PATHO CH 41

What is diabetes mellitus (DM)?

A metabolic disorder causing chronic hyperglycemia due to problems with insulin production, insulin action, or both.

What is insulin's main function?

Moves glucose from the bloodstream into cells for energy and lowers blood glucose.

What hormone raises blood glucose levels?

Glucagon.

Where is excess glucose stored?

In the liver and muscles as glycogen.

What is glycogen?

The storage form of glucose.

What is lipolysis?

Breakdown of fat into fatty acids and ketones for energy.

What are ketones?

Alternative energy molecules produced when fat is broken down due to insufficient insulin.

Which organ requires glucose as its primary energy source?

The brain (although it can use ketones during prolonged starvation).

What is a normal fasting blood glucose?

70–99 mg/dL.

What fasting blood glucose indicates diabetes?

≥126 mg/dL.

What random blood glucose indicates diabetes?

≥200 mg/dL with symptoms

What A1C level diagnoses diabetes?

≥6.5%.

What does Hemoglobin A1C measure?

Average blood glucose over the previous 2–3 months

What causes Type 1 diabetes?

Autoimmune destruction of pancreatic beta cells, causing little or no insulin production.

Who usually develops Type 1 diabetes?

Children, adolescents, or young adults (can occur at any age).

Why do patients with Type 1 diabetes develop ketosis?

Without insulin, the body burns fat for energy, producing ketones.

What are the 3 classic symptoms ("3 Ps") of diabetes?

Polyuria, Polydipsia, and Polyphagia.

What other symptoms occur with Type 1 diabetes?

Weight loss, fatigue, weakness, dehydration, and blurred vision.

How is Type 1 diabetes treated?

Lifelong insulin therapy.

What devices help manage Type 1 diabetes?

Continuous glucose monitors (CGMs) and insulin pumps.

What causes Type 2 diabetes?

Insulin resistance with progressive decline in insulin production.

What are risk factors for Type 2 diabetes?

Obesity, inactivity, family history, aging, hypertension, and hyperlipidemia.

Why does insulin production eventually decrease in Type 2 diabetes?

The pancreas becomes exhausted after producing extra insulin for years.

What symptoms occur in Type 2 diabetes?

Polyuria, polydipsia, fatigue, blurred vision, slow wound healing, infections, and numbness.

How is Type 2 diabetes treated?

Lifestyle changes, oral medications, injectable medications, and sometimes insulin.

What blood glucose level is considered hypoglycemia?

Less than 70 mg/dL.

What causes hypoglycemia?

Too much insulin, skipped meals, increased exercise, or medication errors.

What are symptoms of hypoglycemia?

Sweating, shakiness, hunger, palpitations, headache, confusion, dizziness, seizures, and loss of consciousness.

How is hypoglycemia treated in a conscious patient?

The 15-15 Rule: Give 15 g of fast-acting carbohydrates and recheck glucose in 15 minutes.

How is severe hypoglycemia treated?

IV dextrose or glucagon injection.

What are symptoms of hyperglycemia?

Increased thirst, frequent urination, fatigue, and blurred vision.

What long-term complications result from hyperglycemia?

Kidney disease, nerve damage, eye damage, heart disease, and poor wound healing.

What is DKA?

A life-threatening complication caused by severe insulin deficiency resulting in ketosis and metabolic acidosis.

Which type of diabetes is DKA most common in?

Type 1 diabetes.

Why does DKA occur?

Lack of insulin causes fat breakdown, ketone production, metabolic acidosis, dehydration, and hyperglycemia.

What are symptoms of DKA?

Polyuria, polydipsia, nausea, vomiting, fruity breath, fatigue, dehydration, stupor, and coma.

What glucose level is typically seen in DKA?

Greater than 250 mg/dL.

What acid-base imbalance occurs in DKA?

Metabolic acidosis (pH <7.30).

What happens to ketones in DKA?

They are present in the blood and urine.

What is the bicarbonate level in DKA?

Less than 18 mEq/L.

How is DKA treated?

IV fluids, IV insulin, electrolyte replacement (especially potassium), and frequent monitoring.

What is Hyperosmolar Hyperglycemic State (HHS)?

A life-threatening complication of severe hyperglycemia and dehydration with little or no ketosis.

Which type of diabetes is HHS most common in?

Type 2 diabetes.

Why doesn't HHS usually cause ketosis?

Enough insulin is present to prevent fat breakdown.

What are symptoms of HHS?

Extreme thirst, severe dehydration, weakness, confusion, seizures, and coma.

What glucose level is usually seen in HHS?

Greater than 600 mg/dL.

What is the blood pH in HHS?

Greater than 7.30 (no significant acidosis)

Are ketones present in HHS?

Minimal or absent.

How is HHS treated?

Aggressive IV fluids, insulin therapy, electrolyte replacement, and monitoring for cerebral edema.

Which diabetes type is most associated with DKA?

Type 1 diabetes.

Which diabetes type is most associated with HHS?

Type 2 diabetes.

Which develops faster: DKA or HHS?

DKA develops rapidly (within 24 hours); HHS develops slowly over days to weeks.

Which condition has ketones?

DKA.

Which condition has more severe dehydration?

HHS.

Which condition causes metabolic acidosis?

DKA.

Which condition usually has worse neurological symptoms?

HHS.

Which condition commonly causes fruity-smelling breath?

DKA.

What is diabetic retinopathy?

Damage to retinal blood vessels that can lead to blindness.

What is diabetic nephropathy?

Kidney damage caused by prolonged high blood glucose.

What is diabetic neuropathy?

Nerve damage causing numbness, tingling, pain, and loss of sensation.

What macrovascular complications are common in diabetes?

Heart attack, stroke, and peripheral artery disease.

What should nurses routinely monitor in diabetic patients?

Blood glucose, A1C, diet, exercise, medications, and signs of complications.

What teaching is essential for diabetic patients?

Blood glucose monitoring, medication/insulin use, foot care, healthy diet, exercise, sick-day management, and recognizing hypo- and hyperglycemia.

DKA glucose level?

>250 mg/dL.

HHS glucose level?

>600 mg/dL.

DKA = ______ + ______ + ______.

Hyperglycemia + Ketosis + Metabolic acidosis.

HHS = ______ + ______.

Extreme hyperglycemia + Severe dehydration.