T1 & T2 DM - CCC1

What is diabetes mellitus?

A chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both. $

How many people are affected by diabetes mellitus in the U.S.?

Approximately 37.3 million people. $

What is the rank of diabetes as a cause of death in the U.S.?

Seventh leading cause of death. $

What are the main classes of diabetes?

Type 1, Type 2, Gestational diabetes, Other specific types, and Prediabetes. $

What is the basic pathophysiology of diabetes?

Insulin deficiency or resistance leads to decreased glucose uptake by cells, hyperglycemia, fat and protein breakdown, ketone production, dehydration, and cellular starvation. $

What are the classic three symptoms of diabetes?

Polyuria, polydipsia, and polyphagia. $

What is Type 1 diabetes mellitus?

An autoimmune disorder in which antibodies destroy pancreatic beta cells, resulting in absolute insulin deficiency. $

What percentage of diabetes cases are Type 1?

About 5–10%. $

Who does Type 1 diabetes most commonly affect?

Usually people under age 40, though it can occur at any age. $

Why do patients with Type 1 diabetes require insulin therapy?

Because the pancreas can no longer produce insulin. $

What is the honeymoon phase in Type 1 diabetes?

A temporary remission period 3–12 months after diagnosis when remaining beta cells produce some insulin. $

What are common clinical manifestations of Type 1 diabetes?

Polyuria, polydipsia, polyphagia, weight loss, fatigue, weakness, and mood changes. $

What is Type 2 diabetes mellitus?

A condition in which the pancreas produces insulin but not enough, or the body does not use insulin effectively (insulin resistance). $

What percentage of diabetes cases are Type 2?

Approximately 90–95%. $

What are major risk factors for Type 2 diabetes?

Obesity, advanced age, family history, and sedentary lifestyle. $

Which ethnic groups have a higher prevalence of Type 2 diabetes?

African Americans, Native Hawaiians, Pacific Islanders, and Hispanics. $

What is a key difference between Type 1 and Type 2 diabetes?

Type 1 has an absence of endogenous insulin, while Type 2 has some insulin present. $

Why is Type 2 diabetes often undiagnosed for years?

It has a gradual onset and hyperglycemia may be asymptomatic. $

At diagnosis of Type 2 diabetes, how many beta cells are typically nonfunctional?

About 50–80%. $

What are common clinical manifestations of Type 2 diabetes?

Fatigue, recurrent infections, yeast infections, delayed wound healing, visual changes, and sometimes the 3 Ps. $

What is prediabetes?

An intermediate stage between normal glucose regulation and diabetes with increased risk for Type 2 diabetes. $

What glucose levels define impaired fasting glucose?

Fasting glucose levels of 100–125 mg/dL. $

What glucose levels define impaired glucose tolerance?

Two-hour OGTT levels of 140–199 mg/dL. $

Is prediabetes usually symptomatic?

No, it is usually asymptomatic, but long-term damage may already be occurring. $

What is the diagnostic A1C level for diabetes?

An A1C of 6.5% or higher. $

What fasting plasma glucose level is diagnostic for diabetes?

Greater than or equal to 126 mg/dL. $

What random plasma glucose level with symptoms indicates diabetes?

200 mg/dL or higher. $

What are the goals of diabetes management?

Decrease symptoms, promote well-being, prevent acute complicanions, and delay chronic complications. $

What is the role of nutritional therapy in diabetes?

To help maintain blood glucose levels near normal, manage lipids and blood pressure, and prevent complications. $

What is carbohydrate counting?

A method of meal planning where insulin dosing is based on carbohydrate intake. $

How many grams of carbohydrates are in one serving for carb counting?

15 grams. $

What is the typical carbohydrate intake per meal?

45–60 grams of carbohydrates. $

Why must alcohol intake be monitored in diabetes?

Alcohol inhibits gluconeogenesis and can cause severe hypoglycemia. $

What are exercise guidelines for patients with diabetes?

Start slowly, monitor glucose, exercise one hour after meals, and avoid exercise if glucose is over 300 mg/dL with ketones present. $

Why should patients with diabetes wear medical alert identification?

To inform healthcare providers in emergencies such as unconsciousness. $

Why does blood glucose rise during acute illness or surgery?

Due to counterregulatory stress hormones. $

When should ketone testing be performed?

When blood glucose exceeds 240 mg/dL. $

What is diabetic ketoacidosis (DKA)?

A life-threatening condition caused by severe insulin deficiency leading to hyperglycemia, ketosis, acidosis, and dehydration. $

Which type of diabetes is DKA most common in?

Type 1 diabetes mellitus. $

What are common precipitating factors for DKA?

Infection, illness, inadequate insulin, undiagnosed Type 1 diabetes, poor self-management, or stress. $

What are key clinical manifestations of DKA?

Dehydration, abdominal pain, nausea, vomiting, Kussmaul respirations, fruity breath, hyperglycemia, metabolic acidosis, and ketonuria. $

What blood glucose level is typical in DKA?

Greater than or equal to 250 mg/dL. $

What is hyperosmolar hyperglycemic syndrome (HHS)?

A life-threatening complication of Type 2 diabetes characterized by severe hyperglycemia, dehydration, minimal ketosis, and high serum osmolality. $

What blood glucose levels are often seen in HHS?

Greater than 600 mg/dL. $

Why are neurological symptoms more severe in HHS?

Due to increased serum osmolality. $

How is HHS treated?

IV insulin, aggressive IV fluids, electrolyte monitoring, and treatment of the underlying cause. $

What is diabetic angiopathy?

Damage to blood vessels caused by chronic hyperglycemia. $

What are macrovascular complications of diabetes?

Cardiovascular disease, cerebrovascular disease, and peripheral vascular disease. $

What are microvascular complications of diabetes?

Retinopathy, nephropathy, neuropathy, and dermopathy. $

What is diabetic retinopathy?

Microvascular damage to the retina and the leading cause of new cases of adult blindness. $

How is diabetic retinopathy monitored?

Annual dilated eye examinations. $

What is diabetic nephropathy?

Damage to small blood vessels in the kidneys and the leading cause of end-stage renal disease. $

What is diabetic neuropathy?

Nerve damage due to chronic metabolic derangements of diabetes affecting sensory and autonomic nerves. $

Why are foot complications common in diabetes?

Due to neuropathy, poor circulation, impaired immunity, and increased risk of infection. $

What patient teaching helps prevent diabetic foot ulcers?

Daily foot inspection, proper footwear, good skin care, avoiding injury, and prompt treatment of problems. $

Why are patients with diabetes at increased risk for infection?

Due to impaired inflammatory response and phagocytosis. $