Diabetes Mellitus (DM)

Question 1

Diabetes Mellitus

Answer 1

a chronic disorder of carbohydrate metabolism resutling in hyperglycemia (incr. bl. glucose) due to insufficient product. of the hormone insulin (type 1)/inadequate utilization of insulin by the body’s cells (Type 2)

Question 2

Prevalance

Answer 2

-3 million in canada=8.8% of pop., 30% of pop. >65 y/o, M=F

• type 1: less common (10%), more dangerous
• type 2: more common (90%), increases w/ age

-6th leading cause of death, BC > 1 amputation/day

Question 3

etiology

Answer 3

unknown, probably genetic

Question 4

*ONSET

Answer 4

type 1: abrupt, acute, (juvenile onset) < 30 yo

type 2: insidious, often undiagnosed cause asymptomatic, > 45 (mature onset)

Question 5

types

Answer 5

• Type 1 & 2
• Gestational diabetes:tempr. condition increases risk Type 2
• prediabetes: incr. bl. glucose, 50% progress to Type 2 (try prevent that)
• metabolic syndrome: associated w/ higher risk of developing Type 2 = heart dis./other heart related probl., & 3/more of following
• > hyperglycemia, hypertension, high triglycerides, low HDL (high-density lipoprotein, good cholesterol), abdominal obesity

Question 6

*PATHOPHYSIOLOGY

Answer 6

Type 1 Diabetes (used to be called Insulin Dependent Diabetes Mellitus)

• the body’s autoimmune reaction to a pathogen that’s destroying insulin-producing Beta cells in the pancreas=no insulin produced, body unable to transfer glucose from bl.stream into target tissues=hyperglycemia results
• glucose can’t get out of bl. vessels to nourish muscles & everything else, then body breaks down fat and protein stored to get energy

Type 2 Diabetes (Non-Insullin Dependent Diabetes Mellitus NIDDM)

• The pancreas initially have near-normal ability to produce insulin but target cells (body tissues) remains insensitive/resistant to insulin = bl. glucose can’t be used by body tissues (ex: muscles) & stays in bl. (hyperglycemia). Body produces more insulin to overcome insulin resistence & to get enough glucose to tissues. Over time, the pancreas is unable to produce enough insulin to overcome resistance & bl. glucose elevates, ex after carbohydrate meals.
• increased abdominal fat & reduced lean muscle mass also result in increased insulin resistance
• Type 2 risk factors: age, fam hx, obesity

Question 7

*S&S

Answer 7

hyperglycemia;
Type 1:
early symptoms - polyuria (freq. urination), polydipsia (freq. drinking), weight loss (despite polyphagia [eating alot])
acute complication - diabetic keto-acidosis; fruity/acetone odor on breath (smell like nailpolish remover), shortness of breath, confusion, coma = life threatening emergency, rare

Typer 2:
asymptomatic, blurred/vision probl. (picked DM up during eye exam), loss of energy, getting up at night to urinate; routine bl. & eye screening very important!

Question 8

*Hyperglycemia

Answer 8

= low bl. glucose; acute onset, more likely in Type 1

• S&S: sweaty, shaky, nervous, if untreated can lead to dizziness, slurred speech, unconsciousness (don’t jump to conclusions, ex: drunk)
• caused: not enough food, too much exerc./insulin, alcohol
• treat w/ fast acing carbohydrate (15gms) sugar, OJ, candies

Question 9

diagnosis

Answer 9

glucose tolerance test, fasting bl. glucose (not eating before bl. test)

Question 10

prognosis

Answer 10

decr. lifespan (5-10 yrs) associated w/ complications, heart disease leading cause of death

Question 11

*Late complicaiton of hperglycemia in type 1 & 2

Answer 11

long-term hyperglycemia=damage in bl.v, nerves, organs & hypertension

• retinopathy (eye)= DM main cause new adult blindness, after 15 yrs, 97% of type 1 & 80% type 2
• neuropathy (nerve damage) = prob. w/ neurological funct. (60-70%), peripheral sensory neuropathy (can’t feel feet, hands, legs; can’t feel pain when injured), ex: carpal tunnel
• nephropathy (kidney dis.) = decr. kidney funct (protein in urine 10-20%)
• cardiovascular dis. (coronary artery disc. 6x more) = CVA/stroke (2-4x)
• peripheral artery disease (together w/ sensory loss) leads to foot ulcerations, gangrene, & amputation (causes half of all non-traumatic amputation)

-15-20% have major depression @ some point

Question 12

*Rx

Answer 12

goal = control bl. sugar level prevent complications

• diet: need adequate lvl of bl. sugar, intake, distribution, low in saturated fat & cholesterol, high fiber (glycemic index=chart w/ assigned value of glucose in each food)
• exercise (enough to utilize food intake balance amount of insulin) erobic 150 min/wk) & resistance 2x/wk exercise rd. b. sugar, reduce hypertension, obesity
• meds:
• > type 1: insulin injective (matched to exc. lvl, health & food intake
• > type 2: oral hypoglycemics
• ongoing assessment/screening to monitor bl. glucose, eye & foot checks
• education for fam & self-management, dietary & exc. counselling

Question 13

prevention

Answer 13

lifestyle can reduce progression to DM type 2 by 60% in prediabetics