in the urine (ketones are a byproduct of muscle and fat degradation that occurs when there is not enough insulin available).
• A lot of fatigue.
• Irritability.
• Blurry vision.
• Slow healing sores.
• Frequent infections, such as gum infections, skin and vagina.
• Numbness or tingling in hands and feet.
• ulcers.

Although type 1 diabetes may appear at any stage of life, it usually does it during childhood and adolescence. Type 2 diabetes, the most common type of diabetes, may appear at any age, although it is more normal than in people over 40 years. (Moustarah F, 2014)

Complications

Long -term diabetes complications are developed gradually. The more time you have diabetes (and the less controlled your blood sugar level is), the greater the risk of complications there is. In the long run, diabetes complications can cause disability or even be mortal. Possible complications include the following:

• Cardiovascular disease. Diabetes drastically increases the risk of various cardiovascular problems, heart attack, stroke and narrowing of arteries. If you have diabetes, you are more prone to heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can damage the walls of tiny blood vessels (capillaries) that feed the nerves, especially in the legs. This can cause tingling, numbness, burning or pain, which usually begins at the tips of the fingers of the feet or hands and gradually extends upwards.

If you do not access treatment, you could lose all the sensitivity of the affected areas. Nerve damage in relation to digestion can cause problems with nausea, vomiting, diarrhea or constipation. In the case of men, it can give way to erectile dysfunction.

• Kidney damage (nephropathy). The kidneys contain millions of clusters of tiny blood vessels (the glomeruli) that are responsible for filtering blood residues. Diabetes can affect this delicate filtering system. Severe damage can lead to renal failure or irreversible terminal renal disease, which may require dialysis or even a kidney transplant.
• Ocular damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), which can cause blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts.
• Feet damage. Damage to the nerves of the foot or an insufficient blood flow in the feet increases the risk of various feet complications. If they are not treated, cuts and ampoules can give way to serious infections, which usually have poor healing. These infections can require the amputation of the foot, foot or leg.
• Skin diseases. Diabetes can become more susceptible to dermatological problems, such as bacterial infections.
• Auditory deterioration. Hearing problems are usually common in diabetic people.
• Alzheimer disease. Type 2 diabetes can increase the risk of dementia or madness, such as Alzheimer’s disease. The more poor the control of the sugar level in the bloodstream is, the greater the risk will be. Although there are different theories of how these disorders can be related, none of them has been demonstrated in its entirety.
• Depression. Depression symptoms are common in people with type 1 diabetes and type 2. Depression can affect diabetes management. (Medicllinic, 2018)

Pathogenia prevention.

Type 1 diabetes cannot be prevented. However, the same healthy lifestyle options that help control prediabetes, type 2 diabetes and gestational diabetes can also help prevent it:

• Eat healthy foods. Choose foods with less fat and calorie content, and contain more fiber. As fruits, vegetables and grains of integral preferably. Enter the variety to avoid boredom at food.
• Perform more physical activity. Try to do 30 to 45 minutes per day of moderate physical activity. Make a quick daily walk, go by bicycle, practice swimming. If you can’t perform a long exercise session, you can divide it into small sections a day.
• Eliminate the pounds (or the kilos) that you have more. If you have overweight, lower even 7% of your body weight, for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms), you can reduce the risk of long -term diabetes.

To maintain your weight within a healthy range, you must make permanent changes in your eating and physical activity habits. You must motivate remembering the benefits of losing weight, such as having a healthier heart, more energy and greater self – esteem. (Complications, 2016)

These are some tips you must take and study to be able to control your disease:

• Follow the meal plan that was specifically prepared for you, from your doctor or nutritionist.
• Perform physical activity for 30 minutes almost every day. Ask your doctor what activities are the best for you.
• Take your medications according to the indications.
• Mídase blood glucose levels every day. Every time you do, write down the result on the registration sheet.
• Review your feet daily to see if there are cuts, blisters, sores, swelling, redness or if you have painful nails.
• Brown your teeth and use dental thread daily.
• Control your blood pressure and cholesterol levels.
• No Smoking. (Mediaclub, 2015)

Diagnosis

Type 1 diabetes symptoms usually appear suddenly and are usually the reason why control blood sugar levels. (A, 2014) Because the symptoms of other types of diabetes and prediabetes appear more gradually or may not be evident, the American Diabetes Association (ADA) has recommended detection patterns. The ADA recommends that the following people perform an analysis for diabetes detection:

• Any person with a body mass index greater than 25, who have additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, antecedents of ovarian polychymosis or heart disease and have a close relative that suffersdiabetes.
• Any 45 years is recommended to perform an analysis to establish the initial level of blood sugar;Then, if the results are normal, the analysis is carried out once every three years.
• Every woman is recommended to have a gestational diabetes to perform a diabetes detection analysis every three years.
• Any person is recommended to whom you have diagnosed prediabetes. Testing every year. (ADA, 2016)

Type 1 diabetes tests, type 2 diabetes and prediabetes

• Blood hemoglobin exam. This blood study, which does not require any fast, indicates your average blood sugar level in the last 2 or 3 months. Since it measures the percentage of blood sugar attached to hemoglobin, the protein that transports oxygen in the red blood cells. (Association., 2018)

If the A1C test results are not constant, if the test is not available or if you have certain conditions that can make the A1C test little precise, it is possible that the doctor use the following tests to diagnose diabetes:

• Sugar examination in the bloodstream. A blood sample will be taken after having fasting for a whole night. A fasting blood sugar level less than 100 mg/dl is considered normal. The fasting blood sugar level between or more than 100 mg/dl and 125 mg/dl, is considered prediabetes. If the values are higher than 126 mg/dl or more in two individual exams, it is most likely diabetes.
• Oral glucose tolerance exams. For this test, you must fast for a night, and the blood sugar level is measured. Then you drink a sugary liquid and blood sugar levels are analyzed several times during the following two hours. (S, 2016)

A blood sugar level less than 140 mg/dl (7.8 mmol/l) is normal. A value of more than 200 mg/dl (11.1 mmol/l) after two hours indicates diabetes. A value between 140 mg/dl and 199 mg/dl (7.8 mmol/l and 11.0 mmol/l) indicates prediabetes.

Bibliographic quotes

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