Porth's Essentials of Pathophysiology, 4e

iabetes mellitus is an abnormality in blood glucose regulation and nutrient storage related to an abso- lute or relative deficiency of insulin and/or resistance to the actions of insulin. In the United States alone, dia- betes mellitus affects 25.8 million people, or approxi- mately 8.3% of the population. 1 Type 1 diabetes, which is caused by an absolute deficiency of insulin, accounts for 1 million of these people with the remainder hav- ing type 2 diabetes. In addition, another 79 million people have been categorized as having “prediabetes.” Globally, the prevalence of prediabetes and type 2 dia- betes is increasing at an alarming rate. Diabetes Mellitus and the Metabolic Syndrome 33 C h a p t e r Hormonal Control of Nutrient Metabolism and Storage Nutrient intake and storage in the form of adipose tissue, along with the action of insulin and other hor- mones, play an important role in the development of insulin resistance, the metabolic syndrome, and type 2 diabetes. This section provides a brief overview of nutri- ent (glucose, fat, protein) metabolism and storage and the hormones, including insulin, that are involved in the process. Overweight and obesity, as well as adipose tis- sue and its function in energy storage and as an endo- crine organ, are discussed in Chapter 10. Nutrient Metabolism and Storage The body uses glucose, fatty acids, and other substrates as fuel to satisfy its energy needs. Although the respira- tory and circulatory systems combine efforts to furnish the body with the oxygen needed for metabolic pur- poses, it is the liver, in concert with insulin and other hormones, that controls the storage and mobilization of the body’s fuel supply. D

Hormonal Control of Nutrient Metabolism and Storage Nutrient Metabolism and Storage Glucose Metabolism and Storage Fat Metabolism and Storage Protein Metabolism and Storage Glucose-Regulating Hormones Insulin Glucagon Amylin, Somatostatin, and Gut-Derived Hormones Counterregulatory Hormones Diabetes Mellitus Classification and Etiology Categories of Risk for Diabetes Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus and the Metabolic Syndrome Other Specific Types of Diabetes Gestational Diabetes Clinical Manifestations of Diabetes Diagnostic Tests Blood Tests Urine Tests Diabetes Management Dietary Management Exercise Oral and Injectable Antidiabetic Agents Insulin Pancreas or Islet Cell Transplantation Management of Diabetes in Children Acute Complications Diabetic Ketoacidosis Hyperglycemic Hyperosmolar State Hypoglycemia The Somogyi Effect and Dawn Phenomenon Chronic Complications

Theories of Pathogenesis Diabetic Neuropathies Diabetic Nephropathies Diabetic Retinopathies Macrovascular Complications Diabetic Foot Ulcers Infections

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