(8) Endocrine Lecture 3 - Diabetes Mellitus NSG 101

Introduction to Diabetes Mellitus

• Definition: Diabetes mellitus is a systemic, metabolic disorder affecting the metabolism of carbohydrates, fats, and proteins.

• Role of Insulin:

  • Insulin is a protein that enables body cells to absorb glucose from the bloodstream.

  • Insulin peaks about 30 minutes after a meal and returns to baseline in 2-3 hours.

  • Continuous small amounts of insulin released by the pancreas.

Types of Diabetes Mellitus

Type 1 Diabetes

• Characteristics:

  • Involves destruction of pancreatic beta cells leading to a lack of endogenous insulin.

  • Patients require exogenous insulin to prevent ketoacidosis and sustain life.

• Metabolic Impacts:

  • Liver converts glycerol and fatty acids into glucose, which is crucial when glucose levels drop.

  • When glucose is unavailable, fatty acids convert to ketone bodies for energy.

  • Glycosuria occurs when excessive glucose is excreted in urine.

• Symptoms (Three Ps):

  • Polyuria: Frequent urination due to excess glucose in blood.

  • Polydipsia: Excessive thirst resulting from dehydration.

  • Polyphagia: Increased hunger due to inability to metabolize glucose, leading to weight loss.

Type 2 Diabetes

• Characteristics:

  • Related to insulin action rather than production.

  • Strongly associated with obesity and often diagnosed in individuals with a history of high cholesterol or hypertension.

  • Patients may be asymptomatic in early stages.

• Risk Factors:

  • Insulin resistance and abnormal hepatic glucose regulation.

• Symptoms: Similar to Type 1 but may be less pronounced initially.

Complications of Diabetes Mellitus

• Acute Complications:

  • Coma (due to DKA, HHNC, or severe hypoglycemia).

• Chronic Complications:

  • End-organ damage leading to blindness, cardiovascular disease, and renal failure.

  • Neuropathy leading to loss of sensation, ulcers, and potential gangrene.

Diagnostic Tests

• Normal Blood Sugar Levels: 70-100 mg/dL; A1C of 5-6%.

• Key Tests:

  • HbA1C: Reflects average glucose levels over the past 120 days.

  • Urinalysis for ketonuria to assess risk for DKA.

  • Fasting glucose and oral glucose tolerance test.

Management and Interventions

• Education: Critical for managing diabetes effectively.

• Diet and Exercise:

  • Focus on total carbohydrate intake rather than type.

  • Understanding of the glycemic index is important for meal planning.

• Monitoring:

  • Regular blood glucose checks are essential.

  • Adjustments to insulin and diet based on glucose levels.

• Stress Management:

  • Emotional and physical stress can increase blood glucose levels.

• Skin and Foot Care:

  • Importance of daily foot inspections to prevent ulcers and infections.

Insulin and Treatment Options

• Types of Insulin:

  • Classifications: rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting.

  • Administered subcutaneously or IV in emergencies (only regular insulin).

  • Importance of proper mixing and administration techniques.

• Alternative Therapies:

  • Continuous subcutaneous insulin infusion systems that mimic pancreatic function.

  • Use of adjunct medications like Pramlintide and Glucagon.

• Pancreas Transplantation: Possible for patients with type 1 diabetes and end-stage renal disease.

Summary of Symptoms

• Hyperglycemia Symptoms: Increased thirst, frequent urination, fatigue, dry mouth, blurred vision, weight loss.

• Hypoglycemia Symptoms: Shakiness, sweating, confusion, irregular heartbeat, irritability.