The Quick and Dirty Guide to Diabetes

The pancreas does not produce enough insulin. Insulin helps convert blood sugar into energy. Without the insulin to help the sugar get out of the bloodstream, the body starts burning up fats and dumping ketones into the bloodstream. They make your bloodstream acidic and destroy your organs. Fix it by creating a normal blood sugar. You can do this by elevating blood glucose with food, oral glucose, D50 or glucagon. If blood sugar is too high, you give fluid bolus and O2 for prehospital care and hospitals give insulin.

Diabetic Emergencies

Hypoglycemia - low blood sugar <80mg/dL S&S - weakness, sweating, AMS
Hyperglycemia - DKA - absence or resistance to insulin-producing high glucose levels. Kussmaul = deep, rapid respirations. May have slimy skin, comatose. Treated with o2, iv, monitor, fluids.
HHNK- hyperosmolar hyperglycemic nonketotic coma - older patients with type 2 or undiagnosed diabetes

check out our hyperglycemia and hypoglycemia sections for more info and sample protocols

The glucose song! I like learning things in interesting ways!

2 Minute video showing about diabetics and how they end up losing appendages.

 

Pancreas - has endocrine (insulin and glucagon) and exocrine function (pancreatic juice)  
Islets of Langerhans - 
beta cells secrete insulin (0.6 units/kg of body weight) Alpha cells secrete glucagon, delta cells secrete somatostatin (inhibits the secretion of growth hormone)
Insulin - protein that increases glucose transport into the cells and metabolism by the cells. Decreases blood sugar toward normal levels.

Glucagon
 - protein released by alpha cells when BS falls.
2 effects...
1. Stimulating liver to release glucose stores from glycogen (glycogenolysis) and increases BS.
2. Stimulate glucose formation (gluconeogenesis) through breakdown of fats and fatty acids, thereby maintaining normal BS.

diabetes-glucose-regulation
We give it in hypoglycemic patients when we can't give them oral glucose or we can't start a line and give them D50. Not nearly as quick as giving them sugar.

Growth hormone - Polypeptide hormone secreted by anterior pituitary gland. It antagonizes insulin and doesn't allow insulin to take glucose through the cell membrane.

Regulation of glucose metabolism - normal glucose concentration is 60-120mg/dL
3 Components of food: Carbs, Fats, Proteins.

Diabetes pathophysiology comes in 2 forms. It is either a lack of insulin production or an inability of insulin to transport glucose.

Type 1: not enough insulin produced by the pancreas. Heredity is a factor. Seems to be an autoimmune phenomenon. If you have immediate family, you have a 10% chance of getting it by age 50 and it requires lifelong insulin injections. Onset is often in teenagers and young adults.

Type 2: body's inability to use insulin.

Signs and symptoms - polyuria (frequent urination), polydipsia (drinks a lot of fluid), glucosuria (sugar urine) dizziness. rapid unexplained weight loss.

From Wikipedia:

Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

There are three main types of diabetes:

  • Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
  • Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)
  • Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede the development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.

As of 2000, at least 171 million people worldwide suffer from diabetes or 2.8% of the population.Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetes population.

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