Diabetes

1
Diabetes

• An overview

2
Normally

• Ingested food is broken down into glucose
• The bodies main source of fuel
• Insulin, a pancreatic hormone, is released from
  the pancreas in response to ingestion of a meal
• Glucose passes into the bloodstream after
  digestion
• Insulin facilitates glucose passing into the
  bodies cells where it is utilized for energy and
  growth

3
Diabetes What it is

• Too little or no insulin is produced by the
  pancreas
• Or, cells do not respond properly to the insulin
• Glucose builds up in the blood
• Overflows into the urine
• Passes out of the body

4
Diabetes Mellitus Type 1

• More severe form
• Formerly known as
• Insulin dependent diabetes mellitus
• Juvenile diabetes
• May occur at any age
• More frequently occurs in children adolescents
• Autoimmune disease
• Body attacks and destroys insulin-producing beta
  cells in the pancreas
• Etiology is not well understood
• May be a genetic factor
• Patients must take insulin to live

5
Diabetes Mellitus Type 1

• Symptoms
• Generally develop over a short period and
  include
• Increased thirst (polydipsia)
• Increased urination (polyuria)
• Constant hunger (polyphagia)
• Weight loss
• Blurred vision
• Extreme fatigue

6
Diabetes Mellitus Type 2

• Most common form
• 90-95 of people with diabetes
• Formerly referred to as
• Non-insulin dependent diabetes (NIDDM)
• Mature onset diabetes
• Pancreas is generally producing enough insulin,
  but the body is not able to utilize it
• Insulin resistance
• Later, insulin production deceases
• Patients become insulin dependent

7
Diabetes Mellitus Type 2

• Most often associated with
• Older age
• Obesity
• 80 of people with type 2 diabetes
• Family history of diabetes
• Previous history of gestational diabetes
• Physical inactivity
• Certain ethnicities
• African Americans
• American Indians
• Asian Americans
• Native Hawaiians
• Hispanics

8
Diabetes Mellitus Type 2

• Symptoms develop gradually
• Patients may be asymptomatic
• Symptoms
• Fatigue
• Frequent urination
• Increased thirst and hunger
• Weight loss
• Blurred vision
• Slow healing wounds

9
Gestational Diabetes

• 3-8 of pregnant women develop gestational
  diabetes
• Generally developed late in pregnancy
• Usually disappears after birth of baby
• When occurs, there is an increased chance of
  developing type 2 diabetes
• 20-50 chance within 5-10 years
• May be asymptomatic

10
Gestational Diabetes

• Caused by hormones of pregnancy or a lack of
  insulin
• More prevalent in women with a family history of
  diabetes
• More prevalent in some ethnic groups
• Prevention
• Maintain a reasonable body weight
• Be physically active

11
Diabetes Mellitus Diagnosis

• Fasting blood glucose level
• Blood glucose of gt126 mg/dL after an 8 hour fast
• Oral glucose tolerance test (OGTT)
• Blood glucose of gt200 mg/dL 2 hours after
  drinking 75 grams of glucose dissolved in water
• Random blood glucose
• Blood glucose of gt200 mg/dL
• Presence of diabetes symptoms

12
Gestational Diabetes - Diagnosis

• Blood glucose levels are measured before and then
  1, 2 3 hours during OGTT.
• Two blood glucose values meeting or exceeding any
  of the following are significant for gestational
  diabetes.
• Fasting blood glucose of 95 mg/dL
• 1-hour blood glucose of 180 mg/dL
• 2-hour blood glucose of 155 mg/dL
• 3-hour blood glucose of 140 mg/dL

13
Pre-Diabetes

• Pre-diabetics have blood glucose levels greater
  than normal but lower than diabetics
• Condition raises the risk of
• Type 2 diabetes
• Heart disease
• Stroke
• Defined by
• Resting blood glucose of 100 to 125 mg/dL, or
• Blood glucose level of 140-199 mg/dL after a
  2-hour OGTT

