1 Pancreas A&P + Diabetes PathophysiologyDan Judkins, RN, MS, MPH SEAHEC Santa Cruz County Community Integrated Paramedicine Program Rio Rico Medical & Fire District

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6 Islets of Langerhans: (endocrine)Alpha cells  glucagon Beta cells  insulin & amylin Delta cells  somatostatin PP (F) cells  pancreatatic polypeptide Acini: (exocrine) Digestive juices to duodenum

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12 Glucose  sugar used by body for energyHyperglycemic  high blood sugar level Hypoglycemic  low blood sugar level Glycogen  storage form of glucose Gluconeogenesis  make glucose from fats Glycogenolysis  break down glycogen to glucose Glycogenesis  making glycogen from glucose Glycolysis  glucose converted to energy

13 Polydipsia Polyphagia Polyuria3 Polys Polydipsia Polyphagia Polyuria

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17 Polydipsia Polyphagia Polyuria3 Polys Polydipsia Polyphagia Polyuria

18 Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) Hyperglycemic Hyperosmotic Non-ketoacidosis (HHNK) Very high glucose levels No increased serum ketones Some insulin produced but not enough Loss of more water than sodium

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20 is a property of a solution involving the concentration of solutes.OSMOLALITY is a property of a solution involving the concentration of solutes. TONICITY is a property of a solution in reference to a particular membrane.

21 Signs of HHNK… No ketonuria No fruity breath No significant acidosisExtremely dehydrated BG > 600 ( )

22 Diabetic Ketoacidosis (DKA)High glucose Acidosis Ketosis

23 Signs of DKA… Excessive thirst Fruity-scented breathFrequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Fruity-scented breath Confusion Hyperglycemia High urine ketones Acidosis

24 Hyperglycemia DKA Ketosis Acidosis

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26 DKA Gluconeogenesis  make glucose from fats Fat breakdown  ketones↓ Insulin  glucose ↓ in cell (starvation) Gluconeogenesis  make glucose from fats Fat breakdown  ketones Ketones are acid  acidosis DKA

27 Metabolic Syndrome…

28 Take-home messages: Insulin DKA HHNK