Diabetes Mellitus Key Players: Glucose: • “Sugar” (body needs it to survive) fuels the cells of your body so they can work properly, BUT IT CAN NOT ENTER THE CELL WITHOUT THE HELP OF INSULIN • It is stored mainly in the liver in the form of glycogen Insulin: • “deals with high blood sugar levels” • A hormone that helps regulate the amount of glucose in the blood (too much glucose is very toxic to the body). • It allows your body to use glucose by allowing it to enter the cells (without insulin glucose would just float around in your body) • Secreted by the BETA cells of the pancreas from the islets of Langerhans Glucagon: • “deals with low blood sugar levels” • A peptide hormone that causes the liver to turn glycogen into glucose…does the opposite as insulin. • Also secreted by the pancreas Pancreas: • Releases insulin and glucagon Liver: • Sensitive to insulin levels and stores and turns glycogen into glucose when the pancreas secretes glucagon. Example: (if the body has increased blood glucose/increased insulin in the blood the liver with absorb and store the extra glucose for later….if there is low blood sugar/low insulin levels the liver will release glycogen which turns into glucose to help increase the blood sugar level) Glucagon and Insulin Feedback Loop 1. 2. Increased blood sugar -> pancreas releases insulin -> causes glucose to enter into the cells to be used or be saved as glycogen for later (stored mainly in the liver) Decrease blood sugar -> pancreas release glucagon -> causes the liver to release glycogen which turns into glucose to increase the low blood sugar level What happens in diabetes mellitus? • The body is unable to use glucose due to either the absence of insulin or the body’s resistance to use insulin. Therefore, the patient becomes HYPERGLYCEMIA (the glucose just hangs out in the blood stream which affects major organs of the body) • The body starts to metabolize FATS for energy (since it can’t get to the glucose…remember glucose can NOT enter the cell without the help of INSULIN)….which happens in Type 1 diabetics • OR there is a moderate amount of insulin to deal with fats and proteins BUT carbs cannot be used (Type 2). Causes of Diabetes Mellitus: Type 1: the beta cells located in the islet of Langerhans don’t work (been destroyed) therefore the body doesn’t release anymore insulin. Treatment, the patient MUST USE INSULIN. Risk factors: Genetic, auto-immune (virus) NOT RELATED TO LIFESTYLE What do patients look like clinically? Patients are young and thin….happens suddenly; ketones will be present in the urine Type 2: cells quit responding to insulin (won’t let insulin do its job by taking the glucose into the cell). Therefore, the patient has INSULIN RESISTANCE. This leaves all the glucose floating around in the blood and the pancreas senses there’s a lot of glucose present in the blood so it releases even more insulin. Due to this the patient starts to experience hyperinsulinemia which caused metabolic syndrome Treatment: diet and exercise (first line treatment)…when that doesn’t work oral medications Note: type 2 may NEED INSULIN DURING STRESS, SURGERY, OR INFECTION Risk Factors: Lifestyle- being obese, sedentary, poor diet (sugary drinks), stress AND genetic What do patients look like clinically? Patients are overweight, it happens overtime, rare to have ketones (remember issues with carb metabolism) adult aged Gestational: similar to type 2 diabetes where the cells are not receptive to insulin…typically goes away after birth Complications of Diabetes Mellitus Hypoglycemia: Blood glucose less than 60 mg/dL or drops rapidly from an elevated level. • Remember the mnemonic: “I’m sweaty, cold, and clammy….give me some candy” • Signs and Symptoms: Sweating, clammy, confusion, light headedness, double vision, tremors • Treatment: Need simple carbs if they can eat, or if unconscious IV D50 • Simple carbs include: hard candies, fruit juice, graham crackers, honey • Organ Problems: • Hardens the vessel (atherosclerotic….makes vessels hard from all the glucose that sticks on the proteins of the vessels and it forms plaques). • so, may develop heart disease, strokes, hypertension, neuropathy, poor wound healing (FROM DECREASE circulation), eye trouble, infection DKA (Diabetic Ketoacidosis): Happens in Type 1 diabetics (rare to happen in type 2) There is no insulin in the body and the body starts to burn fats for energy since it can’t get to the glucose • Due to this the ketones, which are acids, start to enter into the body, this causes life-threatening situation, • such as acid/base imbalances Signs and Symptoms of DKA: N&V, excessive thirst, hyperglycemia, Kussmaul breathing • HHNS (Hyperglycemic hyperosmolar nonketotic syndrome): Happens mainly in Type 2 diabetics This presents with hyperglycemia without the breakdown of ketones…so there isn’t acidosis/ketosis because • there is just enough insulin present in the body to prevent the breakdown of fats Signs and Symptoms of HHNS: very dehydrated, thirsty, hyperglycemic, mental status changes • Assessment Findings of DM Hyperglycemia - REMEMBER 3P’s & SUGAR • Polyuria: (frequent urination) Why? elevated levels of glucose in the body causes the body to remove the water from inside the cell (remember in the hypertonic, hypotonic video about OSMOSIS). The water will move to an area of higher concentration which will be the blood stream and this causes more fluid to enter the blood stream. The kidneys will secrete the extra water. HOWEVER, normally your kidneys could handle all of the glucose by reabsorption but there is too much so it leaks into the urine…. GLYCOSURIA • Polydipsia: very thirsty Why? the blood is trying to prevent the body from becoming dehydrated from the excessive urination so it signals to the patient to drink more water…but it doesn’t work because the kidneys will remove the excess water • Polyphagia: very hunger Why? the body is burning FAT for energy since it doesn’t have any glucose to use so the body signals to the person to keep eating so there will be food to use for energy. The patient will have WEIGHTLOSS! *The 3 P’s present - mainly in Type 1 Diabetics BUT Other Assessment findings of the Diabetic Patient Slow wound healing blUrry vision (damaged from glucose on eyes) Glycosuria (kidneys can’t reabsorb all the extra glucose) Acetone smell of breath (from burning ketones) *type 1 Rashes on skin: DRY and itchy, repeated vaginal infections (yeast….loves glucose)
