Pancreas A&P + Diabetes Pathophysiology Dan Judkins, RN, MS, MPH SEAHEC Santa Cruz County Community Integrated Paramedicine Program Rio Rico Medical & Fire District

Islets of Langerhans: (endocrine) Alpha cells  glucagon Beta cells  insulin & amylin Delta cells  somatostatin PP (F) cells  pancreatatic polypeptide Acini: (exocrine) Digestive juices to duodenum

Glucose  sugar used by body for energy Hyperglycemic  high blood sugar level Hypoglycemic  low blood sugar level Glycogen  storage form of glucose Gluconeogenesis  make glucose from fats Glycogenolysis  break down glycogen to glucose Glycogenesis  making glycogen from glucose Glycolysis  glucose converted to energy

Polydipsia Polyphagia Polyuria 3 Polys Polydipsia Polyphagia Polyuria

Polydipsia Polyphagia Polyuria 3 Polys Polydipsia Polyphagia Polyuria

Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) Hyperglycemic Hyperosmotic Non-ketoacidosis (HHNK) Very high glucose levels No increased serum ketones Some insulin produced but not enough Loss of more water than sodium

is a property of a solution involving the concentration of solutes. OSMOLALITY is a property of a solution involving the concentration of solutes. TONICITY is a property of a solution in reference to a particular membrane.

Signs of HHNK… No ketonuria No fruity breath No significant acidosis Extremely dehydrated BG > 600 (800-2000)

Diabetic Ketoacidosis (DKA) High glucose Acidosis Ketosis

Signs of DKA… Excessive thirst Fruity-scented breath Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Fruity-scented breath Confusion Hyperglycemia High urine ketones Acidosis

Hyperglycemia DKA Ketosis Acidosis

DKA Gluconeogenesis  make glucose from fats Fat breakdown  ketones ↓ Insulin  glucose ↓ in cell (starvation) Gluconeogenesis  make glucose from fats Fat breakdown  ketones Ketones are acid  acidosis DKA

Metabolic Syndrome…

Take-home messages: Insulin DKA HHNK