NSB231

What are the three main types of diabetes?

Type 1 Diabetes (T1D) – Autoimmune destruction of beta cells → no insulin production.

Type 2 Diabetes (T2D) – Insulin resistance & beta-cell dysfunction.

Gestational Diabetes (GDM) – Insulin resistance due to pregnancy hormones.

What is the pathophysiology of T1D?

Autoimmune destruction of pancreatic beta cells → no insulin production → hyperglycaemia.

Ketone production occurs due to fat metabolism → risk of Diabetic Ketoacidosis (DKA).

What are the key symptoms of T1D?

Classic triad: Polyuria, Polydipsia, Polyphagia.

Other: Unexplained weight loss, fatigue, blurred vision, slow-healing wounds.

How is T1D diagnosed?

Fasting BGL ≥7.0 mmol/L

Random BGL ≥11.1 mmol/L + symptoms

HbA1c ≥6.5% (less reliable in rapid-onset T1D)

Autoantibody testing to confirm autoimmune origin

What are the main treatment options for T1D?

• Insulin Therapy:

  • MDI (Multiple Daily Injections): Basal + Bolus insulin.

  • Insulin Pump Therapy: Continuous infusion of insulin.

  Blood Glucose Monitoring: 4-6 times/day or CGM (Continuous Glucose Monitoring).

What is the pathophysiology of T2D?

Insulin resistance → body cells do not respond to insulin.

Beta-cell dysfunction → reduced insulin secretion → chronic hyperglycaemia.

What are the key symptoms of T2D?

Polyuria, Polydipsia, Polyphagia.

Fatigue, slow-healing wounds, recurrent infections.

How is T2D diagnosed?

Fasting BGL ≥7.0 mmol/L

Random BGL ≥11.1 mmol/L + symptoms

HbA1c ≥6.5%

OGTT (Oral Glucose Tolerance Test) ≥11.1 mmol/L

What are the key management strategies for T2D?

Lifestyle Modifications: Diet, exercise, weight loss.

First-line Medication: Metformin (unless contraindicated).

Second-line Medications: GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors, insulin if needed.

Regular Monitoring: BGL, HbA1c, BP, lipid profile.

What is the pathophysiology of GDM?

Pregnancy hormones increase insulin resistance → pancreas cannot compensate → hyperglycaemia.

How is GDM diagnosed?

OGTT at 24-28 weeks gestation (BGL ≥11.1 mmol/L)

How is GDM managed?

First-line: Diet & exercise.

If uncontrolled: Insulin therapy (not metformin).

What are the causes & symptoms of hypoglycaemia (BGL <4.0 mmol/L)?

Causes: Too much insulin, missed meals, excessive exercise.

Symptoms: Sweating, tremors, confusion, dizziness, unconsciousness

How do you treat hypoglycaemia?

15g fast-acting carbs (e.g., juice, glucose tablets).

Recheck BGL in 15 min, repeat if needed.

What is Diabetic Ketoacidosis (DKA)?

Severe insulin deficiency (T1D).

Symptoms: Kussmaul breathing, fruity breath, dehydration, acidosis (pH <7.3).

Management: IV fluids, IV insulin, electrolyte correction (K+).

What is Hyperosmolar Hyperglycaemic State (HHS)?

Severe dehydration & hyperglycaemia (BGL >30 mmol/L) without ketones (T2D).

Management: IV fluids, insulin, electrolyte correction.

What are the microvascular complications of diabetes?

Diabetic Retinopathy – Annual eye exams.

Diabetic Nephropathy – Kidney function test, ACE inhibitors for BP control.

Diabetic Neuropathy – Foot care to prevent ulcers & amputations.

What are the macrovascular complications of diabetes?

Cardiovascular Disease (CVD).

Cerebrovascular Disease (Stroke, TIA).

Peripheral Arterial Disease (PAD).

How can chronic complications be prevented?

HbA1c monitoring every 3-6 months.

BP & lipid control (Target BP <130/80 mmHg).

Regular exercise & healthy diet.

What are key nursing responsibilities in diabetes management?

Patient Education: Blood glucose monitoring, insulin administration.

Lifestyle Guidance: Diet, exercise, smoking cessation.

Medication Adherence: Encourage compliance, explain side effects.

Regular Screening: Eyes, feet, kidneys, cardiovascular risk.

How is obesity classified?

Chronic health condition, not a personal choice.

BMI & waist circumference used for risk assessment.

What are the main causes of obesity?

Environmental Factors: Obesogenic environments (unhealthy food, sedentary lifestyle).

Biological Factors: Genetics, metabolic dysfunction, hormonal regulation.

Psychosocial Factors: Trauma, socioeconomic status, cultural influences.

What are the physical health risks of obesity?

Cardiovascular disease

Type 2 diabetes

Respiratory issues

Musculoskeletal disorders

Certain cancers

How does obesity affect mental health?

Higher rates of depression, anxiety, eating disorders, & body image dissatisfaction.

What are the societal impacts of obesity?

Discrimination in employment & education.

Higher healthcare costs.

What are the key lifestyle modifications for obesity management?

Healthy diet, increased physical activity, improved sleep, stress management.

What are the medical interventions for obesity?

Pharmacotherapy: Appetite suppressants, metabolic enhancers.

Bariatric Surgery: Gastric bypass, sleeve gastrectomy (long-term weight loss)

Why is multidisciplinary care important?

Involves GPs, dietitians, psychologists, physiotherapists for holistic management.

Why is weight bias awareness important in nursing care?

Avoid stigma, provide person-centred care.

What are key nursing roles in pre- & post-surgical care?

Manage complications, provide nutritional support, monitor comorbidities.

What should nurses educate obese patients about?

Sustainable lifestyle changes, financial & physical barriers to treatment.