Diabetes :Diabetes


Glucose :Glucose Required as fuel for cellular metabolism Brain’s need for glucose parallels its demand for oxygen


Insulin :Insulin Hormone Produced by Islets of Langerhans in pancreas Required for sugar to enter most cells Brain does not require insulin to use sugar


Pancreas :Pancreas Located in retroperitoneal space Produces, releases Digestive enzymes into duodenum Insulin, glucagon into blood


Islets of Langerhans :Islets of Langerhans Alpha cells Glucagon Raises blood sugar Beta cells Insulin Lowers blood sugar


Diabetes Mellitus :Diabetes Mellitus Metabolic disease Characterized by inadequate, absent insulin production


Type I Diabetes :Type I Diabetes No insulin production Takes insulin injections


Type II Diabetes :Type II Diabetes Inadequate insulin production Increased tissue resistance to insulin effects Controlled with Diet Oral medications: Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage Insulin injections as disease progresses


Problems in Diabetes :Problems in Diabetes


Blood Sugar Imbalance :Blood Sugar Imbalance Hyperglycemia Diabetic ketoacidosis (DKA) Hyperosmolar coma Hypoglycemia


Hyperglycemia :Hyperglycemia Causes Failure to take insulin Overeating, eating wrong diet Stress (fever, infection, emotional stress) New-onset diabetics usually present with an episode of hyperglycemia


Diabetic Ketoacidosis :Diabetic Ketoacidosis Usually Type I diabetic (no insulin) Blood sugar rises Kidneys try to remove excess sugar Urine production increases (polyuria) Patient becomes volume depleted Thirst (polydypsia) Tachycardia Hypotension Dry skin, mucous membranes


Diabetic Ketoacidosis :Diabetic Ketoacidosis Cells cannot burn sugar; patient experiences hunger (polyphagia) Cells burn fat as alternative fuel Acidic ketone bodies produced Patient tries to correct acidosis; exhales CO2 Rapid, deep breathing (Kussmaul respirations) Exhaled ketone bodies produce nail-polish remover or “fruity” breath odor


Diabetic Ketoacidosis :Diabetic Ketoacidosis Volume depletion Ketone body production (ketoacidosis)


Hyperosmolar Coma :Hyperosmolar Coma Usually Type II diabetic (inadequate insulin) Blood sugar rises Kidneys try to remove excess sugar Urine production increases (polyuria) Patient becomes volume depleted Thirst (polydypsia) Tachycardia Hypotension Dry skin, mucous membranes


Hyperosmolar Coma :Hyperosmolar Coma Cells continue to burn sugar Acidic ketone bodies not produced Nail-polish remover or “fruity” breath odor not present


Hyperosmolar Coma :Hyperosmolar Coma Severe volume depletion NO ketone body production


Hyperglycemia :Hyperglycemia Management Support ABC’s Treat for hypovolemic shock Transport When in doubt, give sugar!


Hypoglycemia :Hypoglycemia Causes Insulin overdose Normal insulin use without eating Over-exercise


Hypoglycemia :Hypoglycemia Pale, cool skin; sweating; nausea; tachycardia Is that why hypoglycemia sometimes is called “Insulin Shock?”


Hypoglycemia :Hypoglycemia Insulin shock isn’t really shock Patient just looks “shocky” because of epinephrine adrenals are releasing


Hypoglycemia :Hypoglycemia Can occur in non-diabetics Most common cause =EtOH on empty stomach A patient is never, just drunk


Hypoglycemia Management :Hypoglycemia Management Conscious patient Give sugar orally Unconscious patient Support ABC’s Get ALS back-up for IV glucose When in doubt, Give Sugar!


Ask All Diabetics :Ask All Diabetics Have you eaten today? Have you taken your medication today? When in doubt, give Sugar!


Other Diabetes Complications :Other Diabetes Complications Atherosclerosis Myocardial infarction CVA Peripheral vascular disease Blindness Renal failure


Other Diabetes Complications :Other Diabetes Complications Diabetic Neuropathy Gangrene Increased “silent” myocardial infarction risk


Silent MI :Silent MI Acute MI in diabetic can present without chest pain May resemble “flu” