PATHOPHYSIOLOGY

Diabetes Mellitus Type 2 is referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM).In case our patient we classified the risk factor into two categories the modifiable and non-modifiable. Under modifiable is the diet because diet high in cholesterol increases number of adipose tissue and this tissue are resistant to insulin therefore glucose uptake by cell is poor and the stress because stress stimulates secretion of epinephrine, norepinephrine and glucocorticoids and this neurotransmitters increases glucose level. In the non-modifiable factor hereditary because it can be transfer from parents to offspring. In the case of our pt., her both parents has a diabetes also. And the age with strong heritability patterns which present as type 2 diabetes early in life, usually before 30 years in the case of our patient she was diagnosed at the age of 57 years old. In type 2 diabetes, it can still produce insulin, but do so relatively inadequately for their body's needs, beta cells are primary affected and there is a poor production of insulin. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. If the insulin is deficient the intracellular and the intravascular space are affected. In the intracellular space there is a failure of glucose to enter in the intracellular space because there is a lack of insulin and insulin acts as the key to be able the glucose to enter in the cell and when this happen the glucose supposed to be absorbed by the cells is staying in the blood and this term is hyperglycemia. If cell was not able to absorb the sugar there will be intracellular and extracellular dehydration and body will compensate and the person will have the urge to drink more water it is term polydipsia. Also if cell has no glucose intake there will be cellular starvation and the person will have the urge to eat and it is termed polyphagia. In the intravascular area if the insulin is insufficient and glucose are not absorb by the cell the glucose is staying in the blood stream and the glucose level in the blood will increase as the sugar in blood increase the blood circulation will become viscose. Prolonged high blood glucose level leads to sluggish circulation and when the glucose concentration in the blood is raised beyond its renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst. In a sluggish circulation due to high blood content in blood the oxygen supply in the peripheral site is insufficient and when this happened there is a proliferation of microorganism.

Modifiable
Diet Stress

Non-modifiable
Hereditary Age

Poor production of Beta cells

Insulin Deficiency

Intracellular: failure of glucose to enter in ICS

Intravascular: increase glucose in blood

Hypergylcemia

Systemic blood Viscosity

ECF/ICF dehydration

Cell Starvation Sluggish circulation

Polydipsia

Polyphagia

Poor oxygen delivery to peripheral area

Increase Osmotic pressure in renal tubules

Proliferation of microorganism

Polyuria

Poor wound healing

The Pancreas
The secretions of the pancreas, called pancreatic juice, include various enzymes, including pancreatic amylase (digestion of starch), trypsin, carboxypepiydase, and chymotrypsin (proteases), as well as pancreatic lipase (digestion of fats). Sodium bicarbonate is also produced, making the pancreatic juice alkaline. This alkaline solution stabilizes the pH in the duodenum, thus providing an optimal environment for the action of these enzymes. Pancreatic juice is produced in clusters of exocrine cells called acini. The remaining cells in the pancreas (about 1 percent of the total) also form clusters (pancreatic islets). These are the endocrine cells that produce the hormones insulin, glucagon, somatostatin, and pancreatic polypeptide. Pancreatic juice collects in small ducts that merge to form two large ducts. The main pancreatic duct exits the pancreas and merges with the common bile duct from the liver and gallbladder. This combined duct, called the hepatopancreatic ampulla, then enters the duodenum by passing through the hepatopancreatic sphincter. A smaller, second duct that exits the pancreas, the accessory pancreatic duct, joins the duodenum directly.