Type 2 DM

• Etiology– The pancreas cannot

produce enough insulin for body’s needs

– Impaired insulin secretion

Type 2 DM

• Weakened Beta cells Due to over use– High glucose intake– “Insulin Resistance”• The target cells have decreased

sensitivity to insulin

Risk Factors for Type 2 DM

• Family history• Age• Obesity• Gestational diabetes or large baby• Hypertension• High fat diet• Lack of exercise• High carb. Diet

Insulin and Type 2 DM

• Don’t all require insulin• 1/3 will at some time need to take insulin• Seldom get Ketoacidosis (enough insulin to

prevent high levels of fat metabolism)

Type 1 vs. Type 2

• Etiology– Auto-immune– Idiopathic

• Age of onset– Usually < 30

• Percent of diabetics– 5-10%

• Etiology– Overused/tired

• Age of onset– Usually > 40

• Percent of diabetics85-90%

Type 1 vs. Type 2

• Onset– Rapid less than 1 yr

• Body wt at onset– Normal to thin

• Insulin production– None

• Insulin injections– Always

• Onset– Gradual – years

• Body wt at onset– 80% overweight

• Insulin production– Not enough

• Insulin injections– Sometimes

Type 1 vs. Type 2

• Ketones– Children/adolescence– Stress– Pregnancy

• Management– Insulin– Diet– Exercise

• Ketones– Unlikely problem

• Management– Diet (wt. Loss)– Exercise– Possibly oral

hypoglycemic meds– Possibly insulin

Gestational

• Occurs during pregnancy

• 2nd -3rd trimester• Screening 24-28

weeks• Extra metabolic

demands triggers onset

GDM

• #1 complication Macrosomia

• Controlled with diet and insulin (no oral meds)

• Generally glucose level return to normal after delivery

• Predisposes to – type 2 diabetes

What type of diabetes does Jonny have?

• Jonny is a 11 year old male child. He is a thin youth at 75 lbs and 4’6” tall. He suddenly became very ill and his mother brought him to the ER. He was complaining of weakness, nausea & vomiting and blurred vision. He reported having to urinate a lot. His vital signs were pulse:125; Respirations 28; BP: 80/40. – Type 1

NCLEX Question

The antepartum patient is being routinely screened for gestational diabetes by administering 50 mg of glucose and testing the woman’s blood sugar in an hour. The patient asks for the normal glucose values an hour after taking the glucose. The nurse replies:

A. “It should be less than 140 or we do further testing.”B. “Anything under 105 is acceptable.”C. “We like to see a result between 130 and 165.”D. “It is different for each individual.”

Other specific types of Diabetes Mellitus

• Beta-cell genetic defect• Endocrinopathies• Pancreatitis• Cystic Fibrosis• Drug or chemical induces diabetes (steroids)

S&S of Diabetes Mellitus

• Definition:– A group of disorders characterized by chronic

Hyperglycemia

• 3 P’s– Polydipsia– Polyuria– Polyphagia

S&S of Hyperglycemia

• Neuro– Fatigue– C/O headache– Dull senses– Stupor– Drowsy – Loss of Consciousness– Blurred Vision

S&S of Hyperglycemia

• Cardiovascular– Tachycardia– Decreased BP– (Dehydration)

• Respirations– Kussmaul's respirations– Sweet and fruity breath– Acetone breath

S&S of Hyperglycemia

• Gastro-intestinal– Polyphagia– (Decreased hunger in late stages)– N/V– Abd. Pain– Polydipsia– Dehydration

S&S of Hyperglycemia

• Genital-urinary– Polyuria– Nocturia– Glycosuria

• Skeletal-muscular– Weak

S&S of Hyperglycemia

• Integumentary– Dry skin– Flushed face– Hypothermia

Small Group Questions

Mr. McMillan is a 50 year old client brough into the ER with extreme fatigue and dehydration. After the MD sees him the nurses asks Mr. McMillan some additional questions. Based on the clients answers the nurse requests that the MD add a glucose level to the lab work. The results are 800mg/dL.

Small group questions

• What question did the nurse most likely ask?• Why was Mr. McMillan fatigued?• Why was he dehydrated?