Today in Lab… Digestion Hepatic Portal System Blood Glucose Insulin Shock DKA ** Next lab is comprehensive lab mid-term. Labs 1-5 inclusive.

Digestive System = Gastrointestinal (GI) Tract

Hepatic Portal System & Liver Functions Fig. 19.29

Blood Glucose Most cells have 3 fuel options… Carbs Lipids Proteins Brain… Only fuel is glucose No ability to store glucose Lipids yield Ketones… Potential ketoacidosis… At rest… Storage Liver Skeletal muscle Fat Hormonal controls Insulin Glucagon Blood Glucose Fig. 16.18

Measure your blood glucose

Blood Glucose Values (fasting) Normal = 70-120 mg/dl (a.k.a. mg/100ml) [this range varies with source] Hypoglycemia = <60 mg/dl with S&S S&S? - light-headed, headache, syncope, “shaky” nausea, sweating, LOC, irritable, combative Called Insulin shock if due to insulin misuse Some prone to “Rebound Hypoglycemia” Hyperglycemia = >140 mg/dl S&S for G = 140-300 mg/dl: ?? Usually none until microcirculation has been damaged Some Type I diabetics may become irritable Hyperglycemia common in DM types 1 & 2… Present in DKA and may lead to Diabetic Coma

More on DKA DKA stands for…? Diabetic Ketoacidosis Result of cells burning …? Lipids (FAs) (too many too fast) instead of glucose Ironically, pt. is often hyperglycemic And producing too many …? Ketones are produced faster than liver can process them and kidneys cannot eliminate them Effect on pH …? pH < 7.35 Called Acidosis or Ketoacidosis Theoretically more likely in DM type 1 but DM type 2 is so much more common so…

More on DKA cont’d S&S (g-r-a-d-u-a-l onset) (several days): “fruity” breath due to Acetone (a type of ketoacid) LOC is due to the pH (acidosis) 1) pH causes  RR (compensatory rapid & deep ventilations) “Blows off” too much CO2 . CO2 is a vasodilator. Cerebral vasoconstriction results from low CO2 Therefore cerebral ischemia and hypoxia = LOC 2) Acidosis casues H+ to move into tissue cells K+ moves out to ISF  hyperkalemia Hyperkalemia alters neuron function = LOC

More on DKA cont’d If [G] > 300 mg/dl Glucosuria Polyuria Dehydration Polydipsia abdominal pain (generalized) w N&V if pH goes low enough then diabetic coma Trtmt: hospitalization (several days) to control diet and meds It was a g-r-a-d-u-a-l onset and it’s a g-r-a-d-u-a-l fix

Insulin Shock Severe hypoglycemia due to misuse of insulin Common in IDDM Scenario… S&S (rapid onset): Weak & “shaky,” light headed, diaphoretic (sweating), LOC & syncope, irritable, combative Trtmt: If conscious sugar by mouth followed by balanced meal If unconscious dextrose by injection or IV and possibly glucagon by injection

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