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MIT315 RADIOGRAPHIC PATHOLOGY DIABETES MELLITUS

MIT315
RADIOGRAPHIC PATHOLOGY
DIABETES MELLITUS & HYPOGLYCEMIA
PREPARED BY:
NURHAZWANI BINTI ABU SEMAN
2016627452
HS1125A

DIABETES MELLITUS.
Diabetes mellitus is a disorder of carbohydrate metabolism that occur when there is impaired ability of the body to produce or respond to insulin and maintain proper levels of glucose in the blood. Usually, diabetes mellitus patient have high level of blood glucose in urine. Normal blood glucose levels range is from 80 to 100 milligrams per decilitre (mg/dL). The most common types of diabetes mellitus are type 1 which is caused by a defect in the primary ß cells and type 2 which is resulting in insulin resistance. CITATION Nin14 l 17417 (Kowalczyk, 2014)Clinical diagnostic test.
TEST DESCRIPTION
Fasting plasma glucose. • Test of blood sugar level taken in the morning before eaten. Usually the patient need to fast for 8 hours.

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• If the glucose level higher than 126mg/dL, it can lead to diabetes.

Oral glucose tolerance. • This test has not routinely use nowadays.

• It use to diagnose type 2 diabetes mellitus but commonly this test used to diagnose gestational diabetes.

• The patient entails drinking a beverage glucose and having blood glucose level after 2 hours for every 30-60 minutes for up to 3 hours.

• The patient may have diabetes if the level glucose 200mg/dL or higher for 2 hours.

• This test results shows how well the body deals with glucose before and after drinking.

Haemoglobin A1C. • As known as glycated haemoglobin test / glycohaemoglobin.

• It is important blood test that shows how well your diabetes is being control.

• It is a simple blood test shows average blood sugar levels for past 2-3 months.

If the level A1C 5-6% or higher may have diabetes.

Urine. • This test is for to watch kidney disease and severe high blood sugar by looking for the ketones in the urine with type 1 diabetes.

CITATION Kar07 l 17417 (Dadich, 2007)BLOOD GLUCOSE CHART
Mg/DL Fasting After eating 2-3 hours after eating
Normal 80-100 170-200 120-140
Impaired glucose 101-125 190-230 140-160
Diabetic 126+ 220-300 200+
CITATION Joe13 l 17417 (Garma, 2013)BLOOD GLUCOSE LEVEL TEST CHART
Level HbA1C test score Mean blood (Mg/dL)
Excellent 4.0-6.0 50-115
Good 7.0-8.0 150-180
Diabetic 9.0-14.0 215-380
CITATION hea14 l 17417 (healthlifemedia.com, 2014)
EFFECTS OF DIABETES MELLITUS

CITATION Nat17 l 17417 (Olson, 2017)
TYPE 1 AND TYPE 2 DIABETES.

Details Type 1 (insulin dependent diabetes) Type 2 (non-insulin dependent diabetes)
Description It usually appeared to be a genetic disorder and it is one of the common disease in childhood but it can occur at any age. The pancreas produce little or no insulin. It is an autoimmune condition which means it is occur when the body’s immune system attack and destroy insulin-producing cell in the pancreas. Type 1 diabetes mellitus can risk someone to get of heart disease and stroke. It also often referred to as juvenile diabetes.

CITATION webnd l 17417 (webmd.com, n.d)It is characterized as non-insulin diabetes with an inadequate secretion of insulin. It can occur at any age and increases as getting older or after age 45. This type 2 diabetes mellitus happened when the body is not able to use insulin to bring glucose into the cells effectively. So, the body will rely on alternatively energy sources in tissue, muscles and organs. It can classified in individuals demonstrating three of the following traits which are waist circumference greater than 40 inches (male) and greater than 35 inches (female), triglycerides 150mg/dL or more, high-density lipoprotein (HDL) cholesterol less than 40mg/dL (male) and 50mg/dL in (female), blood pressure 130/85mm Hg or greater and fasting plasma glucose 100mg/dL or greater.

CITATION Nin14 l 17417 (Kowalczyk, 2014)Etiology Genetic, environmental, autoimmune condition.

Obesity, hypertension, inactivity, family history, smoking.

