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
• Etiology
– Overused/tired
• Age of onset
• Age of onset
– Usually < 30
– Usually > 40
• Percent of diabetics
– 5-10%
• Percent of diabetics
85-90%
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?