Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-25

• Body cells are unable to use glucose for energy without adequate insulin. The use and storage of fuel is impaired, and weight loss occurs, despite a possibly increased appetite (polyphagia). Alternate sources of fuel are mobilized to meet the body’s perceived lack of fuel. Gluconeogenesis occurs in the liver, transforming amino acids and FFAs to glucose, and hyperglycemia worsens. • In the total absence of insulin, ketogenesis (fat metabolism releasing ketone bodies) occurs, and ketosis can result. Beta-hydroxybutyrate and acetoacetate production is unrestrained. Dehydration, combined with unregulated ketosis, results in diabetic • Chronic hyperglycemia has a toxic effect on blood-vessel-wall metabolism that may result in the chronic complications associated with diabetes (see Chapter 9: Chronic Complications). As an educator, you will need to work collaboratively with each patient to decide the level and amount of information needed to adequately understand his or her condition at different stages of the disease. Key points • The classic signs and symptoms of diabetes are variable and depend on the amount of insulin deficiency and the level and duration of hyperglycemia. • All forms of uncontrolled diabetes impose substantial burden on the individual with diabetes and on the health-care system. ketoacidosis (see Chapter 8: Acute Complications of Diabetes). • Chronic hyperglycemia itself causes increased insulin resistance.