Diabetes Management Quiz

Lecture 10 - MNT for Diabetes Mellitus

• Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia and disordered insulin metabolism.
• "Diabetes" in Greek refers to excessive urination, a characteristic of untreated diabetes.
• "Mellitus" means sweet, honey-like, referring to the sweet taste of urine in untreated diabetes.

Definition of Diabetes

• Diabetes is characterized by hyperglycemia (high blood sugar).
• Defects in insulin production.
• Autoimmune or other destruction of beta cells.
• Insulin insensitivity.
• Impaired action of insulin on target tissues.

Glucose

• Glucose is an essential nutrient providing energy for proper body cell function.
• The major source of glucose is absorption of ingested food into the gastrointestinal tract, into the blood, and transported to all cells in the body.
• Glucose needs insulin to enter the cells.

Insulin

• Insulin is a hormone produced by the pancreas, especially during meals.
• Insulin controls blood glucose levels by regulating the production and storage of glucose.
• Without insulin, glucose cannot enter cells and remains in the blood.

Pancreas

• The pancreas produces insulin (beta cells) and glucagon (alpha cells).

Types of Diabetes

Type 1

• Deficient insulin production.
• Requires daily insulin.
• Unknown etiology; not preventable.
• Symptoms: polyuria, polydipsia, hunger, weight loss, vision changes, fatigue.

Type 2

• Ineffective use of insulin.
• Results from excess body weight and a sedentary lifestyle.

Gestational Diabetes Mellitus (GDM)

• Hyperglycemia with onset or first recognition during pregnancy.
• Diagnosed through prenatal screening.
• Impaired glucose tolerance and impaired fasting glycemia causing large gestational-aged infants and hypertension.

Classification of Diabetes Mellitus

1. Type 1 Diabetes Mellitus: B-cell dysfunction leading to absolute insulin deficiency.
2. Type 2 Diabetes Mellitus: Predominant insulin resistance with relative insulin deficiency or predominant secretory defect with insulin resistance.
3. Gestational Diabetes Mellitus
4. Secondary Types (steroid-induced, stress-induced)

Other Specific Types

• Genetic defects of beta-cell function.
• Genetic defects in insulin action.
• Disease of exocrine pancreas.
• Endocrine gland disorders.
• Drug-induced.
• Infections.
• Immune-mediated.
• Genetic syndromes.

Features of Type 1 & Type 2

Risk Factors

• Hyperuricemia
• Microalbuminuria
• Dyslipidemia
• Previous IGT (oral glucose tolerance test value 140-199 mg/dL)
• Previous GDM (gestational diabetes) with macrosomic or large gestational-age infant (>3.7 kg birth weight).
• Poor obstetric history
• Obesity (BMI > 23 kg/m2; waist-hip ratio >1; waist circumference >80 cm in females, >90 cm in males)
• Family history of Type 2 diabetes
• Age
• Hypertension
• Coronary heart disease

Etiologic Factors

Type 1

• Beta-cell destruction usually leads to absolute insulin deficiency.
• Autoimmune
• Idiopathic

Type 2

• Relative insulin deficiency.
• Secretory defect with (or without) insulin resistance.

GDM

• Pregnancy hormones (placental lactogen, cortisol, prolactin, progesterone).

Characteristics of Diabetes Mellitus

• Hyperglycemia
• Polydipsia
• Polyuria
• Polyphagia
• Weakness/fatigue
• Blurred vision
• Ketosis
• Glycosuria
• Ketonuria
• Decreased capacity of tissues to heal
• Weight loss

Symptoms of Diabetes Mellitus

• Frequent urination
• Dehydration/dry mouth
• Increased thirst
• Blurred vision
• Increased infections
• Weight loss
• Increased hunger
• Fatigue

Criteria for Diagnosis of Diabetes

Complications of Diabetes Mellitus

1. Macroangiopathies: Damage to large blood vessels.

• Diabetes increases risk of coronary heart disease (CHD) by 300%.
• Atherosclerosis.
• Foot ulceration (15%), recurrence (50% within 2 years), amputation (20%).

2. Microangiopathies: Damage to small blood vessels.

• Retinopathy
• Neuropathy
• Nephropathy

3. Diabetic Ketoacidosis (DKA): Uncontrolled production of ketones by the liver, leading to acidosis due to increased glucose production.

• Characteristics: hypoglycemia, metabolic acidosis, ketones in urine/blood.
• Often associated with Type 1 DM; may occur in Type 2 with intercurrent illness.

4. Nonketotic Hyperosmolar Coma: Hyperglycemia and hyperosmolarity in the absence of ketosis.

• Dehydration of brain cells due to the osmotic pressure exerted by high glucose in the blood.
• Insufficient/defective insulin.
• Characteristics: elderly patients, severe dehydration, polyuria, polydipsia, impaired renal function preventing clearance of glucose in the liver.
• No metabolic acidosis.

5. Gangrene: Death of tissue due to loss of blood supply with or without bacterial infection.

6. Insulin shock: Overdose of insulin.

7. Infection: Depressed immune function.

8. Hyperglycemia: Elevated blood glucose levels due to excessive carbohydrate intake, irregular medication use, infection, or stress.

• Symptoms: Dry mouth, fatigue, excessive thirst, drowsiness, frequent urination.

9. Hypoglycemia : Low blood glucose (less than 50mg/dL or 2.7 mmol/L) due to delayed or skipped meals, insufficient food intake, too much exercise, incorrect medication dose, or heavy alcohol consumption.

• Symptoms: Headache, seizure or coma, shakiness, weakness/fatigue, sweating, disorientation, numbness/tingling of lips or fingers.

What to Do

• Hyperglycemia:* Check blood sugar, drink plenty of water, stick to diet plan, consult doctor if hospitalization needed.
• Hypoglycemia:* Have quick-acting sugar (15 grams of carbohydrate), e.g. 1/2 cup fruit juice, 1/2 cup soda, 1 cup milk, glucose gel/tablet, 1-2 teaspoons sugar/honey, 5-6 hard candies. If unconscious, bring to hospital for dextrose 50% IV.

Prevention of Hypoglycemia

• Take medications as prescribed
• Keep regular meal schedule.
• Have quick-acting sugars available.
• Avoid strenuous activities immediately after medication or insulin injection.
• Carry a source of sugar during heavy activity.
• Do not operate machinery or drive if blood sugars are low.

Guidelines to Follow During Illness

• Take insulin or oral anti-diabetic agents as usual.
• Test blood sugar more often; and record results.
• Report elevated blood sugar levels (> 300mg/dL) to physician.
• Drink plenty of water, especially if vomiting or diarrhea.
• Eat crackers or soup frequently if unable to eat regular food.
• Consult physician if infection or symptoms persist.

Management of Diabetes Mellitus

1. Medical (insulin, oral hypoglycemic drugs)
2. Dietary
3. Behavior Modification
4. Pancreas Transplant

Monitoring and Control

• Control blood glucose levels.
• Monitor other risk factors that damage blood vessels.
• Monitor blood pressure.
• Practice foot care.
• Screen for retinopathy, blood lipids, early signs of diabetes-related kidney disease.

Test your knowledge about effective diabetes management strategies, including treatment options, dietary recommendations, and essential measures to prevent hypoglycemia. This quiz covers critical aspects of managing diabetes and understanding its complications.