Diabetes Mellitus

Ch 13 ~ Endocrine SystemMed Term

• 18.8 million adults & children diagnosed

• 7.0 million diagnosed

• 79 million are prediabetic

History of the Disease• 1500 BC ~ Egyptian physician Hesy-Re

described disease with polyuria

• 1st century AD ~ described as ‘melting down of flesh & limbs into urine’

• Up to 11th century ~ diagnosed by ‘water tasters’ who tasted the urine of suspected diabetics. Latin for ‘honey’ is ‘mellitus’

• Dec. 1921 ~ insulin discovered by Dr. F. Banting

• 1940s ~ advances made in understanding of diabetes and better use of insulin

• 1950s ~ oral preparations discovered

What is diabetes?

• Chronic disorder characterized by high blood glucose levels

• Body is not able to utilize insulin to aid with the absorption of glucose into the cells

• May be due to a deficiency in the amt of insulin or due to the individual’s resistance to their own insulin

What is insulin?

• A hormone secreted by the pancreas

• Functions to ‘carry’ glucose through the cell wall so the cell can produce energy

• Released after a meal when glucose is absorbed into the bloodstream

What is normal blood sugar?

• Narrow range of 70 – 110 mg/dl of blood

• BS naturally remains elevated aprox. 2 hrs after a meal or drink then returns to normal

Signs & Symptoms of DM• If insulin is deficient and sugars in blood are not

utilized by the cells for energy then the following S&S will appear:

• Extreme fatigue• Blurred vision• Polyuria

*dehydration* polydipsia

• Polyphagia• Unexplained weight loss • Slow healing

Types of Diabetes• Type I Diabetes ~ (insulin deficiency)

* it’s all about lack of insulin

* formerly known as ‘juvenile diabetes’, an autoimmune insulin deficiency

* treated with insulin (injected), diet , exercise

Etiology of Type I

• * autoimmune onset triggered by an event such as viral illness

• * insulin in not produced in type I

Type I Signs & Symptoms• Extreme weakness/fatigue• Extreme thirst - dehydration (polydipsia)• Increased urination (polyuria)• Abd. Pain• N & V• Blurred vision• Slow healing wounds• Mood changes• Amenorrhea• Unexplained weight loss

Treatment of Type I DM

• Obtaining ideal body wt.• Close monitoring of blood sugar levels• Following a diabetic diet with prescribed

calories (16 cal/lb per day)• Regular exercise• Insulin injections

Type II Diabetes• Formerly known as ‘adult onset diabetes’

• Usually develops in middle age but more children & young adults are now susceptible

• Associated with insulin resistance or lack of insulin

• Usually hereditary tendency

• Predisposed by obesity & hi caloric intake

• As obesity rates increase in the US, the diabetic rate increases in ALL age groups

Type II Signs & Symptoms

• Come on more gradually than Type I

• Polyphagia• Polydipsia• Polyuria• Weight loss• Extreme fatigue• Slow healing

Treatment of Type II DM

• Diet• Exercise• Oral hypoglycemic agents• Insulin (injections, pump)

Long Term Complications of Diabetes Mellitus

• Chronic elevated blood sugars →→ • Microvascular Complications due to

atherosclerosis →→arteriostenosis →→

Coronary artery disease diabetic retinopathyChronic kidney disease diabetic neuropathy

Complications cont

• Slow wound healing

• Decreased ability to fight infection

• Decrease sensation leads to increased injury

Diabetic Foot Ulcers

Gestational Diabetes• Cause is unknown; probably insulin resistance

• Mother not using available insulin

• Hyperglycemia apparent at aprox. 28 weeks

• Extra glucose from mother crosses placental barrier

• Baby can’t utilize all the extra glucose and stores it as fat.

• Baby likely to be higher birth weight

• May be complications at birth due to ↑ size

Gestational Diabetes

• Babies of mothers with GD may have ‘macrosomia’

• Higher risk of obesity as they grow

• Moms with GB at higher risk of developing DM as they get older

Diabetic Testing

• Blood sugars = finger sticksFBS = done with pt. fasting and

at least 2 hrs postprandial

Hemoglobin A1C = measures average bld sugars for past 2-3

months