Manifestation Sign:
Frequent urination, sudden weight loss, nausea and vomiting, shortness of breath.

Symptom:
Abnormal thirst and hunger, weakness and fatigue, abnormal pain.

Sign:
Weight loss, frequent urination, itchy skin.

Symptom:
Dry mouth, fatigue, excessive thirst, blurry vision, lack of energy, constant hunger.

Effect on body Lead to high blood pressure, cardiovascular disease, stroke, skin and mouth infections, gastroparesis.

CITATION Fed15 l 17417 (Federic H. Martini, 2015)Lead to coronary artery disease (CAD), stroke, peripheral vascular disease, poor circulation to the feet, hearing impairment, kidney damage and kidney failure.

CITATION Fed15 l 17417 (Federic H. Martini, 2015)Typical treatment The treatment for patient type 1 diabetes mellitus usually is taking insulin by injected through skin into the fatty tissue. The injected equipment are using syringe, insulin pens that use pre-filled cartridges and a fine needle, jet injector which is using high pressure air to send a spray of insulin through skin or an insulin pump that dispense insulin through flexible tubing to a catheter under skin of the abdomen.

CITATION webnd l 17417 (webmd.com, n.d)It has no cure but we can prevent it from occur. If someone has diagnosed with type 2 diabetes, they should taking care of their diet, eat meals and snack on schedule, choose variety foods that have high in nutrition and low in empty calories, do not overeat, often check blood glucose levels, control weight, doing exercises and take medication.

CITATION webnd l 17417 (webmd.com, n.d)Pathogenesis When the person come from family that have type 1 diabetes, the chance for them to get the same disease is higher. It occur when the pancreas cannot synthesize enough amounts of insulin as required by the body. The immune system in the body generates secretion of substances that attack the beta cells of the pancreas. The pancreas secretes little or no insulin enters the blood stream. Glucose build up in the blood stream and is not moving into the cells because insulin is not available. The body’s cell need for nutrient and other system in the body need to provide energy for many important bodily functions. High blood glucose developed.

CITATION Hea18 l 17417 (Healthhearty.com, 2018)One of the causes of type 2 diabetes is obesity. It occurs when the insulin hormone secreted by the beta cells is normal or slightly lower than the ideal amount. The body cells are not responding to insulin. Since the body cells and tissues are resistant to insulin, they do not absorb glucose and it remains in the bloodstream.

CITATION Hea18 l 17417 (Healthhearty.com, 2018)

Imaging modalities Radiographic appearance
General x-ray
Primary imaging modality for diabetic foot patient.

Provide information about bone structure and alignment.
The image shows of Charcot foot in diabetes. Dislocation of tarso-metatarsal joint and reduced inclination angle of calcaneum are clearly seen in the image.

CITATION Lee11 l 17417 (Rogers, 2011)CT scan
Shows fragmentation and disorganization of bones.

This is the image of Charcot foot in diabetes. The image shows of subchondral cyst (arrow) and loss of normal architecture of the talus, calcaneus and bases of metatarsal.

CITATION Gro13 l 17417 (Grover, 2013)
MRI
Allows detection of changes in early stage while x -rays still normal.

Shows pathology in soft tissue and bones in great detail.

The image shows of the Charcot foot in diabetes. The destruction of the middle and lateral cuneiform bones and subluxation of talonavicular, naviculocuneiform and intercuneiform joints can be seen.

CITATION DrAnd l 17417 (Abdrabou, n.d)
HYPOGLYCEMIA.

Hypoglycemia can be define as a condition where there is not enough glucose or sugar in the blood. Diabetes mellitus (DM) is the disease that most commonly associated with hypoglycemia. Type 1 diabetes patients can experience asymptomatic hypoglycemia as their disease progresses, while it is less common in patients with Type 2 diabetes. Someone can lead to hypoglycaemia when the level of blood sugar lower 4mmol/L (72mg/dL) CITATION Chr17 l 17417 (Nordqvist, 2017). It can also effect the children and adult especially when they have diagnosed with diabetes.
Etiology It occurs when a person with diabetes take too much insulin, not eating enough carbohydrate, skipping or delay a meal and drinking too much alcohol without taking enough food.

CITATION Mar16 l 17417 (Funnell, 2016)Manifestation Sign:
Shaking and trembling, sweating, pale face.