14
Pre-Diabetes - Prevalence

• 2000
• 40 of US adults aged 40-74
• 41 million people
• 2002
• 54 million US adults
• Many develop type 2 diabetes within 10 years

15
Diabetes - Impact

• In 2002
• 6th leading cause of death
• Cost 132 billion
• Associated with long-term complications,
  affecting almost every part of the body
• Leading to
• Blindness
• Kidney failure
• Amputations
• Nerve damage
• Possible pregnancy complications
• Possible birth defects

16
Diabetes Treatment

• Diet, weight loss exercise
• Often the first treatment for type 2 diabetes
• Oral medications not an exhaustive list
• Glucotrol
• Diabeta
• Prandin
• Glucophage
• Avandia
• Precose
• Glyset
• Insulin replacement

17
Diabetes Hypoglycemia

• More common in type 1 diabetes
• Sudden
• Following strenuous exercise
• Error in dosage
• Vomiting
• Skipping a meal
• Diabetics generally recognize onset
• Can be life threatening
• If conscious give a concentrated carbohydrate
• Sweetened fruit juice or candy
• If unconscious
• Glucose or glucagon by IV

18
Hypoglycemia - Symptoms

• Impaired neurologic function
• Poor concentration
• Slurred speech
• Lack of coordination
• Staggering gait
• Sympathetic nervous system stimulation
• Increased pulse
• Pale
• Moist skin
• Anxiety
• Tremors
• May lead to
• Loss of consciousness
• Seizures
• Death

19
Diabetic Ketoacidosis

• More common in type 1 diabetes
• Usually develops over a few days
• Insufficient insulin ? elevated blood glucose
  levels mobilization of lipids
• Often in response to an infection or stress
• Signs and symptoms
• Signs of dehydration
• Thirst
• Warm, dry skin
• Rapid pulse
• Low blood pressure
• Oliguria
• Metabolic acidosis
• Electrolyte imbalances

20
Diabetic Ketoacidosis

• Signs and symptoms - continued
• Rapid, deep respirations
• Kussmauls respirations
• Acetone breath (sweet, fruity smell)
• Lethargy
• Decreased responsiveness
• Metabolic acidosis
• Ketoacids bind with bicarbonate ions
• Serum pH falls
• Loss of consciousness
• Electrolyte imbalances
• Imbalances of sodium, potassium and chloride
• Abdominal cramps
• Nausea
• Vomiting
• weakness

21
Diabetic Ketoacidosis

• Treatment
• Insulin
• Replacement of fluid and electrolytes
• Bicarbonate administration to reverse the acidosis

22
Diabetes Insipidus

• Not the same as diabetes mellitus (sugar
  diabetes)
• Diabetes insipidus is sometimes called water
  diabetes
• Some symptoms are similar
• Thirst
• Increased fluid intake
• Increased urine output
• Urine is not concentrated
• Pale and colorless
• Cause and treatment are completely unrelated from
  diabetes mellitus

23
Diabetes Insipidus

• Causes/Types (four)
• Pituitary Diabetes Insipidus
• Most common type
• Lack of vasopressin (antidiuretic hormone) (ADH)
• Secreted by the pituitary gland
• Generally due to destruction of the portion of
  the pituitary gland which is normally produces
  ADH
• Gestational Diabetes Insipidus
• Lack of vasopressin which develops during
  pregnancy
• Due to possible pituitary damage, and/or
• Placenta destroys the hormone too rapidly
• Often disappears 4-6 weeks after delivery

24
Diabetes Insipidus

• Causes/Types
• Nephrogenic Diabetes Insipidus
• Kidneys are unable to respond normally to
  vasopressin
• Caused by certain drugs or kidney diseases
• Dipsogenic Diabetes Insipidus
• Occurs when vasopressin is suppressed by
  excessive intake of fluids
• Primary polydipsia
• Most often caused by an abnormality in the part
  of the brain that regulates thirst
• Results in water intoxication

25
Resources

• Pathophysiology for the Health Professions,
  3rd Ed., Barbara E. Gould, Elsevier
• American Diabetes Association
• Diabetes Insipidus Foundation