Professional Documents
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OBJECTIVES
WHAT IS DIABETES?
TYPES OF DIABETES
ETIOLOGY
INSULIN AND ITS FUNCTIONS
NORMAL GLUCOSE METABOLISM
GLUCOSE METABOLISM IN DIABETES
SYMPTOMS OF DIABETES
COMPLICATIONS OF DIABETES
DIABETIC KETOACIDOSIS AND HYPEROSMOLAR
COMA
THE DIABETIC FOOT
DIAGNOSIS OF DIABETES
MEDICAL MANAGEMENT
NURSING MANAGEMENT
WHAT IS DIABETES?
Diabetes mellitus (DM) is impaired insulin secretion
and variable degrees of peripheral insulin
resistance leading to hyperglycemia. Early
symptoms are related to hyperglycemia and
include polydipsia, polyphagia, polyuria, and
blurred vision. Later complications include vascular
disease, peripheral neuropathy, nephropathy, and
predisposition to infection. Diagnosis is by
measuring plasma glucose. Treatment is diet,
exercise, and drugs that reduce glucose levels,
including insulin and oral antihyperglycemic drugs.
Complications can be delayed or prevented with
adequate glycemic control; heart disease remains
the leading cause of mortality in DM- Merck Manual
(2014).
What is Diabetes?
8.5% of the US population have diabetes - 25.8 million
children and adults.
Researchers from the Jefferson School of Population
Health (Philadelphia, PA) published a study which
estimates that by 2025 there could be 53.1 million
people with the disease.
18.8 million people have been diagnosed with diabetes
About 7 million people with diabetes have not been
diagnosed.
TYPES OF DIABETES
Pre-diabetes
Pre-diabetes- The vast majority of patients with type 2
diabetes initially had pre-diabetes. Their blood glucose
levels where higher than normal, but not high enough to
merit a diabetes diagnosis. The cells in the body are
becoming resistant to insulin.
Studies have indicated that even at the pre-diabetes
stage, some damage to the circulatory system and the
heart may already have occurred.
TYPE 1 DIABETES
TYPE 2 DIABETES
Gestational diabetes
TYPE 3 DIABETES
TYPE 1 DM
These patients (33.33%) first present with diabetic
ketoacidosis (discussed later).
Symptoms develop quickly in type 1 diabetes, usually
over 2 to 3 weeks or less, and tend to be quite obvious.
High blood sugar levels cause the child to urinate
excessively. This fluid loss causes an increase in thirst
and the consumption of fluids. Some children become
dehydrated, resulting in weakness, weight loss, lethargy,
and a rapid pulse. Vision may become blurred.
Type 2 DM
People with type 2 diabetes may not have any
symptoms for years or decades before they are
diagnosed. Symptoms may be subtle. Increased
urination and thirst are mild at first and gradually worsen
over weeks or months. Eventually, people feel extremely
fatigued, are likely to develop blurred vision, and may
become dehydrated.
Sometimes during the early stages of diabetes, the blood
glucose level is abnormally low at times, a condition
called hypoglycemia.
Because people with type 2 diabetes produce some
insulin, ketoacidosis does not usually develop even when
type 2 diabetes is untreated for a long time.
COMPLICATIONS OF
DIABETES
Blood vessels
Fatty material (atherosclerotic plaque) builds up
and blocks large or medium-sized arteries in the
heart, brain, legs, and penis.
The walls of small blood vessels are damaged
so that the vessels do not transfer oxygen to
tissues normally, and the vessels may leak.
Poor circulation causes wounds to heal poorly
and can lead to heart attacks, strokes, gangrene
of the feet and hands, erectile dysfunction
(impotence), and infections.
Eyes
The small blood vessels of the retina are
damaged, leading to formation of new fragile
blood vessels that tend to bleed.
Vision decreases, and ultimately, blindness
occurs.
Diabetic retinopathy is the most common cause
of adult blindness in the US
Kidneys
Blood vessels in the kidneys thicken.
Protein leaks into urine.
Blood is not filtered normally.
The kidneys malfunction, and
ultimately, kidney failure occurs.
Diabetic nephropathy is a leading
cause of chronic kidney disease in
the US.
Nerves
Nerves are damaged because glucose is not used normally and
because the blood supply is inadequate
Legs suddenly or gradually weaken.
People have reduced sensation, tingling, and pain in their hands
and feet.
Diabetic neuropathy is the result of nerve ischemia due to
microvascular disease, direct effects of hyperglycemia on neurons,
and intracellular metabolic changes that impair nerve function.
There are multiple types, including :
Skin
Blood flow to the skin is reduced, and
sensation is decreased, resulting in
repeated injury
Sores and deep infections (diabetic
ulcers) develop.
Healing is poor.
Blood
White blood cell function is
impaired.
People become more susceptible
to infections, especially of the
urinary tract and skin.
DIABETIC KETOACIDOSIS
Diabetic ketoacidosis develops when your body
is unable to produce enough insulin. Insulin
normally plays a key role in helping sugar
(glucose) a major source of energy for your
muscles and other tissues enter your cells.
Without enough insulin, your body begins to
break down fat as an alternate fuel. This process
produces a buildup of toxic acids in the
bloodstream called ketones, eventually leading
to diabetic ketoacidosis if untreated.
HYPEROSMOLAR HYPERGLYCEMIC
NON-KETONIC COMA
HHC is characterized by hyperglycemia,
hyperosmolarity, and dehydration without significant
ketoacidosis. Most patients present with severe
dehydration and focal or global neurologic deficits.
Plasma glucose level of 600 mg/dL or greater
Effective serum osmolality of 320 mOsm/kg or greater
Profound dehydration, up to an average of 9L
Serum pH greater than 7.30
Bicarbonate concentration greater than 15 mEq/L
Small ketonuria and absent-to-low ketonemia
Some alteration in consciousness
DIABETIC FOOT
A diabetic foot is a foot that exhibits any pathology that
results from diabetes mellitus.
Features:
Cellulitis
Ulcers
Abcess
Osteomyelitis
Gangrene
Neuropathic Arthropathy
DIAGNOSIS OF DIABETES