Pathophysiology of Diabetes
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Hyperglycemia is the primary manifestation of diabetes mellitus. It develops from impaired insulin secretion plus varied amounts of peripheral insulin resistance. Hyperglycemia may also occur in newborns after glucocorticoid hormones are administered, or because of excessive infusion of IV solutions containing glucose. This is common in poorly monitored hyperalimentation over a long period of time. Hyperglycemia causes osmotic diuresis. This is due to glycosuria, which leads to urinary frequency, plus polyuria and polydipsia. Orthostatic hypotension and dehydration can result. Hyperglycemia also causes weight loss, nausea, vomiting, blurred vision, and a predisposition to bacterial or fungal infections. Poorly controlled hyperglycemia that continues for years leads to vascular complications that affect the microvascular or macrovascular vessels, or both. There is glycosylation of the glomerular proteins in the kidneys. This may result in mesangial cell proliferation, expansion of the matrix, and vascular endothelial damage. There is usually a thickening of the glomerular basement membrane.
Type 1 Diabetes
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Elevated serum glucose concentrations (> 200 mg/dL) can result in an osmotic diuresis and lead to the symptoms of polyuria and polydipsia that are characteristic of diabetes. This diuresis leads to excessive urinary loss of sodium and results in varying degrees of sodium depletion and dehydration. Other salts, such as potassium, phosphate, and magnesium, are also lost, resulting in total body depletion. These losses may be less obvious at the time of diagnosis owing to intracellu- lar-extracellular shifts from concurrent acid-base disturbances and that these salts are primarily found intracellularly. The major symptoms resulting from hyperglycemia and dehydration are fatigue and reduced stamina, weight loss, postural lightheadedness, visual blurring, and genital yeast infections. As progressive dehydration occurs, more marked degrees of hyperglycemia may be seen, leading to a hyperosmolar state and mental status changes.
Athletes with Chronic Conditions
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
The definition of hyperglycemia varies from source to source. In its strictest definition, a blood glucose level higher than the normal range (i.e., >approximately 7.0 mmol/L or 126 mg/dL) could be considered hyperglycemia. For the purposes of individuals with diabetes, however, where blood glucose fluctuations outside the normal physiological range occur more frequently, the term hyperglycemia is generally used to describe blood glucose levels greater than 11.1 mmol/L (200 mg/dL) (Clement et al. 2004; Canadian Diabetes Association Clinical Guidelines Expert Commmittee 2013). While mild hyperglycemia can result in thirst, blurred vision, fatigue, and headaches, symptoms of severe and/or prolonged hyperglycemia can include vomiting and diarrhea, which can occasionally make it difficult to differentiate it from heat stroke, if training and/or competition is taking place in the heat. Unfortunately, and for a variety of reasons, most individuals with type 1 diabetes are likely to encounter blood glucose levels greater than 11.1 mmol/L (200 mg/dL) on a regular basis (Yardley et al. 2013). The reasons for hyperglycemia related to exercise are discussed in more detail below.
Enhanced transdermal insulin basal release from silk fibroin (SF) hydrogels via iontophoresis
Published in Drug Delivery, 2022
Phimchanok Sakunpongpitiporn, Witthawat Naeowong, Anuvat Sirivat
In recent decades, diabetes mellitus has become one of the most common noncommunicable diseases in the world. In 2018, the International Diabetes Federation reported that the number of diabetes patients of around 425 millions (Mallawarachchi et al., 2019). It is expected to rise to 552 millions by 2030 (Shah et al., 2016). Diabetes is a condition in which blood sugar levels are too high (hyperglycemia). Blood glucose levels above 7.0 mmol/L during fasting and 11.1 mmol/L after lunch or dinner are indicative of diabetes (Mansoor et al., 2019). Diabetes mellitus can be classified into 2 types; type 1 is the failure of insulin secretion by the pancreas (T1DM): type 2 is the defective response of the body to insulin (T2DM) (Zhang et al., 2018). Insulin is a peptide hormone that can be used in the insulin deficiency treatment for both T1DM and T2DM (Shah et al., 2016). However, insulin can be degraded or metabolized in the gastrointestinal tract if taken orally. The self-injection is a common route for insulin delivery, but it introduces a pain and an infectious risk near the injection area. Therefore, the transdermal drug delivery (TDDS) is an alternative route for the controllable insulin administration (Tokumoto et al., 2006).
Hyperglycaemia and the risk of post-surgical adhesion
Published in Archives of Physiology and Biochemistry, 2022
Gordon A. Ferns, Seyed Mahdi Hassanian, Mohammad-Hassan Arjmand
Hyperglycaemia is a condition defined by an increase in blood glucose, and is the primary feature of diabetes mellitus (DM) (Dobbs et al.1975). Today, DM has a high prevalence globally with a prevalence that has risen from 108 million in 1980 to 422 million in 2014, in 2016; about 1.6 million deaths are directly attributable to DM (Bourne et al.2013, Bethesda 2014). Chronic hyperglycaemia promotes inflammation (Esposito et al.2003), oxidative stress (King and Loeken 2004) and fibrotic pathways in heart (Zhao et al.2014), kidney (Sudamrao Garud and Anant Kulkarni 2014), liver (Sahai et al.2004), and the lung (Honiden and Gong 2009). These fibrotic conditions are related to increasing inflammation (Sivakumar and Das 2008), oxidative stress (Poli and Parola 1997), and increase the expression of pro-fibrotic molecules like transforming growth factor β (TGF-β) (Branton and Kopp 1999), hence the aim of this study was to explore the hypothesis that chronic hyperglycaemia in diabetic conditions is a risk factor for post-surgical adhesion by increasing the inflammatory, oxidative stress, and fibrotic pathways.
Squamous cell carcinoma of the lung: improving the detection and management of immune-related adverse events
Published in Expert Review of Anticancer Therapy, 2022
Lara Kujtan, Rama Krishna Kancha, Beth Gustafson, Lindsey Douglass, Christopher RH Ward, Blake Buzard, Janakiraman Subramanian
ICI therapy is known to induce endocrine gland autoimmunity, potentially leading to dysfunction of organs such as the pancreas. Although not as common as other endocrine toxicities, diabetes mellitus (DM) can occur. One retrospective review reported an incidence of new-onset insulin-dependent diabetes at 0.9% in a population of 2960 patients receiving ICI therapy [49]. Typically, a fasting glucose level is used to assess hyperglycemia. Management of diabetes and hyperglycemia depends on a patient’s prior history of diabetes, the fasting glucose levels, and symptoms of diabetic ketoacidosis (DKA). Symptoms of DKA may include excessive thirst, frequent urination, vomiting, confusion, abdominal pain, dry mouth, or skin, increased heart rate, and fruity odor on breath. Patients with a fasting blood glucose >160 mg/dL should undergo further work-up, particularly if it represents new-onset hyperglycemia, or if any signs of DKA are present. For patients with a fasting blood glucose >160 mg/dL, ICI should be held until glucose is controlled. Endocrine should be consulted for any new-onset type 1 DM. If the fasting blood glucose >250 mg/dL, insulin should be initiated. Patients should be admitted to hospital if concerns for ketoacidosis exist, if patients are symptomatic regardless of diabetes type, or in some cases of new-onset type I diabetes to expedite evaluation and treatment [37,39].
Related Knowledge Centers
- Diabetes
- Diabetic Neuropathy
- Diabetic Retinopathy
- Diuresis
- Glucose
- Glycosuria
- Polyphagia
- Type 1 Diabetes
- Blood Plasma
- Blood Sugar Level