Go to Tutorial on Diabetes

OBJECTIVES

1. Briefly describe the roles of each of the following in affecting blood glucose levels; liver, muscle, fat cells, insulin, glucagon.

2. Define and give the value for the normal renal threshold for glucose. (p. 942)

3. For insulin-dependent diabetes (juvenile form), give the following : age group involved, severity, signs and symptoms, and the types and rationale for treatments.

4. For non-insulin-dependent diabetes (adult form), give the following : age group involved, severity, signs and symptoms, and the types and rationale for treatments.

5. Briefly describe secondary diabetes mellitus and gestational diabetes mellitus.

6. List examples in each of two major categories (metabolic and vascular) of complications of diabetes mellitus.

7. Explain the basis of the signs, symptoms and complications associated with diabetes mellitus.

8. Know all underlined terms and * questions, including case study questions.

Gangrene - Preserved foot showing necrosis (p. 38)

This foot was amputated from a person with diabetes mellitus because it developed gangrene. Foot infections are a common complication from diabetes. Observe the superior surface of the foot. Note the color of the skin and nails. Compare the specimen with Fig. 3-8, p. 38.

            Foot with previous healed transmetatarsal amputation and recent ulcer, gross.
           Gangrenous necrosis and ulceration, lower extremity, gross.

* What distinguishes gangrene from other types of necrosis? (p. 38)

* What other vascular complications are common with diabetes? (p. 949)

Normal Pancreas - (H 8122) Click here 

As you study this slide, note that scattered amongst  the pink staining glandular cells are scattered foci of lighter staining cells. The cells staining dark pink are the cells of the exocrine pancreas, which produce digestive enzymes. The scattered lighter foci are called the Islets of Langerhans and they form the endocrine pancreas which makes 2 hormones involved in maintaining blood glucose levels.

            Normal islets of Langerhans, with immunoperoxidase stains (right, insulin and left, glucagon), microscopic.  *

* Name these 2 hormones and the cells that produce them. (p. 942, Fig. 63-1)

Diabetic Pancreas - (PH 1600) Click here 

In this slide, there appear to be fewer glandular cells and more connective tissue throughout the pancreas. It is very difficult to find a recognizable Islet of Langerhans. See if you can find one.

            Islet of Langerhans, insulitis, microscopic. *
            Islet of Langerhans, deposition of amyloid, microscopic. *

Mr. W. is a 51 year-old black male who lives with his wife and four children. He has been a truck driver for the past 30 years. Three days ago he developed a minor stroke (CVA) while driving his truck and was rushed to the hospital by a policeman. At the age of 40, he noticed symptoms of polyuria, polydypsia, polyphagia and weight loss. He did not seek medical attention until one year later when his large toe became infected. After various home remedies without success, he decided to see a physician. He was hospitalized with a tentative diagnosis of diabetes mellitus. After the toe infection healed, Mr. W. was discharged on a diabetic diet and Diabenese (an oral hypoglycemic agent). Over the years he developed a habit of adjusting his medications to his eating habits. During his present hospitalization, a neurology consult revealed severe cerebral atherosclerosis. Renal studies showed decrease functioning of both kidneys.

Laboratory results included the following abnormally high values:

Cholesterol 380 mg/dl
Fasting blood sugar 490 mg/dl
Urinalysis 4+ glucose
Blood pressure 180/105

Discussion Questions

*1. Compare the three types of diabetes. (pp. 944-945, Box 63-1, p. 944)

*2. What were Mr. W's clinical manifestations of diabetes? Explain the underlying reason for the development of each manifestation. (p. 9454)

*3. What is the relationship between diabetes and his infected toe? (pp. 948-949)

*4. What complications did Mr. W develop that are related to diabetes? What other complications could occur? Explain the pathophysiological changes that caused these complications. (pp. 948-949)

*5. What factors could influence his need for an increase or decrease in insulin? (pp. 947-948)

8Copyright 2001 - Augustine G. DiGiovanna - All rights reserved.