Diabetes Mellitus 1: Types, Symptoms & Diagnosis

• Insulin's main role is facilitating glucose transport into cells; without it resulting in hyperglycemia
• "3 Ps" (polyuria, polydipsia, polyphagia) are hallmark symptoms of Type 1 Diabetes Mellitus.
• Type 2 Diabetes Mellitus's primary issues are insulin resistance and decreased insulin secretion.
• Fasting blood glucose of 126 mg/dL or higher on two occasions confirms diabetes.
• Hemoglobin A1C lab test shows average blood glucose over approximately 120 days due to RBC lifespan

Teaching Type 1 DM

• A key point is that insulin is essential because the body does not produce any.
• Glucocorticoids can cause iatrogenic diabetes by increasing insulin resistance and hyperglycemia.
• Gestational diabetes is associated with pregnancy and raises later Type 2 DM risk

Key Points

• Regular exercise is not a risk factor; as physical activity reduces insulin resistance and Type 2 DM risk.
• Shakiness and diaphoresis point to hypoglycemia, stemming from autonomic symptoms.
• For a conscious patient with blood glucose of 60 mg/dL, give 15 grams of carbohydrates and follow the "15/15 rule".
• The main goal of insulin therapy is mimicking natural insulin release for stable blood glucose.
• Diabetic Ketoacidosis (DKA) is primarily associated with Type 1 Diabetes, causing ketosis and metabolic acidosis from severe insulin deficiency.

Hyperosmolar Hyperglycemic State (HHS)

• Severe dehydration is its hallmark sign, along with extreme hyperglycemia.
• Managing Type 2 Diabetes: Daily exercise is recommended, increasing insulin sensitivity plus aiding glucose metabolism.
• Treat suspected Diabetic Ketoacidosis (DKA) by administering IV fluids first.

Metformin

• For a Type 2 Diabetes regimen, educate to hold before CT scans with contrast dye to prevent lactic acidosis.
• Patient is confused / blood glucose is 45 mg/dL, administer IV dextrose right away for hypoglycemia.
• Acute pancreatitis isn't a long-term diabetes complication.

Foot Care for Diabetics

• Check feet daily for cuts or blisters due to risks from diabetic neuropathy.
• Patient with hyperglycemia, dehydration is common, encourage fluid intake.
• Maturity-Onset Diabetes of the Young (MODY) is a monogenic diabetes form, linked with single-gene mutation, in young individuals.

Insulin Injections & Blood Sugar Control

• Insulin therapy: teach patient to rotate sites for injections to prevent fat tissue changes like lipodystrophy.
• Skipping insulin should never be done hyperglycemia can worsen.
• Hypoglycemia: Eat regular meals/snacks for stable blood glucose.
• Administer insulin at room temperature: cold insulin can cause pain
• A hemoglobin A1C of 9.0% needs emphasis to consider this indicates poor blood sugar control over the past 3 months, with increased risk of complications.

Diabetic Patient Care

• Nausea and vomiting: key to monitor is dehydration, which worsens hyperglycemia.
• Diet: brown rice and grilled salmon is the best food choice for maintaining stable blood glucose.
• Hemoglobin A1C within the target range is the best indicator that diabetes management is effective over 3 months.