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This disease is defined as a lack or inadequate secretion of insulin, or insulin resistance resulting in hyperglycemia

Diabetes mellitus


2 major classifications of diabetes include:

Type 1-insulin dependent diabetes mellitus and Type-2- non-insulin-dependent diabetes mellitus


In diabetes, what organ fails to secrete an adequate amount of insulin (hormone responsible for glucose metabolism)

Pancreas, specifically beta cells of islets of Langerhans


Type 1- IDDM

Results from destruction of pancreatic beta cells, which leads to insulin dependence (little to no insulin is produced from beta cells of pancreas), 20-30% hereditary, and ketoacidosis very likely, insulin must be received exogenously



Results from a decrease in beta cell weight and number or insulin resistance (some, but not enough insulin produced), 90% hereditary (e.g. diet patterns from parents), may be managed with diet and exercise and/or antodiabetic agents,


Difference between type I and type II

Same symptoms but type II has a more gradual onset, can be undetected for years, no ketones are usually present, and experiences weight gain, not weight loss found in type I


Causes of Type 1 Diabetes

occurs as a result of genetic, environmental, or immunological factors that damage the pancreatic beta cells (the insulin-secreting cells)


Causes of Type 2 Diabetes

idiopathic, but obesity is the single most important risk factor


Gestational diabetes

pt. likely to be overweight, risk for developing type 2 diabetes


Other types of diabetes include:

stress diabetes (critically ill patients) and steroid diabetes


Diabetes mellitus affects the metabolism of ___, ____, and ___

protein, carbs, and fats


Dyslipidemia, hypertension and hyperglycemia cluster together to form _____

Syndrome X- insulin resistance syndrome and metabolic syndrome


What is metabolic syndrome?

Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes.


What type of obesity is most strongly associated with the metabolic syndrome?

Abdominal obesity (apple shaped)- Excess adipose tissue releases several products: fatty acids (NEFA), cytokines, PAI-1, and adiponectin.


Beside central obesity, what is the second most important risk factor?

Insulin resistance. The body uses insulin less effectively than normal Insulin is needed to help control the amount of sugar in the body As a result, blood sugar and fat levels rise.


As a nurse caring for a patient with metabolic syndrome, what can you educate the patient about to reduce risk for heart disease and diabetes?

lose weight, get 30 min of moderate intensity exercise, quit smoking, decrease insulin resistance [(using metformin and insulin sensitizers- thiazolidinediones (TZDs)], decrease hyperlipidemia (use Statins), treat HTN, aspirin


What are the 7 labs you expect ordered for a diabetic patient?

Serum fasting glucose (>126 mg/dL), serum glycosylated hemoglobin levels ( > 7%), UA (+ for glucose, ketones, protein), Serum K+ (hypokalemia), 2h plasma glucose (after meal > 200 mg/dL), and cholesterol and triglyceride levels (elevated)


As a diabetic nurse, describe the AACE treatment goals you want your patient to fall within:

A1C less than or equal to 6.5%, pre-prandial plasma glucose less than or equal to 110mg/dl, postprandial plasma glucose less than equal to 140 mg/dl, and blood pressure < 130/85mmHg.


The most recent diagnostic parameter for diabetes is a fasting (4 hours) glucose level, either serum or capillary, of greater than ____ mg/dl

126 mg/dl- test must be preformed twice to be definitive


What is the parameters for the oral glucose tolerance test?

blood glucose >200 mg/dL at 120 mins


How much glucose is needed to support the brain?

68-105 mg/dL. Brain cannot make or store Glucose so a continuous supply is needed.


Describe the renal threshold for glucose

180-200 mg/dL, glucose spills into urine once it exceeds renal threshold


You are ordered to obtain a urine Sample for Bob, a patient suspected for Type II diabetes. What are you looking for?

ketones, renal function, glucose


What are the 3 Ps of type I diabetes?

polyuria, polydipsia, and polyphagia


Why does a diabetic develop polyuria?

Because glucose is highly osmotic, fluids "follow" glucose and are excreted from body in large amounts, causing an excess loss of fluids and electrolytes (Polyuria)


Loss of fluids leads to _____

polydipsia (excessive thirst)


Why does DKA, weight loss, and polyphagia occur?

because of lack of insulin, body is unable to utilize carbs (source of energy), the body must use proteins and fats for energy, leading to unexplained weight loss. The use of fat results in Ketones > Acidosis> DKA. Breakdown of nutritional stores leads to excessive hunger (polyphagia).


Early manifestations of Type I Diabetes

polyuria, polydipsia, polyphagia, glucosuria, fatigue, weight loss, N/V, abdominal pain


Early manifestations of Type II Diabetes

polyuria, polydipsia, blurred vision, and weight gain


What can happen in the absence of insulin?

hyperglycemia, polyuria, polydipsia, polyphagia, hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion hypoxia, acidosis, kussmaul respiration, hypo/hyperkalemia or normal K levels