What are leading risk factors for DM?
-heart disease
-stroke
-adult blindness
-non-traumatic limb amputation
-HTN
-ESRD
What is the etiology of DM?
-genetic
-autoimmune
-environmental factors
-abnormal insulin production or utilization or both
Where is insulin produced?
-páncreas
-islet of landerhans
-by beta cells
What is the average amount of insulting produced per day by an adult?
18-40 units
What are the two primary functions of insulin?
-glucose transport from blood into cell
-storage of glucose as glycogen
-inhibits breakdown of stored glucose in protein and fat stores
What are key characteristics of T1DM?
-autoimmune
-hereditary
-viral trigger
-destruction of beta cells
-absent or minimal insulin production
What are potential complication of T1DM?
DKA
What are signs and symptoms of T1DM?
3 Ps
What are key characteristics of T2DM?
-environmental factors
-insulin resistance/decreased production over time
What are s/sx of T2DM?
-subtle, long period undiagnosed
-fatigue
-infection
-3 Ps
What ethnicity has highest incidence of T1DM?
Caucasian
What ethnicities have highest incidence of T2DM?
-native
-AA
-latinos
-Hawaiians
-southeast islanders
What are controllable risk factors for DM?
-obesity
-physical inactivity
-metabolic syndrome (3 of below)
-high glucose levels
-abdominal obesity
-low HDL
-HTN
-high triglycerides
What are counter regulatory mechanisms?
-hormones that oppsoe effects of insulin
-work with insulin to keep glucose in normal range
What are some counter regulatory hormones?
-glucagon (changes glycogen to glucose)
-epinephrine (maintains BP)
-growth hormone (antiinsulin activity)
-cortisol (increase glucose w/ stress)
What are sx of hypoglycemia?
-cold clammy skin
-diaphoresis
-tachycardia
-nervousness
-tremors
-slurred speech
-change LOC
-coma
-seizures
-HA
-pallor
-vision changes
What are causes of hypoglycemia?
-alcohol (inhibit glycogenesis)
-too little food
-too much antidiabetics
-too much exercise
What is tx for hypoglycemia?
immediate intake of simple carbs (PO or IV)
Hot and Dry
Sugar High
Cold and Clammy
Need some candy
How is DM tx?
-tight glucose control
-labs (A1C, anion gap, glucose)
-sick day tx
What are characteristics of DKA?
-in undiagnose or newly diagnose T1DM
-viral trigger
-results in counter regulatory hormone response response resulting in hyperglycemia
-inability of body to use glucose
-osmotic diuresis
-can lead to F & E
What leads to ketoacidosis in DKA?
-fat stores broken down as secondary source of energy
-ketones are fatty acid byproduct
-acidic ketone accumulate in blood and urine
-sweet fruity smell
-leads to metabolic acidosis
What happens in untx DKA?
-worsening hyperglycemia
-ketosis
-acidosis
-dehydration
-electrolyte depletion
-hypovolemia
-shock
-renal failure
-death
