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

2. Digestive System = Gastrointestinal (GI) Tract

3. Hepatic Portal System & Liver Functions
Fig

4. 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

5. Measure your blood glucose

6. Blood Glucose Values (fasting)
Normal = 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 = 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

7. 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…

8. 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

9. 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

10. 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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