LEC 7: Diabetes Mellitus Flashcards
What is the function of the pancreas?
Has both exocrine and endocrine functions
- Releases enzymes
Endocrine Functions
Group of cells that secrete hormones into circulation that have an effect on tissues in a different are of the body
What are the two cells in the Islets of Langerhans?
- Alpha cells
2. Beta cells
What cells secrete glucose?
Alpha cells
What cells secrete insulin?
Beta cells
What is the role of insulin in the body?
Normally, inulin is continuously releases into the blood stream with extra released when food is ingest
- Insulin is secreted 24 hours a day
What does insulin help to do?
- Helps transport glucose across the cell membrane
- Helps to decrease glucose within the blood stream
- If there is any extra sugar, it is stored in the liver
What tissues in our body are dependent on insulin?
- Muscle
- Adipose tissue
What tissues do not rely on insulin?
- Brain
- Liver
- Blood cells
What happens is there is no insulin to assists glucose?
Our cells start to think that our body is starving and start ti break down fat and protein as fule sources for our body
What is the role of glucagon in the body?
- Stimulated by the pancreas
- Stimulates the liver into releasing glucose into the blood stream when body says its hungry
What is diabetes mellitus (DM)?
A chronic multisystem disease related to:
- Abnormal insulin production
- Impaired insulin utilization
- Or both
- The pancreas is not able to produce any or enough insulin that the body needs OR the insulin cannot be used
- Insulin cannot be bound to cell
Etiology and Pathophysiology
Theories link cause to single/ combination of these factors
- Genetic
- Autoimmune
- Viral
- Environmental
What are the three types of diabetes?
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
What are the two common types of diabetes?
- Type 1 diabetes
- Type 2 diabetes
Type 1 DM
- 10% if diabetes
- Usually diagnosed by age 30
- Though to be autoimmune disease- own body destroys beta cells
- Bata cells incapable of producing insulin (80 to 90% damaged)
What are the clinical manifestations of Type 1 DM?
- Polydipsia
- Polyuria
- Polyphagia
- Weight loss
- Fatigue
- Weakness
Polydipsia
Excessive thirst retaliated to:
- High sugar concentration
- Fluid is being pulled through from osmosis
- Water is pulled by osmosis to a high concentration
Polyuria
Excess urination
- Kidneys trying to eliminate the excess water
Polyphagia
Excessively hungry
- Telling the body they are hungry
- Cells are starving
Pre-Diabetes
- At risk for Type 2 DM
- Blood glucose high but not high enough to be diagnosed as having diabetes
What is pre-diabetes characterized by?
- Impaired fasting glucose (IFG)
2. Impaired glucose tolerance (IGT)
What needs to happen for pre-diabetic patients?
Need to change their lifestyle, if they do not change lifestyle will have Type 2 diabetes within 10 years
- Weight loss
- Medication
- Diet
What are risk factors for DM?
- Genetics
- Aboriginal, Hispanic, African, Asian, populations high risk
- History of pre-diabetes
- Obesity
- Increased cholesterol
- Hypertension
- Increased waist circumference
Type 2 DM
- 90% of diabetes
- Insulin resistance, insulin deficiency or both
- Usually diagnosed after age 40
- Often asymptomatic
- Progressive nature, gets worse if left untreated
What are the four major metabolic abnormalities?
- Insulin resistance
- Pancreas reduced ability to produce insulin
- Inappropriate glucose production from liver
- Alteration of regulating hormones and adipocytokines
Metabolic Abnormalities: Insulin Resistance
- Body tissue dose not respond to insulin
- Insulin receptors are either unresponsive or insufficient in number
- Results in hyperglycaemia
Metabolic Abnormalities: Pancreas Reduced Ability to Produce Insulin
- Beta cells fatigued from compensating
- Beta cell mass lost
- Beta cells become damaged due to overuse
Metabolic Abnormalities: Inappropriate Glucose Production from Liver
Liver’s response of regulating release of glucose is haphazard
Metabolic Abnormalities: Alteration in Production of Hormones and Adipocytokines
Play a role in glucose and fat metabolism
What is the clinical manifestation of Type 2 DM?
