Diabetes Mellitus Types 1 & 2: Pathophysiology, Risk Factors, and Management

What are the major risk factors for Type 1 Diabetes Mellitus (DM1)?

Genetic factors, environmental factors, viruses, toxic chemicals, •Bovine antibodies(early exposure to cows milk), and autoimmune destruction of beta cells.

What is the primary cause of Type 1 Diabetes Mellitus?

Insulin deficiency due to the destruction of beta cells in the pancreas.

What are the classic clinical manifestations (symptoms) of DM1?

Polyuria, polydipsia, polyphagia, fatigue, and weight loss.

What is the typical treatment for Type 1 Diabetes Mellitus?

•Insulin

•Subq (syringe or pen)

• Long acting

• Short acting

• Intermediate

• Rapid acting

•Nasal

• Short acting

•Prandial insulin

• Rapid or short-acting at meal times

•Sliding scale (finger stick)

•Insulin pumps

• Rapid acting

• Continuous

• Can be with CGM

dm 2

When there are defects in the action of insulin at the cell membrane, the glucose remains in the blood stream causing hyperglycemia

What are the major risk factors for Type 2 Diabetes Mellitus (DM2)?

Obesity, inactivity, genetics, and modifiable risk factors like BMI and cholesterol levels activity, metabolic syndrome(Metabolic syndrome - abdominal obesity, high triglycerides, low HDL, HTN, Fasting BG >100),

•Nonmodifiable risk factors

•1st degree relative

•High risk ethnicity

•Gestational diabetes

•HTN despite meds (high blood pressure)

•PCOS(Polycystic ovary syndrome)

•HgbA1C ≥5.7%

•CVD

What are the classic clinical manifestations (symptoms) of DM2?

CVD, visual disturbances, renal insufficiency, recurring infections, polyuria, polydipsia, polyphagia, fatigue, and poor wound healing.

Hemoglobin A1C (HgbA1C).

long-term glucose control, Average blood glucose over 3 months; does not need to be fasting

•Fasting Blood Glucose

•8 hours .>100

•Oral Glucose Tolerance Test

•Fast 8-12 hours

•Drink glucose

•1 & 2 hour blood draw

•Random Blood Glucose Test

•≥200

•Urine Test

•Renal Threshold

•Point at which glucose appears ("spills") into urine

•Normal Renal Threshold is 180-200 mg/dl

•Easy screen for diabetes (without blood draw)

•The renal threshold can change in people with chronic DM (increased threshold-kidneys "get used to" high BG)

What is diabetic ketoacidosis (DKA)?

A complication of diabetes characterized by insufficient insulin, leading to fat breakdown and ketone production, causing metabolic acidosis.

What are the symptoms of diabetic ketoacidosis?

Dehydration, electrolyte imbalance, and the classic 3 P's: polyuria, polydipsia, and polyphagia.

•Emergency DK

•Hypotensive really low BP, tachycardic, fruity smell, lethargy, coma

treatment DK

•Fluids, electrolytes, IV insulin

What is hypoglycemia?

to much insulin

A condition where blood glucose levels drop below 65 mg/dL, leading to symptoms •Clinical Manifestations (SNS)

•Anxiety

•Hunger

•Palpitations

if goes ot stage 2 whihc is like confusion, dizziness, and weakness. big prob

If not treated seizures and coma

What are the treatment options for hypoglycemia?

Oral glucose(crackers good option), rechecking blood sugar re check after 15 eating and eat a meal, or administering IV dextrose or glucagon if unable to swallow.

DM complicaitons

•Microvascular Disease(small blood vessels)

•Neuropathy (loss sensation, pain, foot ulcers)

•Nephropathy (renal failure)

•Retinopathy (vision impairment, blindness)

•Macrovascular Disease(bigger arteries)

•Atherosclerosis CAD(cornary ateries disase), HTN, stroke

•Impaired Immune function (infection, delayed wound healing)

•Peripheral Vascular Disease (gangrene(death fo bdoy tissue), neuropathy(disfunction of nerves))

manging diabetes at home

•Carbs 45-60 gm/meal

•Protein 15-20% of daily food

•Fiber 25-50 gm/day

•Fat < 30% of daily food

•Limit alcohol

•Exercise

•Insulin (DM1) or Oral agents (DM2)

What is the onset, peak, and duration of rapid-acting insulin (Humalog, Aspart)?

•Appearance: Clear

Onset: 10-30 minutes,

Peak: 1-1.5 hours,

Duration: 2-5 hours.

What is the onset, peak, and duration of short-acting insulin((Regular, "R"))?

⚬Appearance: Clear

Onset: 30-60 minutes,

Peak: 2-5 hours,

Duration: 5-8 hours.

What is the onset, peak, and duration of intermediate-acting insulin(Humulin N, NPH)?

⚬Appearance: Cloudy

Onset: 1-2 hours,

Peak: 4-12 hours,

Duration: 18-24 hours.

What is the onset, peak, and duration of long-acting insulin(Insulin detemir (Levemir), Insulin glargine (Lantus))?

⚬Appearance: Clear Onset: 1-2 hours, Peak: No peak, Duration: 24 hours.

What is the significance of monitoring blood glucose levels for athletes with diabetes?

Insulin sensitivity increases, and monitoring is crucial to manage glucose levels during and after exercise.