Dcef

• Euglycemia


  Normal blood glucose levels
• Hyperglycemia


  Blood glucose levels above 100
• Hypoglycemia


  Blood glucose levels below 70
• The desired outcome is to help patients maintain blood glucose levels in the normal range (euglycemia) without causing either hyperglycemia or hypoglycemia
• Diabetes


  A disease classified by the underlying problem causing a lack of insulin or its action, and the severity of the insulin deficiency
• No matter the specific type of diabetes, the organ damaging consequences and complications of impaired glucose regulation are the same
• Pancreas


  An organ that has an exocrine function to help with digestion by releasing enzymes, and an endocrine function to control blood sugar levels by releasing hormones
• Islets of Langerhans


  Small groups of cells in the pancreas that help regulate blood sugar
• Cells in the Islets of Langerhans

  • Alpha cells
  • Beta cells
• Alpha cells


  Release a hormone called Glucagon
• Beta cells


  Release insulin and another hormone called Amylin
• Glucagon


  A hormone released when the body needs more sugar, it tells the liver and muscles to release stored sugar into the blood, preventing low blood sugar levels
• Insulin


  A hormone released when the body has too much sugar in the blood, it helps cells in the body take in and use sugar, lowering blood sugar levels
• Basal insulin


  A small amount of insulin released all the time, even when not eating
• Prandial insulin


  Additional insulin released in two phases after eating, with a quick first burst and then more released until blood sugar levels go back to normal
• Our brain cells mainly rely on glucose for energy, and since the brain can't store much glucose, it needs a steady supply from the blood to work properly and avoid damage
• Glycogen


  Extra glucose that gets stored in the liver and muscles
• Insulin


  Helps muscles and the heart take in glucose, stops the liver from making too much glucose, and promotes storing glucose as glycogen
• Insulin helps prevent blood glucose levels from getting too high and also helps maintain normal blood lipid levels, keeping the body's energy balance in check
• Type 1 diabetes


  Where the body's immune system destroys the beta cells in the pancreas, which are the ones that make insulin
• Idiopathic type 1 diabetes


  Type 1 diabetes that occurs for reasons we do not know
• Type 2 diabetes


  Can either be from insulin resistance or insulin deficiency
• Insulin resistance


  When the body's cells don't respond well to insulin, so even though insulin is present, it doesn't work effectively in helping cells take in glucose from the blood
• Insulin deficiency


  When the body doesn't make enough insulin to overcome the insulin resistance, creating a situation where there's not enough insulin to regulate blood sugar levels properly
• Gestational diabetes


  Occurs during pregnancy and means having trouble processing sugar during pregnancy
• All women should be tested for gestational diabetes, usually around 24 to 28 weeks, and if they are high risk they will be screened sooner
• Fasting


  1. Insulin production goes down

  2. Increased production of glucose in the liver and kidneys through gluconeogenesis

  3. Breakdown of stored sugar in the liver (glycogen) to release more glucose into the blood
• Eating and insulin release

  1. Insulin tells the liver and kidneys to stop making so much glucose

  2. Insulin tells the liver and kidneys to stop breaking down stored sugar (glycogen)

  3. Insulin helps cells take in and use glucose for energy

  4. Insulin reduces the breakdown of body fat and protein

  5. If there's too much glucose in the liver, insulin helps turn the excess glucose into fat, which is stored in fat cells
• Incretin hormones


  Have many functions, one being to slow down the emptying of the stomach, which helps prevent blood sugar levels from spiking too high after eating
• Counter regulatory hormones


  Also known as balancing hormones, work opposite to insulin, with one being Glucagon which signals the liver to release stored glucose into the blood
• Other counter regulatory hormones

  • Epinephrine
  • Norepinephrine
  • Growth hormone
  • Cortisol
• Insulin and counterregulatory hormones work together to keep blood sugar levels in a healthy range
• When blood sugar levels drop

  1. Insulin secretion stops

  2. Glucagon is released to raise blood sugar levels

  3. The liver can release stored glucose when needed

  4. If that's not enough, the body starts breaking down fat and muscle to provide energy
• Hyperglycemia


  High blood sugar caused by the buildup of glucose in the blood due to lack of insulin
• How hyperglycemia leads to dehydration

  1. Excess glucose is lost in urine (polyuria)

  2. Dehydration causes excessive thirst (polydipsia) and hunger (polyphagia)
• Without insulin, the body uses stored fat for energy


  1. Releasing fatty acids and ketones

  2. Ketones are acidic and can cause metabolic acidosis disrupting the body's acid base balance
• Insulin deficiency can lead to potassium depletion

  1. Due to excessive urine output

  2. However, in acidosis, potassium may shift out of the cells into the blood, leading to high blood potassium levels
• Kussmaul respirations


  The body's compensation for acidosis by increasing the breathing rate to remove excess carbon dioxide, which can cause a fruity breath odor due to acetone exhalation
• Blood tests may show low blood pH and bicarbonate levels (metabolic acidosis) and low or high potassium levels
• Glucose related emergencies (can be fatal if treatment is delayed)

  • Diabetic Ketoacidosis (DKA)
  • Hyperglycemic-hyperosmolar state (HHS)
  • Hypoglycemia