Diabetes Mellitus Types I & II
Diabetes Mellitus
Diabetes
Type 1 Diabetes
- Autoimmune reaction that destroys the beta cells in the pancreas, which are responsible for producing insulin.
- The pancreas completely or almost stops producing insulin.
Risk Factors for Type 1 Diabetes
- Genetics and Family History:
- The ADA (American Diabetes Association) recommends that anyone with a first-degree relative with type 1 diabetes is at a higher or increased risk.
- A simple blood test can be used to diagnose the condition.
- Diseases of the Pancreas:
- Injury or diseases of the pancreas can inhibit its ability to produce insulin, leading to type 1 diabetes.
- Infection or Illness:
- A range of relatively rare infections and illnesses can damage the pancreas and cause type 1 diabetes.
Symptoms of Type 1 Diabetes in Adults and Children
- Excessive thirst
- Excessive hunger
- Weight loss
- Blurred vision
- Slow healing of cuts and sores
- Fatigue
- Vaginal yeast infection
- Frequent urination
Insulin Treatment
| Type/Brand | Generic Name | Onset | Peak | Duration |
|---|
| Ultra Rapid (Fiasp) | Insulin Aspart | 2-15 mins | 30-60 mins | 4 hrs |
| Rapid (Novorapid/Novolog, Humalog) | Insulin Aspart, Insulin Lispro | 15-20 mins | 45 mins, 60 mins | 3-5 hrs |
| Short (Huminsulin R) | Insulin Regular | 30 mins | 2-4 hrs | 6-8 hrs |
| Intermediate (Huminsulin N) | Insulin NPH | 1-2 hrs | 4-6 hrs | 12-18 hrs |
| Long (Lantus, Toujeo) | Insulin Glargine | 1-1.5 hrs | minimal | 22-24 hrs, >24 hrs |
| Long (Levemir) | Insulin Detemir | 1-2 hrs | minimal | 18-23 hrs |
| Long (Tresiba) | Insulin Degludec | 30-90 mins | minimal | ~40 hrs |
Diabetic Ketoacidosis (DKA)
- Life-Threatening Complication
- Occurs in:
- Type 1 Diabetes
- Illness or Infection
- Diabetes with Suboptimal Glycemic Control
- Interruption in Therapy
- Diagnosis:
- Blood Work:
- Metabolic Acidosis
- Hyperglycemia
- Ketones in Urine
- H2N
- Insulin
- Glucagon
Type 2 Diabetes
Diabetes Type 2
- The pancreas can still produce insulin, but the body becomes resistant to using it effectively, leading to dysregulation of blood glucose levels.
Risk Factors for Type 2 Diabetes
- Obesity
- Inactivity
- Genetics
- Age
- Ethnicity
- High Blood Pressure
- High Fat & Cholesterol Levels
- Overweight
- Smoking
- Sedentary Lifestyle
Medications used to treat Diabetes Type 2
- Metformin: Increases insulin sensitivity.
- Sulfonylureas (e.g., Glipizide): Increase insulin production in the pancreas.
- SGLT2 Inhibitors (e.g., Dapagliflozin (Farxiga), Empagliflozin (Jardiance)): Remove excess glucose in the blood through urine.
- GLP-1 Agonists (e.g., Semaglutide, Tirzepatide): Slow digestion to lower blood glucose.
- DPP-4 Inhibitors (e.g., Sitagliptin (Januvia)): Help the body increase insulin production.
- Alpha-glucosidase inhibitors (e.g. Acrabose): slow down absorption of carbohydrates
Complications of Diabetes
Major Complications of Diabetes
| Microvascular | Macrovascular |
|---|
| Eye: High blood glucose and high blood pressure can damage eye blood vessels, causing retinopathy, cataracts, and glaucoma. | Brain: Increased risk of stroke and cerebrovascular disease, including transient ischemic attack, cognitive impairment, etc. |
| Kidney: High blood pressure damages small blood vessels, and excess blood glucose overworks the kidneys, resulting in nephropathy. | Heart: High blood pressure and insulin resistance increase the risk of coronary heart disease. |
| Neuropathy: Hyperglycemia damages nerves in the peripheral nervous system, potentially causing pain and/or numbness. Feet wounds may go undetected. | Extremities: Peripheral vascular disease results from narrowing of blood vessels increasing the risk for reduced or lack of blood flow in legs. Feet wounds are likely to heal slowly, contributing to gangrene |