PATHOPHYSIOLOGY OF DIABETES MELLITUS, HYPERTENSION AND CEREBRAL EDEMA LEGEND:

̷ manifested
---signs & symptoms
Medical
intervention done

Predisposing Factors
̷Increasing age Precipitating Factors
Gender Obesity
̷ Genetic predisposition Physical inactivity
Race ̷ Diet (High glucose intake)

Multiple genetic defects

Destruction of the alpha beta cells of the pancreas

Decreased glucose induced insulin secretion Decresed tissue response to insulin

Increased hepatic glucose production Decrease cellular glucose uptake

HYPERGLYCEMIA

s/sx:
Production of excess glucagon
increase ketones s/sx:
acidosis ̷ polydipsia
acetone breath Production of glucose from Increase osmolarity due to
------------------------------- glucose ----------------------- ̷ polyuria
protein & fat ketones polyphagia

Wasting of lean Impaired beta cell function

s/sx: ------------------------- body mass
s/sx:
̷ fatigue
Beta cell exhaustion ̷ Blurred vision
̷ weight loss
Chronic elevation in Rectile dysfunction
blood glucose ̷ Fatigue
TYPE II DIABETES MELLTIUS --------------------
̷ Frequent or slow healing
infection
Diabetic Ketoacidosis Body lipids increase 5 times than Increase appetite
normal ̷ Increase thirst
̷ Increase urination
 Increase atheroschlerosis

Changes in arteriolar bed increase in vascular resistance

Increase afterload

Decrease blood flow to organs

Beta receptor activation Decrease renal perfusion

Juxtaglomerular cells

Renin

angiotensinogen

Angiotensin I

Angiotensin converting enzyme

Angiotensin II

Sympathetic Nervous System Adrenal cortex stimulation

Stimulation
Increase aldosterone
Arteriolar vasoconstriction

Increase sodium reabsorption

Increase peripheral resistance

Increase water reabsorption S/Sx:

Increase heart contractility
Chest pain
Increase extracellular fluid Confusion
Increase workload of the heart Ear noise or buzzing
Irregular heartbeat
HYPERTENSION ---------------------------------------------------------- Nosebleed
Tiredness
Vision changes
Prolonged increased vascular resistance
 Injury to the lining of the arterial wall

Increase permeability of the endothelial cells

Thrombus formation within the lumen of the artery

Plaque formation can occur (fat, thrombi, cholesterol)

Narrowing of the lumen of the vessel

Insufficient blood flow/delivery of blood to different organs

S/SX:
Aphasia (inability to speak or understand
language) Decrease blood supply to the brain
Apraxia (altered voluntarymovement)
̷ Visual field defect
̷ Memory deficit
̷ Altered movement coordination Hypoxia
̷ Vertigo Deficiency of oxygen to the brain tissues
Trouble walking
LOC
Headache that start suddenly and occurs
Irreversible tissue damage or
when lying flat
̷ Muscle weak ness
infarction to the affected brain
̷ Numbness or tingling on one side of the
body
̷ Change in alertness
̷ Personality, mood, emotional changes ----------------------------------
CEREBRAL STROKE
̷ Lack of control over bladder or bowel
 With medical intervention WITHOUT MEDICAL INTERVENTIONS
For DIABETES MELLITUS
Diagnostic test
Cerebral Ischemia
FBS (diagnosed DM if glucose is higher than 126 mg/dl)
RBS (diagnosed DM if glucose is higher than 200 mg/dl)
Oral glucose test ( diagnosed DM if glucose is higher than 126
mg/dl after 2 hours) Prolonged perfusion problem
Interventions
Promote proper nutrition
Artificial sweeteners like fructose, sorbitol, xylitol
Altered cellular metabolism
Administer medication (oral anti diabetic agent for type II DM
& insulin therapy for type 1 DM)
For HYPERTENSION
Diagnostic test
Cell death
Elevated blood pressure within normal range
Interventions
Normalizing arterial blood pressure exercise
Lifestyle modification alcohol restriction POOR PROGNOSIS
Weight reduction caffeine restriction
Sodium restriction relaxation techniques
Dietary fat modification smoking cessation DEATH
Potassium supplementation
Pharmacologic intervention (ACE inhibitors, calcium channel blockers, beta
blockers, diuretic)
For STROKE
Diagnostic test
CT Scan CBC, bleeding time, blood clotting test
ECG Carotid duplex Scanning
Interventions
Maintain cerebral oxygenation
Restore cerebral blood flow through thrombolytic therapy
Prevent complications like bleeding, cerebral edema, blood glucose control,
stroke recurrence, aspiration
Physical therapy Speech therapy
Occupational therapy

No recurrence

GOOD PROGNOSIS