Pathophysiology

Diabetes mellitus is a condition in which a person has a high blood sugar

(glucose) level as a result of the body either not producing enough insulin, or

because body cells do not properly responding to the insulin that is produced.

Insulin is a hormone produced in the pancreas which enables body cells to

absorb glucose, to turn into energy. If the body cells do not absorb the glucose,

the glucose accumulates in the blood (hyperglycemia), leading to various

potential medical complications.

Etiology:

unknown
Predisposing Factors: Risk Factors:

 Stress  Family History of

 Heredity Diabetes
 Obesity  Age ≥ 45 years old
 Sedentary  Hypertension (≥
Lifestyle 140/90mmHg)

Hypothalamus will signals the β-cells

of the islets of the Langerhans in
pancreas

Insufficient insulin is produced or

when tissue resists insulin

Difficulty for glucose to enter the cells

Liver cells were not able to Muscle cells were not able Glucose remains to the
metabolize glucose to metabolize glucose blood

 ATP Production Glucogenesis and  ATP Production hyperglycemia

Gluconeogenesis
 energy
 energy Breakdown  protein  Osmolality and
of fats synthesis viscosity
 activity
 activity
Ketone Sluggish blood
production  muscular contractility flow
 bile  heme
production filtration

B C D F
A E
 A B C D E F

 fat Atrophy Potassium

Anterior Impaired
digestion transport
Pituitary blood
from the
Toxicity Gland supply
blood to
Steatorrhea secretes
the muscle
Vasopressin Cellular
Irritation to
hypoxia
the neurons
Osmotic
Diuresis Necrosis on
Neuropathy the lower
extremities
Water
Numbness  brain Conservation
or tingling function
on the
Lethargy
extremities
Hypernatremia

Confusion Emotional Resistance Hypokalemia

Disturbance

Release D
Catecholamine Polyuria Polyphagia

 gamma-
Release globulins Polydipsia
Catecholamine F

Susceptibility
Pruritus Increase blood
to infection
pressure

Susceptibility
to infection BP= 150/90

Impaired immune
defense

Risk for
infection
Cerebrovascular accident or stroke (also called brain attack) results from sudden interruption of
blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours.
Stroke are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by
cerebral thrombosis or embolism or hemorrhage (leakage of blood from a vessel causes
compression of brain tissue and spasm of adjacent vessels). Hemorrhage may occur outside the
dura (extradural), beneath the dura mater (subdural), in the subarachnoid space (subarachnoid),
or within the brain substance itself (intracerebral).

Risk factors for stroke include transient ischemic attacks (TIAs) – warning sign of impending
stroke – hypertension, arteriosclerosis, heart disease, elevated cholesterol, diabetes mellitus,
obesity, carotid stenosis, polycythemia, hormonal use, I.V., drug use, arrhythmias, and cigarette
smoking. Complications of stroke include aspiration pneumonia, dysphagia, constractures, deep
vein thrombosis, pulmonary embolism, depression and brain stem herniation.

Cerebrovascular accident is the term that refers to any functional abnormality of the Central
Nervous System that occurs when the normal blood supply to the brain is disrupted, as by a
blood clot or a ruptured blood vessel, and vital brain tissue dies. Cerebrovascular accident is
commonly called Strokes.

Cerebrovascular accident may be caused by any of three mechanisms.

 Cerebral Thrombosis – blockage in the thrombus (clot) that has built up on the wall of
the brain artery.
 Cerebral Embolism – blockage by an embolus (usually a clot) swept into the artery in the
brain.
 Hemorrhage – Rupture of a blood vessel and bleeding within or over the surface of the
brain.
Precipitating Factors: Predisposing Factors:

1. Diet (high caloric intake, high fat) 1. Age (30+)

2. Stress and Depression 2. Gender (Female)
3. Family Status 3. Family History of Cardiovascular
4. Low Income Disease
4. History of Transient Ischemic Attack

Nonspecific injury to the arterial Wall (Endothelial Lining)

Desquamation of Endothelial Lining

Increased Permeability / Adhesion Molecules

Lipids and Platelets assimilate into the area

Oxydized LDL attracts monocytes and Macrophages to the site

Plaques begin to form from cells which imbed into the Endothelium

Lipids are engulfed by the cells and smooth muscle cells develop

Thrombus formation and occlusion at the site of Atherosclerosis

Deprivation of blood supply on the part of the right hemisphere

Cerebral Hypoxia

Energy failure of the neurons

acidosis Ion imbalance

Increase Glutamate Depolarization

Intracellular calcium increased

Cellmembranes and proteins break down

Formation of free radicals
Protein production dereased

Cell injury and death

Memory Gap Mood Ataxia

Disorder