c.

Schematic Diagram

Predisposing Factors: Precipitating Factors:

 Age greater than 45 years (though, as
noted above, type 2 diabetes mellitus is
occurring with increasing frequency in
young individuals)
 Family history of type 2 diabetes in a first-
degree relative (eg, parent or sibling)
 Hispanic, Native American, African
American, Asian American, or Pacific
Islander descent
 Weight greater than 120% of desirable
body weight
 History of previous impaired glucose
tolerance (IGT) or impaired fasting
glucose (IFG)
 Hypertension (>140/90 mm Hg) or
dyslipidemia (HDL cholesterol level < 40
mg/dL or triglyceride level >150 mg/dL)
 History of gestational diabetes mellitus or
of delivering a baby with a birth weight of
over 9 lbs.
 Polycystic ovarian syndrome (which
results in insulin resistance)

Elevated levels of free fatty acids and intra-

cellular deposits of triglycerides and
cholesterol

FFAs bind to G-protein-coupled receptors,

which modulates several responses

These changes interfere with intra-cellular

signaling, decreasing tissue responses to
insulin, and causing alterations in insulin
incretion and glucagon secretion

Changes in adipokines have effects on

hypothalamic and pancreatic functions

Hyperinsulinemia and decreased insulin

receptors
 Insulin Resistance

Hyperinsulinemia

 Excessive thirst
 Increased urine output Reduces glucagon utilization  Hunger
(polyuria)
 Headache

 Numbness, tingling
or burning of the feet
(peripheral
Decreased glucose transport into muscle neuropathy)
cells  Dry eyes
 Blurred vision
 Slow healing or
frequent infections

Elevated hepatic glucose production Increase breakdown of adipose fat and

tissue.

 Weight loss or
gain

Hyperglycemia occurs

DIABETED MELLITUS TYPE 2

Lack or decrease in Imperfect insulin Lack of glucagon

insulin replacement
  Headache
 Confusion
 Personality changes Decrease in glucose  Weight reduction
 Weight reduction circulation
 Nausea and vomiting
 Fatigue
 Somnolence

HYPOGLYCEMIA

Decrease glucose in
circulation

Affects the regulatory mechanisms

of the brain that regulates
hormones and electrolytes

 Confusion
 Cognitive deficits
The brain cannot compensate
 Difficulty speaking
and functions deteriorates
 Seizures

 Drowsiness  Depression
 Muscle weakness Electrolytes and hormones goes  Involuntary twitching
off balance
 Trembling

 LOC Brain slowly shuts down due to

over circulation of electrolytes
 METABOLIC
ENCEPHALOPATHY

Impairs body ability to fight of

infection and respond to foreign
pathogens

Aspiration of flora present in the  Myalgias

oropharynx  Ear pain

Blood-borne organisms enter

the pulmonary circulation

Proliferation of microbial
pathogens at alveolar level

 Diarrhea
 Rash (Horder spots in
 Abdominal pain Inflammatory reaction occur in psittacosis; erythema
the alveoli multiforme
in Mycoplasmapneum
onia)
 Nonexudative
pharyngitis

WBCs tries to counter the

pathogens and enters the alveoli
 Secretions fill the lungs and
 Hemoptysis
 Cough ventilation is impaired due to the
partial occlusion of the bronchi  Splenomegaly
or alveoli

 Mental confusion
Decrease in alveolar oxygen
 Relative bradycardia
tension

Exudate build-up and

consolidation of lobes or lung
occur

COMMUNITY ACQUIRED
PNUEMONIA
Predisposing Factors: Precipitating Factors:
 Sex  High blood pressure
 Older age  High blood cholesterol
 Family history and genetics
 Race and ethnicity: African Americans,
Hispanics, and whites

Non-specific injury to arterial

wall (Endothelial Injury)

Desquamation of endothelial
lining

Increased Permeability or
Adhesion of Molecules

Oxydized LDL attracts

monocytes and macrophages to
the site

Plaques begin to form from cells

which imbibed into the
endothelium
 Lipids are engulfed by the cells
(foam cells) and Smooth Muscle
Cells Develop

Disruption of plaque and

continuous aggregation of
platelets

Thrombus Formation

Reduction of blood flow

Decreased Blood Supply to the

Myocardium

 Extreme Fatigue
 Dizziness  Shortness of breath
 Chest pain  Swelling on legs and feet
Decreased Myocardial Oxygen
 Heart palpitations  Swelling in abdomen
Supply
 Cough  Weight gain
 Difficulty sleeping

ISCHEMIC HEART DISEASE