Type 2 Diabetes Mellitus & Hyperglycemic State (HHS) Overview

**TYPE 2 DIABETES MELLITUS** Body is not making either enough insulin or the insulin is not working properly. The pancreas is still making some insulin but not enough. **METABOLIC ABNORMALITIES** - **Insulin resistance or inadequate insulin secretion of pancreatic beta cells** \-- insulin r...

**TYPE 2 DIABETES MELLITUS** Body is not making either enough insulin or the insulin is not working properly. The pancreas is still making some insulin but not enough. **METABOLIC ABNORMALITIES** - **Insulin resistance or inadequate insulin secretion of pancreatic beta cells** \-- insulin receptors are not working properly; not enough insulin is produced or both. As the glucose enters the blood stream, the insulin is not able to take that glucose into the cells and remains in the blood stream leading to hyperglycemia - **Liver abnormality** - the liver responds to the amount of glucose in the blood and will either release more or release less. The liver is confused either to release more or less and generally releases too much glucose. - **Adipose tissue (fats)** releases cytokines which will cause chronic inflammation which is linked to Type 2 diabetes **RISK FACTORS OF DEVELOPING TYPE 2 DIABETES MELLITUS** **Non-Modifiable** - At least age 45 years old - Family history - history of gestational diabetes **Modifiable (more on adipose tissue)** - **Overweight or obese** - **Physical inactivity** - **Hyperlipidemia** - **Hypertension** - vasoconstriction decreases perfusion to the pancreas leading to **pancreatic dysfunction.** - **Cigarette smoking** - causes inflammation and vasoconstriction **CLINICAL FEATURES** - **Gradual onset** - **Asymptomatic hyperglycemia** - **3 Ps** - **Polydipsia** - **Polyuria** Both are caused by too much glucose. the hyperglycemic state causes an osmotic gradient. Water is pulled into the bloodstream and the client gets thirsty, urges to urinate - **Polyphagia** - **Blurry Vision** - blood sugar get into the eyes causing damage to lenses **DIAGNOSTIC CRITERIA** - Hemoglobin A1C above or equal to 6.5 % - Fasting glucose at least 120 mg/dL - Random glucose at least 200 mg/dL with hyperglycemia symptoms - Oral glucose tolerance test (pregnancy) **COMPLICATIONS** **Macrovascular** - atherosclerosis leading to - Coronary artery disease - Stroke, Transient Ischemic Attack - Peripheral artery disease **Microvascular** - small blood vessels are affected - Peripheral neuropathy - lack of circulation on small blood vessels feeding the nerves - Retinopathy - Nephropathy - Delayed wound healing - Recurrent infections - bacteria and fungus love glucose **COMPLICATIONS:** **Hyperosmolar Hyperglycemic State (HHS) -** Life threatening, Gradual onset Pancreas is making enough insulin to make sure that ketoacidosis doesn't develop and no ketones are seen on urine. On the other hand, pancreas is not making enough insulin to prevent severe hyperglycemia and this leads to severe hydration and concentrated blood. Concentrated blood causes water to be drawn out of the cells that results in severe dehydration **CLINICAL FEATURES ** - **Blood glucose \> 600 mg/dL**, normally caused by underlying infection, medication or an acute or chronic illness - **Severe polyuria** \--\> dehydration - **Neurologic manifestations** (blurry vision, lethargy, altered level of consciousness \--\> coma) **Goal**: Lower glucose level within normal limits - Administration of IV fluids - IV insulin and electrolyte replacement for severe dehydration **LIFESTYLE MODIFICATION** - Moderate activity to decrease insulin, blood pressure, cholesterol - Low fat diet, high fiber and low in glycemic index - Weight loss if client is obese - Avoid alcohol (hypoglycemia risk) - Oral medications - oral antidiabetic medications - Prescribed insulin therapy if oral medication is not effective - Treatment for hyperlipidemia (statins) - Monitor hyperglycemia and HHS **PROPER FOOT CARE** - **Inspect feet daily** -report signs of infection immediately - Protective shoes, not open toe sandal - Separate overlapping toes with silk fabric - Wash daily with lukewarm water   - Avoid heating pads - **Sick day management** -insulin should be continued as directed - Routine eye exams for retinopathy - Stress reduction techniques - Prevent infections by up to date receiving of vaccines **Key Difference of Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS)**