Question | Answer |
Diabetes Mellitus | -chronic metabolic disorder characterized by abnormal regulation of glucose, resulting in hyperglycemia
-defect in the secretion of insulin, action of insulin or both |
Type 1 Diabetes- cause | occurs due to autoimmune destruction of the beta-cells of the pancreas leading to absolute insulin deficiency |
Type 2 Diabetes- cause | peripheral resistance to insulin is presenet & hyperglycemia develops despite above-average levels of insulin |
Gestational Diabetes | -diagnosed during pregnancy
-50-60% of women with GDM develop type 2 in the following 5 years |
Functions of the Pancreas | -functions as an endocrine gland to secrete hormones, insulin and glucagon
-also as an exocrine gland by producing digestive enzymes |
Islets of Langerhans | -alpha cells= secrete glucagon which increases blood glucose levels
-beta cells= secrete insulin which decreases blood glucose levels
-delta cells= secrete somatostatin which regulates the release of insulin and glucagon |
Type 1 Diabetes- characteristics | -generally <30 yrs
-autoimmune dysfunction
-insulin deficiency
-quick onset
-NO oral meds are effective
-shots to survive |
Type 2 Diabetes- characteristics | -generally >30 yrs
-heredity/ethnicity incr risk
-history of GDM
-resistance to insulin
-slow onset
-oral anti-hyerglycemic meds
-HTN & lipids meds
-injectables & insulin |
Possessing 3 or more of these 5 characteristics indicates insulin resistance (type 2): | -increased blood glucose (>200mg/dl)
-increased blood pressure (>130/80)
-increased triglycerides (>150)
-decreased HDL (good cholesterol)
-<50 for women/<40 for males
-increased central obesity (apple vs pear)
-waist= >35 in for women; >40 in f |
Diabetes Mellitus Incidence | -18.2 mill ppl have diabetes
-1.3 mill new cases each yr
-type 2 accounts for 90% of all cases
-of ppl over 40, 12% have type 2
-of ppl over 60, 18.3% have type 2
->$100 bill spent annually to treat diabetes & its resulting health probs |
Prevalence of Diabetes in IN | -Indiana= 14th largest
-nearly 338,000 of the 6 mill ppl in IN have diabetes
-180,000 have diabetes but don't know it
-7.5% of pop has diabetes vs 6.7% for the entire nation |
Diabetes Stats | -leading cause of new blindness
-leading cause of end-stage renal disease
-3rd leading cause of death due to disease in US
-diabetics are 2-4x more likely to develop heart disease
-second leading cause of leg amputation behind only trauma |
Criteria for diagnosis of DM | -symptoms of diabetes and a causal plasma glucose of 200mg/dl
-fasting plasma glucose of 126 mg/dl
-2 hr plasma glucose of 200 mg/dl during an oral glucose tolerance test |
Glycoslated Hemoglobin | -may be used for diagnosis of DM
-an estimated 2-3 month mean blood glucose level
-6 to 6.5= considered diabetic |
Facts on Gestational Diabetes | -usually occurs during the 24th to 28th week of pregnancy
-every woman is tested
-if gestational during one birth, more likely to be in the following births as well
-usually end up having babies over 9 pounds |
Risk to baby & mother with gestational diabetes | -baby= no diabetes but at risk for developing DM
-post partum: 90% return to norm; 8% diagnosed w/ pre-diabetes; 2% diagnosed with type 2
-mother is at high risk of developing type 2 in next 5 to 10 yrs
-returning to norm body weight decreases risk by |
Signs and Symptoms of DM | -polyuria
-polydipsia (incr thirst)
-polyphagia (incr hunger)
-weight loss (T1)
-blurred vision
-ketonuria (T1)
-weakness, fatigue, dizziness
-asymptomatic (T2) |
Ketones | -byproduct of the body burning fat for energy
-usually the result of prolonged hyperglycemia or increased blood sugar
-without insulin, the glucose or energy source cannot enter the bloodstream; therefore, the body turns to burning fat. |
Acute Complication of Diabetes | -hypoglycemia
-diabetic ketoacidosis
-hyperosmolar hyperglycemic state
*must be treated immediately |
Hypoglycemia | -blood glucose level < or = to 70 mg/dl
-three potential causes:
1. too little food or delayed meals
2.unplanned exercise or too muh w/o eating
3.too much medicine
-insulin or insulin stimulators |
Signs and Symptoms of Hypoglycemia | -unconsciousness
-rapid heart rate
-sweaty and shaky
-paleness
-dizziness
-agitated, not making sense |
Treatment for conscious person with hypoglycemia | -15 g of fast acting carbs
-Ex: 120 ml of sprite, 120 ml of apple juice, 3 glucose tabs, 120 ml of milk
-recheck in 15 mins (15-15 rule)
-repeat until BG > 80 mg/dl |
Treatment for an Unconscious person with hypoglycemia | -IV access: turn on side, administer 50% dextrose over 5-10 mins
-no IV access: administer glucagon 1mg SQ |
Hyperglycemia | = blood glucose >130mg/dl fasting, 3 times in a row or a post meal glucose >160mg/dl (2hrs after eating)
-if left untreated, can result in DKA or HHS |
Signs and Symptoms of hyperglycemia | -polyuria (frequent urination)
-polysipsia (excessive thirst)
-polyphagia (excessive hunger)
-blurred vision
-headaches
-slow wound healing
-mental status changes
*some ppl experience few symptoms |
Pathogenesis of Type 1 diabetes | deficiency of insulin=metabolic problems:
-Decreased utilization of glucose
-Increased fat mobilization
-Impaired protein utilization |
Decreased utilization of glucose | -the liver, muscle, & fat cells do not take up glucose from the blood stream
-Excessive glucose spills over into the urine
-Glucose in the urine acts an osmotic diuretic
-results in excessive fluid loss through urination
-Thirst and dehydration can oc |
Increased fat mobilization | -Bc glucose can't be used as energy, fat= broken down resulting in ketones
-Ketones accumulate & disrupt acid-base balance
-pH falls & can lead to metabolic acidosis
-Ketones excreted into urine; osmotic diuresis leads to severe dehydration |
Impaired protein utilization | -Amino acids not transported due to lack of insulin which in turn alters protein synthesis
-Protein catabolism and protein loss impairs the body’s ability to repair tissue
-slowed/non-existent wound healing; no energy to build or repair tissues |
Diabetic Ketoacidosis (DKA) | -blood glucose levels rise too high & the body becomes very dehydrated & begins to burn an excessive amt of fat for energy
-most serious metabolic disturbance of type 1 DM (mortality rate ~5%) |
Hyperosmolar Hyperglycemic State (HHS) | the most serious metabolic disturbance in type 2 DM (mortality rate ~ 15%) |