Hypoglycemia/Diabetes Mellitus

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Hypoglycemia/Diabetes Mellitus by Mind Map: Hypoglycemia/Diabetes Mellitus

1. Histology

1.1. Pancreas

1.1.1. Exocrine Acinar cells Pancreatic digestive enzymes Pancreatic ductal cells Secrete bicarbonate

1.1.2. Endocrine Pancreatic Islets (Islets of Langerhan) Alpha cells Beta cells F Cells / PP cells Delta cells

1.2. Insulin receptors

1.2.1. Signal cells for blood glucose uptake

2. Biochemistry

2.1. Insulin exacerbates hypoglycemia

2.1.1. Liver Glycogenesis - stores glucose into glycogen Increased glucose uptake via GLUT2 Transporter

2.1.2. Muscle Increased glucose uptake via GLUT 4 Transporter Promotes protein synthesis Glycogen synthase activity upregulated Synthesizes glycogen (decreases free glucose) Glycogen phosphorylase activity downregulated Breaks down glycogen (increase free glucose)

2.1.3. Adipose Increase glucose uptake into adipose tissue Promotes triglyceride storage Alpha glycerol phosphate activity upregulated Synthesizes triglycerides from fatty acids Lipase activity downregulated Breaks down triglycerides

2.1.4. Bone metabolism Decreases bone resoprtion Stimulates osteoblast differentiation

2.2. Ketosis in the context of hypoglycemia

2.2.1. Fats broken down turn into ketones Acetone Acetoacetate beta-hydroxybutyrate

2.2.2. Blood becomes more acidic

3. Anatomy

3.1. Pancreas

3.1.1. Regions Head Near Duodenum Pancreatic duct drains into major duodenal papilla Neck Body Tail Near spleen

3.1.2. Function Pancreatic duct Stretches along pancreas, moves digestive enzymes into duodenum

3.1.3. Innervation Vagus nerve Superior mesenteric plexus Celiac plexus

3.1.4. Vasculature Arterial supply MAJOR - Celiac trunk Venous drainage Splenic vein Lymphatic drainage pancreaticosplenic nodes

3.1.5. Location Retroperitoneal posterior to stomach supported by floor of lesser omentum

4. Clinical Manifestations

4.1. Polyuria - Frequent urination

4.2. Polydipsia - Abnormally excessive thirst

4.3. Polyphagia - Extreme hunger

4.4. Unexplained weight loss

4.5. Blurred vision changes

4.6. Tingling or numbness in the hands or feet

4.7. Fatigue - Feeling very tired much of the time

4.8. Very dry skin

4.9. Sores that are slow to heal

4.10. Xerostomia - Dry mouth

4.11. Bacterial, viral, fungal infections

4.12. Increased incidence and severity of dental caries

4.13. Gingivitis and periodontal disease

4.14. Burning mouth symptoms

4.15. Oral candidiasis

5. Dental implications

5.1. Schedule appointments in the morning

5.2. Keep source of glucose ready

5.3. Poor wound healing

5.4. Increased risk for perio disease

5.5. Increased susceptibility to infections

5.6. Limit treatment duration

5.7. Dental specific clinical symptoms that must be accounted for during clinical visit

5.7.1. Oral Candidiasis

5.7.2. Xerostomia

5.7.3. Dental Caries

5.7.4. Burning Mouth Syndrome

5.7.5. Gingivitis and Periodontitis

6. Physiology

6.1. Endocrine

6.1.1. Hypoglycemic State - low blood sugar levels Glucagon Effect on blood glucose Effect on blood fatty acids Effect on blood amino acids Effect on muscle protein Major stimuli for secretion Primary role in metabolism

6.1.2. Hyperglycemic State - high blood sugar levels Insulin Effect on blood glucose Effect on blood fatty acids Effect on Blood amino acids Effect on muscle protein Major stimuli for secretion Primary role in metabolism

7. Pathogenesis

7.1. Type 1

7.1.1. Beta cells in pancreatic islets cant produce insulin due to autoimmune destruction

7.1.2. Autoimmune disorder

7.1.3. Typically onset at young age

7.1.4. 10% of all diabetes cases

7.2. Type 2

7.2.1. Insulin receptors become less sensitive

7.2.2. 90% of all diabetes cases

8. Treatment

8.1. Specific

8.1.1. Type 1 Insulin Rapid acting Short acting Intermediate acting Long acting Pre-mixed

8.1.2. Type 2 Metformin Lowers liver's glucose production Improves body's sensitivity to insulin Side effects Thiazolidiniones Improves body's sensitivity to insulin Side effects Sulfonylurea Increase production of insulin Side effects Meglitinides Similar to sulfonylurea, but faster acting Increase production of insulin Side effects DPP-4 inhibitors Help reduce blood sugar Side effects GLP-1 receptor agonists Help lower blood sugar Slow digestion Side effects SGLT2 inhibitors Prevents kidney from reabsorbing filtered sugar Side effects Insulin Must be injected Side effects

8.2. Universal

8.2.1. Diet Fewer refined carbohydrates Fewer saturated fats More fruits and vegetables

8.2.2. Physical activity

9. Epidemiology

9.1. Diabetes Mellitus

9.1.1. 30 million Americans Type 1 Diabetes 5-10% of population with diabetes Type 2 Diabetes 90-95% of population with diabetes Gestational Diabetes 24th week in pregnancy

9.2. Prediabetes

9.2.1. 84.1 million American adults

9.2.2. 1 out of 3 Americans

9.2.3. 9 out of 10 people with prediabetes don't know they have it

9.3. Risk Factors

9.3.1. Low Socioeconomic Factors

9.3.2. Underserved and underrepresented communities

9.3.3. Diabetes risk assessment (DRA)

9.3.4. Stress

9.3.5. Poor Oral Hygiene

9.3.6. Medications

9.3.7. Poor diet

10. Differential Diagnosis

10.1. diabetes mellitus

10.2. hepatic disease

10.3. transient ischemic attacks

10.4. cardiac dysrhythmia

10.5. endocrine disorders