Diabetes Mellitus

• Pancreas


  Both an endocrine gland and an exocrine gland.
• Pancreas


  6 inches long and sits across the back of the abdomen behind the stomach
• islets of Langerhans


  it contains beta cells alpha cells, and delta cells.
• alpha cells


  it secretes glucagon which increases glucose levels. (function with glucogenesis)
• beta cells


  secretes insulin decreasing the glucose level. It inhibits the breakdown of CHON.
• delta cells


  secretes somatostatin which inhibits the action of growth hormone.
• Diabetes Mellitus


  Disorder of the pancreas as an endocrine gland. Chronic metabolic disease characterized by hyperglycemia due to disorder of carbohydrate, fat, and protein metabolism
• DM type 2


  (Assessment findings) Hereditary
• Insulin-dependent DM type 1


  The onset is less than 30 years.

  Common on children or in non-obese adults

  No insulin production

  Prone for Diabetic ketoacidosis (DKA)
• Insulin-dependent DM type 1


  Also known as Juvenile-onset, Brittle DM, Unstable DM
• Non-insulin-dependent DM type 2

  Also known as Maturity-onset, Stable DM, Ketosis-resistant DM
• Non-insulin-dependent DM type 2


  The onset is 40 years

  Common in obese adults

  There is inadequate production or cells do not respond to insulin.

  Prone for Hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS)
• Hyperglycemia


  Insulin deficiency
• Polyuria (excessive urination) Polydipsia (excessive thirst) polyphagia (extreme hunger)


  Hyperglycemia may lead to these 3
• Glycosuria 


  It will occur when the glucose level in the blood is greater than 180mg/dl (renal threshold)
• DKA metabolic Acidosis


  Acute complication of DM. It develops ketone bodies
• Atherosclerosis


  A chronic complication of DM. Thickening or hardening of artieries.
• Ketones


  A CNS depressants and may decrease brain pH leading to Comatose.
• Gastroparesis


  Delayed gastric emptying
• Neurogenic bladder


  Bladder does not empty properly
• normal value

  pre DM

  DM

  70-100mg/dl

  100-126mg/dl

  >126mg/dl
• 8 hours


  Hours of fasting in before taking blood sugar test (Fasting blood sugar test)
• 2 hours after a high CHO meal


  (postprandial blood sugar) this is taken after. 70-140mg/dl no DM.
• Random blood sugar (RBS)


  The blood specimen is drawn without preplanning. >200mg/dl + symptoms is suggestive of Diabetes Mellitus
• Oral glucose tolerance test (OGTT)


  most reliable test.

  Diet high in CHO is eaten after 3 days.
• Glycosylated hemoglobin 


  It will determine the glucose level for past 2 to 3 months. Sample of venous blood is withdrawn
• human insulin

  purest insulin and has the lowest incident of hypertoxicity
• Lifetime

  type 1 insulin
• Instances

  type 2 insulin
• Rapid acting(Clear)3x a day


  Lispro (Humalog)

  Aspart (Novalog)
• Short acting (Clear)3x a day


  Humulin R, Novolin R, Iletin II R
• Intermediate(cloudy)2x a day


  NPH

  Humulin N

  Lente, Humulin L
• Long acting once a day


  Ultralente

  Lantus
• Sulfonylureas


  It stimulates the beta cells to secrete more insulin. Also known as insulin releaser. But can precipitate extreme vomiting if given with alcohol
• Biguanides


  It increases the sensitivity of insulin receptors to insulin. (non sulfonylureas)
• alpha-glucosidase


  it breaks down CHO to glucose and absorbed to small intestine more slowly
• 90* and 45*


  how many degrees for thin and fat people in insulin administration
• Regular insulin


  Only insulin that can be given through IV
• Cold insulin can cause 


  Lipodystrophy (losing of fats from some part of the body including organs)
• Lipoatrophy


  loss of subcutaneous fat caused by utilization of animal insulin.