- Gradual onset
- May have classic symptoms
- Fatigue
- Recurrent infections
- Prolonged wound healing
- Visual changes
Diabetes Diagnosis
- Fasting blood sugar
- NPO for at least 8 hours prior
- Greater than or equal to 7.0 mmol/L - Casual blood sugar
- Taken at any time in the day
- Greater than or equal to 11.1 mmol/L with symptoms of high blood sugars - 75 gram oral glucose tolerance test (OGTT)
- Greater than or equal to 11.1 mmol/L
- 2 hours after ingesting glucose drink - Hemoglobin A1C
- Greater or equal to 6.5%
- Glucose control or 3 months
Oral Antihyperglycemic Meds
- Alpha-glucosidase inhibitors
- Biguanides
- Dipeptidyl peptidase-4 inhibitors
- Sulfonylurea insulin secretagogues
Basal Insulin
Type of insulin for Type 1 diabetics
- Background insulin: mimics the function of pancreas
Prandial Insulin
- Can give 4 times a day
- Meal time/ bolus insulin
- Given in anticipation of a spike in blood glucose
Correction Insulin
- Extra dose when glucose level above range
- Used when blood glucose levels are higher then the targeted range
Intermediate Acting
Used as basal insulin
- Can give 2 times a day
Extended Long Acting
Used as basal insulin
- Can give 1 a day
Rapid Acting
Used as prandial and/or correction insulin
- Can give 4 times a day
Short Acting
Used as prandial and/or correction insulin
- Can give 4 times a day
What is the stepwise approach to Type 2 DM management?
- Diet and exercise
- Oral mon therapy
- 1 drug orally to start - Oral combination
- Oral and insulin
- Insulin
Exercise: Type 2 DM
- Accumulate 150 minutes of aerobic activity spread over at least 3 nonconsecutive days of the week
- Goal is to increase to 4 hours or more per week
- Encourage resistance exercise in addition to aerobi
- Start with small realistic goal
Nutrition: Plate Method
- Vegetables
- Half the plate with 2 kinds of vegetables at least - Grains & Starches
- A quarter of the plate
- Potato, rice, corn, pasta - Meat & Alternatives
- A quarter of the palte
- Fish, lean meat, chicken, beans, lentils
Dose fiber count as a carbohydrate?
No, fiber does not count as a carbohydrate because it dose not raise glucose levels
Carbohydrate Counting
- Women: 45 to 60 grams of carb per meal
- Men: 60 to 75 grams of carb per meal
- Snacks: 15 to 30 grams
ABCDE’s to Reduce Cardiovascular Risk
- A: A1C measure of blood sugar levels over the previous 2 to 3 months
- Target is 7% lower - B: Blood pressure
- Target is 130/80 mmHg or lower - C: Cholesterol LDL
- Target is 2.0 mmol/L or lower - D: Drugs to protect the heart
- ACR inhibitors, ARBs, Statins, and/or ASA - E: Exercise- regular
- Physical activity and a balanced diet to achieve a healthy body weight
6.S: Smoking cessation and manage stress
What are chronic complications of DM?
- Macrovascular
- Microvascualr
- Foot and lower extremities
- Integumentary
- Infection
Chronic Complications of DM: Macrovascular
Disease of large and medium-sized blood vessels
Chronic Complications of DM: Mircorvascular
- Result from thickening of vessel membranes in capillaries and arterioles
- Retinopathy. neuropathy
Chronic Complications of DM: Foot and Lower Extremities
Related to micro and macrovascular complications
Chronic Complications of DM: Integumentary
Related to micro and macrovascualr complications
Chronic Complications of DM: Infection
Related to micro and macrovascualr complications
Hypoglycaemia in the Diabetic Patient
- Blood glucose levels less than 4 mmol/L
- Signs & Symptoms
- Diaphoresis
- Tremors
- Hunger
- Pallor
- Palpitations
- Irritability
- Visual distrubances
- Difficulty speaking
- Confusion
- Stupor - Can lead to loss of consciousness, seizures, coma and death
What is the treatment of mild to moderate hypoglycaemia?
- BGM less than 4 mmol/L
Treat with 15 to 16 grams of fast acting carbs
- 4 glucose tables
- 3 tsp sugar (15mL) or 3 packets of sugar dissolved in warm water
- 25 mL IV dextrose
What is the treatment for severe hypoglycaemia?
- BGM less then 2.8 mmol/L
Treat with 20 grams of fast acting carbs:
- 5 glucose tables
- 4 tsp of sugar (15mL) or 4 sugar packets dissolved in warm water
- 50mL of IV dextrose
