Week 15: Diabetes Mellitus Flashcards
What is it?
A condition where there is inadequate insulin for carbohydrate metabolism, therefore glucose from the GI tract cannot be metabolised or stored, so reaches higher than normal levels
What is insulin and where is it produced?
A hormone that is produced by the islets of langerhans in the pancreas
What is insulin used for?
Required for sugar to enter most cells, and regulates blood glucose within a normal range
How does insulin work?
Forces many cells of the body to absorb and use glucose thereby decreasing blood sugar levels
When is insulin secreted?
In response to high blood glucose
When is insulin secretion inhibitied?
By low blood glucose
What part of the body does not require insulin to use sugar?
The brain
What is the purpose of glucagon?
Assist insulin in regulating blood glucose in the normal range
How does glucagon work?
Forces many cells of the body to release glucose to increase blood glucose
When is glucagon secreted?
In response to low blood glucose
When is glucagon secretion inhibited?
By high blood sugar
What is glucose needed for?
Required for fuel as cellular metabolism, the brain also needs glucose
Where is the pancreas located?
In the retroperitoneal space
What does the pancreas produce?
- digestive enzymes into duodenum
- insulin, glucagon into the blood
When is a person considered hypoglycaemic?
non diabetic- <3.3mmol/L
diabetic - <4.0mmol/L
What is diabetes insipidus?
A rare form of diabetes where there is inadequate amounts of anti-diuretic hormones (ADH)
What are the main symptoms of diabetes insipidus?
- producing large amounts of urine urine, especially at night (polyuria)
- feeling thirsty (polydipsia)
What is diabetes mellitus?
A metabolic disease characterised by inadequate or absent insulin production
What is type 1 diabetes?
The destruction of islet cells within the pancreas, occurring manly in children and young adults, having a sudden onset
What is the cause of type 1 diabetes?
Unknown, but considered it could be hereditary
What are symptoms of type 1 diabetes?
- polyphagia
- polydipsia
- blurry vision
- polyuria
- weight loss
What is type 2 diabetes?
The most common form of diabetes, blood insulin levels are higher than normal but insulin receptors have become insensitive to it, overall pt produces low levels of insulin
What is the cause of diabetes?
Unknown, but common in obese patients, women over 75 and men over 65
How is type 2 diabetes controlled?
Via oral or diet controlled
What are some symptoms of type 2 diabetes?
- history of high bp
- fatigue or low energy
- obesity
- recurrent infections
- polyuria
- polydipsia
- FBS> 126mg/dl
What are some medications that can be used for diabetes?
- givenclamide
- cholorpropamide
- gliclazide
- glimepiride
- metformin hydrochloride
- tirxepatide
How does tirxepatide (monjaro) work?
Activates two receptors to increase hormones on the body, this works to aid insulin and reduces the amount of glucose produced by the liver
What do the NICE guidelines state about diabetes medication?
Patients using 3 medications and diabetes management is not controlled or due to side effects of medication
What risks are associated with diabetic medications?
Hypos are common with glicazide, glipizide, glimpepiride
What is secondary diabetes?
When diabetes occurs due to:
- acute or chronic pancreatitis
- some drugs
- pregnancy
What are some complications associated with diabetes?
- cardiovascular disease
- infection
- renal failure
- hypoglycaemic coma
- hyperglycaemic coma
How does cardiovascular disease create complications?
Atherome and calcification of tunica media can lead to MI/peripheral vascular disease
What can thickening of the epithelial basement membrane of arterioles, capillaries and vessels lead too?
- vascular disease
- retinopathy
- nephropathy
- neuropathy
What are diabetics more at risk of?
Infection, especially from bacteria or fungi
How can diabetes cause renal failure?
Due to vascular changes and infection, its a common cause of death in diabetes
What is hypoglycemia?
Occurs when blood glucose levels fall below 4mmol/L
What is hyperglycemia?
Diabetic ketoacidosis:
- occurs when the body has no insulin to use and switches burning fatty acids and producing ketone acidic bodies
What is a symptom of DKA?
Breath has a pear drop smell
What is a hypersmolar coma?
Non-kettic coma is a dangerous condition brought on by very high blood glucose levels in T2D (above 22mmol/L)
What are causes of hyperglycemia ?
- failure to take insulin
- overeating/eating wrong diet
- stress (fever, infection, emotional stress)
What is the management of someone with hyperglycemia?
- support ABC
- treat for hypovolemic shock
- check BSM
- rapid transport
- management
- consider interventions: fluids
What are symptoms diabetic ketoacidosis?
- blood sugar rises
- kindeys try to remove excess water
- patients volume is depleted
- thirst
- tachycardia
- hypotension
- dry skim, mucous membranes
What happens to the body with diabetic ketoacidosis?
- cells cannot burn sugar and patient is hungry
- cells burn fat as an alternative fuel
- acidic ketone bodies produced
- patient tries to correct acidosis - exhales CO2
- rapid, deep breathing
What are causes of hypoglycaemia?
- insulin overdose
- normal insulin use without eating
- over exercise
- excess alcohol
- patients look shocked, dizzy, lightheaded, confused, sweating
What is the management of hypoglycemia?
- give sugar orally/ glucose/ complex carbs
- glucose 40% gel
- IM glucagon
If patient is unconscious and in hypoglycemia what management is needed?
- support ABC’s
- IM glucagon/IV glucose 10%
What questions should you always ask a diabetic?
- have you eaten today?
- have you taken your medication today?
- are your sugars normally under control?
- do you see the diabetic nurse on a regular basis?
When can you discharge a diabetic patient at home?
After 30 mins of reassessment to ensure they do not fall low again, a referral must be made to the diabetic nurse or GP as medication may need reviewing