Symptom:
Headache, hunger, dizziness, anxiety, tired, confusion, blurred vision.

CITATION Tay16 l 17417 (Walker, 2016)Clinical diagnostic test Doing blood test to measure the blood sugar level.

Treatment Always check blood glucose level. If the hypoglycaemia suddenly attack someone, give them glucose or sugar or anything sweet as soon as possible.

CITATION Mar16 l 17417 (Funnell, 2016)Effect on body Can lead to seizure, loss of consciousness and coma.

Pathogenesis Level of glucose falls. The pancreas release glucagon. In respond to glycogen, the liver breaks down glycogen and release glucose into the blood. Then, the blood glucose level rises and will be stabilize.

CITATION Fed15 l 17417 (Federic H. Martini, 2015).

Imaging modalities Radiographic appearance
MRI
Demonstrates alteration of the diffusion of water within the extracellular space and between intracellular and extracellular spaces.

May shows suggestive changes of hypoglycemia by limited spread in affected areas.
The image shows restricted diffusion along posterior limb of bilateral internal capsules with blood sugar level 45 mg/dL. The patient known to present with focal neurological deficit and may mimic stroke. 
CITATION DrB12 l 17417 (Anvekar, 2012)CT scan
Provides a three dimensional picture of the inside of the body.

Can be used to determine the position and size of neuroendocrine tumours.

Regular scans are useful to find out the rate of tumour growth.
Contrasted abdominal CT scan shows enhancing mass at the head of the pancreas due to the presents with severe hypoglycaemia induced by an insulinoma.

CITATION Sal04 l 17417 (Fahmi, 2004)
References
BIBLIOGRAPHY 1) Dadich, K. A., 2007. Assessment and Diagnosis. In: Diabetis Mellitus a Guide to Patient Care. s.l.:Lippincott Williams & Wilkins, pp. 34-35.

2) Kowalczyk, N., 2014. Endocrine System. In: Radiologic Pathology for Technologists (sixth edition). s.l.:Elsevier Mosby, p. 348.

3) Federic H. Martini, W. C. O. J. L. N. E. F. B. K. P., 2015. The Endocrine System. In: Visual Anatomy & Physiology (second edition). United State: Pearson Education, p. 653.

4) Grover, F., 2013. The Diabetic Charcot Foot New Insights on treatment. https://www.intechopen.com/books/type-2-diabetes/the-diabetic-charcot-foot-new-insights-on-treatment
5) Healthhearty.com, 2018. Detailed Information on the Pathophysiology of Diabetes Mellitus. https://healthhearty.com/pathophysiology-of-diabetes-mellitus
6) Nordqvist, C., 2017. All about hypoglycemia (low blood sugar). https://www.medicalnewstoday.com/articles/166815.php
7) Rogers, L. C., 2011. The Charcot foot in diabetes. http://care.diabetesjournals.org/content/34/9/2123.full
8) Abdrabou, D. A., n.d. Diabetic Foot. https://radiopaedia.org/cases/diabetic-foot-5
9) webmd.com, n.d. Types of diabetes mellitus. https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1-2
10) Anvekar, D. B., 2012. Hypoglycemic Encephalopathy MRI Diffusion. http://www.neuroradiologycases.com/2012/05/hypoglycemic-encephalopathy-mri.html
11) Fahmi, S. Y., 2004. Case Study: An 82-Year-Old Woman Presents With Severe Hypoglycemia Induced by an Insulinoma, s.l.: s.n. http://clinical.diabetesjournals.org/content/22/2/102
12) Funnell, M., 2016. low blood glucose (hypoglycemia).
13) Garma, J., 2013. blood sugar management. blood glucose chart, 29 September. https://www.garmaonhealth.com/know-your-blood-number/
14) healthlifemedia.com, 2014. importance of monitoring blood glucose level. 24 July. https://healthlifemedia.com/healthy/tag/blood-gluecose/
15) Olson, N., 2017. the effects of diabetes on your body. https://www.healthline.com/health/diabetes/effects-on-body#1
16) Walker, T., 2016. can you have hypoglycemia without having diabetes?. https://www.healthline.com/health/hypoglycemia-without-diabetes#prevention

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