[HNF 129] - Chapter 5

• Diabetes Mellitus


  A multisystem disease related to an endocrine disorder with abnormal insulin production and impaired utilization, and abnormal metabolism of fuels glucose and fat
• Diabetes Mellitus is a chronic disorder
• Diabetes Mellitus is the leading cause of heart disease, stroke, adult blindness, and non traumatic lower limb amputations
• Normal insulin metabolism


  • Produced by the β cells in the islets of Langerhans of the pancreas
  • Facilitates normal glucose range of 70 to 120 mg/dl

  
• Insulin


  Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell

  
• Types of Diabetes Mellitus


  • Type 1
  • Type 2
  • Gestational
  • Secondary
• Type 1 Diabetes Mellitus


  Formerly known as "juvenile onset" or "insulin dependent" diabetes, most often occurs in people under 30 years of age, with peak onset between ages 11 and 13
• Type 1 Diabetes Mellitus


  • Progressive destruction of pancreatic β cells
  • Autoantibodies cause a reduction of 80% to 90% of normal β cell function before manifestations occur
• Causes of Type 1 Diabetes Mellitus


  • Genetic predisposition related to human leukocyte antigens (HLAs)
  • Exposure to a virus
• Onset of Type 1 Diabetes Mellitus


  Manifestations develop when the pancreas can no longer produce insulin, with rapid onset of symptoms and presentation at ER with ketoacidosis
• Diabetic ketoacidosis (DKA)


  Occurs in the absence of exogenous insulin, a life-threatening condition resulting in metabolic acidosis
• Type 2 Diabetes Mellitus


  Accounts for 90% of patients with diabetes, usually occurs in people over 40 years of age, with 80-90% of patients being overweight
• Type 2 Diabetes Mellitus

  • Pancreas continues to produce some endogenous insulin, but insulin produced is either insufficient or poorly utilized by the tissues, resulting in insulin resistance and hyperglycemia

  
• Diabetes Mellitus


  A multisystem disease related to an endocrine disorder with abnormal insulin production and impaired utilization, and abnormal metabolism of fuels glucose and fat

  
• Diabetes Mellitus is a chronic disorder
• Diabetes Mellitus is the leading cause of heart disease, stroke, adult blindness, and non traumatic lower limb amputations
• Normal insulin metabolism


  • Produced by the β cells in the islets of Langerhans of the pancreas
  • Facilitates normal glucose range of 70 to 120 mg/dl

  
• Insulin


  Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell

  
• Types of Diabetes Mellitus


  • Type 1
  • Type 2
  • Gestational
  • Secondary
• Type 1 Diabetes Mellitus


  Formerly known as "juvenile onset" or "insulin dependent" diabetes, most often occurs in people under 30 years of age, with peak onset between ages 11 and 13
• Type 1 Diabetes Mellitus


  • Progressive destruction of pancreatic β cells
  • Autoantibodies cause a reduction of 80% to 90% of normal β cell function before manifestations occur
• Causes of Type 1 Diabetes Mellitus


  • Genetic predisposition related to human leukocyte antigens (HLAs)
  • Exposure to a virus
• Onset of Type 1 Diabetes Mellitus


  Manifestations develop when the pancreas can no longer produce insulin, with rapid onset of symptoms and presentation at ER with ketoacidosis
• Diabetic ketoacidosis (DKA)


  Occurs in the absence of exogenous insulin, a life-threatening condition resulting in metabolic acidosis
• Clinical Manifestations of Type 1 Diabetes Mellitus


  • Polyuria
  • Polydipsia (excessive thirst)
  • Polyphagia
  • Weight loss
  • Weakness and fatigue
  • Ketoacidosis
• Type 2 Diabetes Mellitus


  Accounts for 90% of patients with diabetes, usually occurs in people over 40 years of age, with 80-90% of patients being overweight
• Type 2 Diabetes Mellitus


  • Pancreas continues to produce some endogenous insulin, but insulin produced is either insufficient or poorly utilized by the tissues, resulting in insulin resistance and hyperglycemia
• Impaired glucose tolerance (IGT)


  Alteration in β cell function is mild, with blood glucose levels higher than normal but not high enough for a diagnosis of diabetes

  
• Onset of Type 2 Diabetes Mellitus


  Gradual onset, with the person may going many years with undetected hyperglycemia, and marked hyperglycemia (500 to 1000 mg/dl)
• Gestational Diabetes


  Develops during pregnancy, detected at 24 to 28 weeks of gestation, with increased risk for cesarean delivery, perinatal death, and neonatal complications
• Secondary Diabetes


  Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels
• Acute Complications of Diabetes Mellitus


  • Diabetic ketoacidosis (DKA)
  • Hyperosmolar hyperglycemic non ketotic syndrome (HHNS/ HONK)
  • Hypoglycemia
• Diabetic Ketoacidosis (DKA)


  A life-threatening illness in type 1 diabetes, characterized by hyperglycemia, dehydration, and coma, resulting from excess glucose leading to dehydration, sodium and potassium loss, and burning of fat leading to ketosis
• Treatment of DKA

  1. Hospital admission

  2. Fluids, insulin, electrolytes
• Hyperosmolar hyperglycemic non-ketotic syndrome (HHNS/ HONK)


  A serious condition most frequently seen in older persons with either type 1 or type 2 diabetes, precipitated by illness or infection, and if untreated, leads to severe dehydration resulting in seizures, coma and eventually death
• Hypoglycemia


  A condition that can occur in type 1 or type 2 diabetes, caused by too much insulin, overdose of oral antidiabetic agents, too little food, or excess physical activity, with sudden onset and blood glucose < 50 mg/dL
• Treatment of Hypoglycemia

  1. Mild: Immediate treatment with 15 g rapid-acting sugar

  2. Severe: Hospitalized, intravenous glucose
• Hypoglycemia Unawareness


  May develop in some people with long-standing type 1 diabetes, with no symptoms of hypoglycemia in the presence of a low blood glucose level
• Chronic Complications of Diabetes Mellitus

  • Macrovascular (atherosclerotic plaque): Coronary arteries, Cerebral arteries, Peripheral vessels
  • Microvascular (capillary damage): Retinopathy, Neuropathy, Nephropathy
• Macrovascular Complications


  Large blood vessels undergo changes due to atherosclerosis, leading to coronary artery disease, stroke, and peripheral vascular disease