what is DM?
it is a disorder of the carbohydrate (protein and fat) metabolism characterized by high level of blood glucose secondary to inability to produce or utilize insulin
the chronic elevated BG level eventually results in what 4 problems?
- cardiovascular disease
- renal problems
- PVDs
- disorders of the eyes
what are the 3 types of DM
- type 1
- type 2
- gestational
what are the 3 types of testing for DM (diagnostics)
- Fasting BG/sugar (FBS) - fasted for 12 hours
- A1c (HgA1c is the same thing) - avg of the blood sugar over the past 3 months, looking for compliance with managing your DM
- others: OGTT (oral glucose tolerance test) and random plasma glucose
what are the ranges for diagnostics with FBS?
- Prediabetes: 100- 125 mg/dl
- Diabetes: 126 mg/dl or greater
- Normal: 99 mg/dl (equal or less)
what are the ranges for diagnostics with A1c?
- Prediabetes: 5.7% - 6.4 %
- Diabetes: 6.5 % or greater
- Normal: < 5.7%
what 2 diagnostic tests can be paired on the same day?
FBS and A1c can be paired on the same day-
- if both are on diabetes range, diagnosis is confirmed
- for FBS- must be repeated on 2 different days.
what is the cause of type 1 DM?
- unknown
- they do NOT produce insulin
= absolute insulin deficiency, affects the metabolism of carbs, fats, and proteins - destruction of pancreatic beta cells
type 1 DM complications from not having insulin (2)
- glucose can NOT enter muscle tissues
- glucose stays in the blood (hyperglycemia)
= cells are starved = increased hunger sensation (polyphagia)
type 1 DM: high BG causes what effect to the cells?
high BG causes osmotic fluid loss from cells
1. intracellular dehydration
2. dehydration stimulates the hypothalamus to feel thirsty
= polydipsia
high BG is filtered where?
in the glomeruli within the kidney
- renal threshold for glucose is 160-190 mg
what occurs when high BG exceeds 160-190mg in the glomeruli?
glucose spills into the urine = glycosursia
if carbs cannot be metabolized, what happens to energy and the body?
if carbs cannot be metabolized = fats and proteins are used for energy
= body tissue loss
pathway of acute DM Pt’s with increased and uncontrolled metabolism of fats and proteins
- increased formation of ketones
- decreases blood pH (becomes acidic!)
- compensation: lungs blow off = Kussmaul’s respiration (deep and rapid breathing)
if acute DM Pt’s have increased ketones what happens?
increased ketones = metabolic acidosis = DKA: 1. hypovolemia 2. hypokalemia 3. increased serum osmolality (person is dehydrated from the polydipsia)
when does type 2 DM start
starts as insulin resistance - disorder in which body’s cells do NOT use insulin properly
what 2 factors increase insulin resistance
- obesity
2. inactivity
pathway (4) of type 2 DM
- The insensitivity of body cells to insulin causes the pancreas to secrete more insulin as compensatory mechanism
- pancreas eventually become overwork
- become exhausted and unable to secrete the needed amount of insulin
- = hyperglycemia
type 2 DM is associated with (affecting factors)
- advancing age
- obesity
- family history
- history of gestational DM
- physical inactivity
race/ethnicity’s that have a higher chance of type 2 DM
- African-American
- Hispanics
- Native Americans
- Asians
- Native Hawaiians
- other Pacific Islanders
it is rare but children of these ethnic groups have been getting diagnosed w/ type 2
race/ethnicity’s that have a higher chance of type 1 DM
caucasians
some s/s of DM
- Pruritus
- Paresthesia
- 60-80% are obese (just type2)
DKA is NOT typically a feature of type 2 because of the presence of some insulin =
allows some glucose uptake preventing massive fat breakdown which causes an acute complication of HHS, HHNKS, HHNKC
complications of DM (6)
- hypoglycemia
- Somogyi Effect
- Dawn Phenomenon
- Type 1- DKA, positive for ketones
- Type 2- HHS/ HHNKS, negative for ketones
- Both DKA and HHS are massively dehydrated so we give them a huge amount of fluids
