Diabetes Mellitus Flashcards
What is the Function of the Pancreas?
Function of the Endocrine Pancreas is to secrete the hormones Insulin and Glucagon which are principally concerned with the Regulation of Blood Glucose levels.
Alpha Cells - Glucagon
Beta Cells - Insulin
What is Insulin?
Purpose is to regulate Blood Glucose in the normal range.
Action - forces cells to absorb and use glucose there by decreasing blood sugar levels.
Secrete in response to: High Blood Sugar
Secretion inhibited by: Low Blood Sugar
What is Glucagon?
Purpose is to Regulate Blood Glucose in the Normal Range. Actions force cells to release (or produce) Glucose, thereby increasing blood sugar levels
Secreted in response to Low Blood Sugar
Secretion inhibited by High Blood Sugar.
What is Diabetes Mellitus?
“A Metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of Carbohydrates, Fat and Protein metabolism, resulting from defects in Insulin secretion, Insulin action or Both”. (WHO, 1999)
How to Diagnose Diabetes Mellitus?
According to the WHO a person is suffering from Diabetes Mellitus if they have:
- A random blood sugar greater than 11 mmol/l or
- A fasting blood sugar greater than 8 mmol/l
- A non-diabetic individual maintains their serum glucose between 3-5.6 mmol per litre.
What are the Types of Diabetes Mellitus?
Type I - Absolute efficiency of Insulin. Insulin dependent Diabetes Mellitus also previously known as ‘Juvenile onset Diabetes mellitus’
Type II - Relative Deficiency of Insulin. Non Insulin dependent Diabetes Mellitus also previously known as ‘Maturity onset Diabetes Mellitus’.
What is Secondary Diabetes?
Gestational Diabetes - occurs in pregnancy, usually in the third trimester and disappears after the baby is born. Women with Gestational Diabetes are more likely to develop Type 2 Diabetes later in life.
Drug induced Diabetes - a Number of Drugs may include Diabetes (possibly only in the Genetically predisposed).
These Include:
Corticosteroids - Enhance Gluconeogenesis
Thiazide and other diuretics - have direct suppressive effects on insulin secretion as well as on Peripheral Glucose uptake.
What is the Epidemiology?
DM is the most common Endocrine Disorder. Affects approx 1.5% - 2% of population of industrialised nations and its incidence is increasing.
Type 1 accounts for approx. 25% - 30% of all diabetic cases. 90% of these cases present before the age of 35 years.
Type 2 accounts for approx 70%-75% of all diabetic cases.
What is the Aetiology of Diabetes Mellitus?
DM is commonly caused by a deficient secretion of insulin from the Beta cells of the pancreas.
May also result from Increased tissue resistance to the action of Insulin or from factors in the blood antagonising Insulin (excess cortisol or somatotrophin).
However exact causes of major types of DM not known.
What is the Aetiology of Type 1 Diabetes?
Due to ‘autoimmune’ destruction of beta cells.
Dramatic onset/needs insulin replacement from diagnosis.
What is the Aetiology of Type 2?
Insufficient insulin secretion by Beta cells or Insulin resistance - cells of the body become resistant to hormone insulin - precedes development of Type 2 Diabetes, associated with higher risk of developing Heart Disease.
Problems with Glucose entry into cells.
Usually older and approximately 80% are overweight.
Persons with upper body obesity are at greater risk of developing type 2 than persons with lower body obesity.
What is a Second type of Type 2?
A Second type of NIDDM occurs in non obese persons, generally younger and with a strongly positive family history. Genetic factors are important in NIDDM as evidenced by the much higher concordance rate (almost 100%) for Type II than in Type I Diabetes (25%-30%) when identical twins are examined.
What is Hyperglycaemia?
In the total absence of Insulin, Blood Glucose concentrations rise, sometimes reaching levels in excess of 35 mmol/l.
What is the assessment and management of Hyperglycaemia?
ABCD assessment - start correcting ABC problems.
If time critical, correct life threatening condition on scene
Commence transfer immediately
Look for medical alert bracelet, chains, cards
Assess blood glucose level
Assess for signs of Dehydration
Severe cases may lead to Hypovolaemic shock
Shocked patient, poor capillary refill, tachycardia, reduced GCS, hypotension.
Do not delay at scene for fluid replacement
Access Heart Rhythm - ECG
Measure oxygen saturation - administer Oxygen if patient is hypoxaemic SpO2 less than 94%
Provide pre alert messages
If available take records of patient’s blood sugar levels with patient.
What are the Signs, Symptoms and Pathophysiology of Type 2 Diabetes?
Recurrent infections - growth of micro-organisms stimulated by high glucose levels.
Prolonged wound healing - abnormal blood sugar levels hinder healing.
Genital pruritus/ Balanitis/ Vaginal thrush - Hyperglycaemia and Glycosuria favour fungal growth.
Visual Changes - blurred vision as the water balance in the eye fluctuates. Opacity of the lens (Cataract). Diabetic Retinopathy.
Paraesthesia, pain, numbness and tingling in the extremities - manifestations of Diabetic neuropathy. May be vascular, metabolic or a combination of both in origin.
Fatigue - Metabolic changes result in poor use of food products contributing to lethargy and fatigue.
