Pathophysiology of hyperglycaemic states

Question 1

What are the 2 types of insulin deficiency?

Answer 1

• Absolute insulin deficiency (T1DM)
• Relative insulin deficiency

Question 2

What is released in response to insulin deficiency?

Answer 2

Cortisol
Adrenaline
Glucagon

Question 3

Describe the pathophysiology of hyperosmolar hyperglycaemic state

Answer 3

1. Cortisol, adrenaline and glucagon is released by insulin deficiency
2. This causes protein synthesis, glycogenolysis and gluconeogenesis
3. This causes hyperglycaemia
4. This leads to glycosuria and dehydration
5. This causes hyperosmolarity
6. Hyperosmolar, hyperglycaemic state

Question 4

Describe the pathophysiology of diabetic ketoacidosis

Answer 4

1. Absolute insulin deficiency leads to increased lipolysis
2. This increases free fatty acids
3. This causes an increase in ketogenesis
4. This causes ketoacidosis and hyperlipidaemia

Question 5

What are some causes of relative insulin deficiency? (5Is)

Answer 5

• Infections
• Inflammation
• Intoxication
• Infarction
• Iatrogenic
  (Also untreated diabetes)