Chapter46

Chapter 46 Management of Patients with Diabetes

Overview of Diabetes

• Definition: Diabetes encompasses a group of diseases characterized by hyperglycemia due to deficiencies in insulin secretion or action, or both.

• Statistics:

  • Approximately 34.1 million people are affected in the U.S.

  • Roughly one-third of cases are undiagnosed.

  • The prevalence of diabetes is increasing, particularly among ethnic and racial minority populations.

Classifications of Diabetes

• Types of Diabetes:

  • Type 1 Diabetes

  • Type 2 Diabetes

  • Gestational Diabetes

  • Prediabetes

  • Latent Autoimmune Diabetes of Adults (LADA)

  • Diabetes associated with other conditions

Classification Details

1. Type 1 Diabetes (5%)

   • Onset: Usually before age 30.

   • Characteristics: Often presents with weight loss and patients typically have no islet cell antibodies.

   • Treatment: Requires insulin for survival.

   • Complications: Diabetic Ketoacidosis (DKA) is a common acute complication.

2. Type 2 Diabetes (95%)

   • Onset: Usually after age 30, often associated with obesity, heredity, and environmental factors.

   • Characteristics: Patients generally are overweight and may have insulin resistance.

   • Treatment: Managed with oral medications, diet modification, and exercise.

   • Complications: Hyperglycemic Hyperosmolar Syndrome (HHS).

3. Gestational Diabetes

   • Occurs during pregnancy as a result of insulin resistance due to placental hormones.

   • Testing typically occurs between 24-28 weeks of gestation.

   • Management aims to maintain ideal body weight and blood glucose levels.

4. Prediabetes

   • Characterized by abnormal glucose tolerance, but not high enough to be classified as diabetes.

Functions of Insulin

• Role in Body:

  • Transports glucose into cells for energy.

  • Stimulates storage of glucose as glycogen in the liver and muscle.

  • Stops the liver from releasing glucose.

  • Enhances the storage of dietary fat.

  • Accelerates transport of amino acids into cells.

  • Inhibits the breakdown of glucose, fat, and protein reserves.

Pathophysiology of Type 1 Diabetes

• Mechanism: Beta cells in the pancreas are destroyed, leading to decreased insulin production, which causes high blood glucose levels and fasting hyperglycemia.

• Impact: Affects roughly 5-10% of adults with diabetes.

Symptoms of Type 1 Diabetes

• Key symptoms include excessive thirst, frequent urination, weight loss, and blurred vision.

• Often occurs in patients under 30 years of age, with history involving viral infection and genetic predisposition.

Pathophysiology of Type 2 Diabetes

• Mechanism: Characterized by insulin resistance and impaired insulin secretion.

• Demographics: Affects 90-95% of adults, with increasing prevalence in children due to rising obesity rates.

Risk Factors for Diabetes

• Type 1

  • Early-onset (under 30 years)

  • Genetic predisposition

  • Ethnicity

• Type 2

  • Obesity

  • Age over 30

  • History of gestational diabetes or impaired fasting glucose

Clinical Manifestations of Diabetes

• Symptoms often include the Three Ps:

  • Polyuria (frequent urination)

  • Polydipsia (excessive thirst)

  • Polyphagia (increased hunger)

• Other symptoms: fatigue, vision changes, slow healing wounds, recurrent infections.