PRESENTATION OF DIABETES

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DM is shown two groups of related disorders: metabolic disorders and abnormal tissues, organs, systems. This disorder leads to life of the organism as a whole. In patients with diabetes revealed signs of disorders of all types of metabolism, not only of carbohydrate as its name implies.

Metabolic disorders

1. Carbohydrate

- Hyperglycemia

- hyperlactatemia

- glycosuria

- Acidosis

2. The protein

- hyperasotemia

- Improving the levels of residual nitrogen in the blood

- azoturia

3. Adipose

- Hyperlipidemia

- ketonuria

- ketonemia

- Acidosis

4. Liquids

- polyuria

- Polydipsia

Carbohydrate metabolism

Disorders of carbohydrate metabolism clinically manifested by hyperglycemia, glycosuria and hyperlactacedemic.

1. Hyperglycemia

Glucose level patients with diabetes exceeds the norm. If the content is constantly fasting glucose above 140 mg% (7.7 mmol / l), it is considered a sign of impaired glucose tolerance; above 200 mg% (11 mmol / l) - possible symptom of diabetes. In untreated patients HPA can be increased to an average of 500 mg% (22 mmol / l), and in states precoma - 1000 mg% or more.

Causes of hyperglycemia:

- The lack of or absence of insulin effects in target cells: as a stimulant (transport of glucose into the cells, the synthesis of glycogen from glucose, glucose oxidation in the citric acid cycle and pentozomonofosfatnom, liponeogenez from carbohydrates) and inhibitory (gluconeogenesis and glycogenolysis).

- Violation of renal excretory function, including glucose excretion (as a result of diabetic nephropathy).

2. Glucosuria

Normally urine glucose not detected. It appears only after exceeding its physiological renal threshold of around 180 mg% (9.9 mmol / L). This threshold is subject individual variations with age it rises. Therefore glucosuria test is only a guide for admission hyperglycemia.

Reasons glucosuria:

- Hyperglycemia, exceeding the threshold for glucose;

- Violation of glucose reabsorption in the renal tubules.

3. Hyperlactacedemic

Hyperlactacedemic - increase in blood MK concentration above normal (more than 16 mg%, or 1.3 mmol / l).

Causes:

- Inhibition of the oxidative catabolism of lactate in the Krebs cycle,

- Violation of glycogen re-synthesis of lactate.

Protein metabolism

Disorders of protein metabolism in diabetes characterized hyperasotemia, increased residual nitrogen in the blood, azoturia.

1. Hyperasotemia

Hyperasotemia - Increase in blood levels of nitrogenous compounds (protein products of metabolism) above normal. Nitrogen protein normally is 0.86 mmol/l, total nitrogen - 0.87 mmol/l.

Causes:

- Increased protein catabolism,

- Activation of the process of deamination of amino acids in the liver because of the intensification of gluconeogenesis.

2. The residual nitrogen

In DM elevated blood levels of non-protein nitrogen (residual nitrogen) higher than normal (over 30 mmol / l). Non-protein nitrogen represented urea nitrogen, amino acids, uric acid, creatinine, ammonia. Reason: increased protein degradation, mainly in the liver and muscles.

3. Azoturia

When DM in the urine increased content of nitrogen compounds (azoturia). Reason: increasing the blood concentration of nitrogen-containing products and their excretion in urine.

Fat metabolism

Disorders of lipid metabolism in diabetes appear hyperlipidemia, ketonemia, ketonuria.

1. Hyperlipidemia

For typical DM hyperlipidemia - increase in blood total lipids levels above normal (more than 8 g / l). Causes of hyperlipidemia:

- Activation of lipolysis in tissues

- Inhibition of lipid cells waste,

- The intensification of the synthesis of cholesterol ketone bodies

- Vehicle deceleration higher fatty acids in cells

- Reduction LPLase activity.

2. Ketonemia

Ketonemia - increase in blood concentration of CT above normal (more than 2.5 mg%). By CT include acetone, acetoacetic and β-hydroxybutyric acid. Ketonemia usually develops in IDDM. The total content of CT in the blood may exceed 30-50 mg%.

Causes:

- Activation of lipolysis,

- Intensification of the oxidation of IVH in the cells,

- Inhibition of lipid synthesis,

- Suppression of the oxidation of acetyl-CoA in the hepatocytes with the formation of CT.

3. Ketonuria

Ketonuria - excretion ketone bodies is excreted in the urine - is considered to be a symptom of an unfavorable course of diabetes. Reason ketonuria - high concentration in the blood ketone bodies, which is well filtered in the kidney.

Water metabolism

Metabolic water in diabetes appear polyuria and polydipsia.

1. Polyuria

Polyuria - education and urine in excess of the norm (in normal conditions of 1000-1200 ml per day). In DM daily urine output reaches 4000-10000 ml.

Causes:

- Hyperosmia- urine due to excretion of excess glucose, nitrogenous compounds, ketone bodies, ions and other osmotically active substances. This stimulates the fluid filtration in the glomeruli and inhibits its reabsorption in the renal tubules.

- Violation fluid excretion and reabsorption in the kidney caused by diabetic neuropathy.

2. Polydipsia

Polydipsia - an increased fluid intake as a result of abnormal thirst.

Causes:

- Hydropenia the body as a result of polyuria.

- Blood hyperosmia- due to hyperglycemia, azotemia, ketonemia, hyperlactacedemic increase in the content of individual ions. The osmolality of serum exceeds the norm. Usually it is more than 300 mOsm / kg.

- Dryness of the mouth and throat caused by the suppression of the function of the salivary glands.

The pathology of tissues, organs and systems

When diabetes affects all the tissues and organs, although to varying degrees. To the greatest extent damaged by the heart, blood vessels, nervous system, kidney, eye tissue, the NBI system. This is evident cardiopathy, angiopathy, neuro- and encephalopathy, nephropathy, reduction of visual acuity and blindness, comas and other disorders. They are referred to as diabetes complications.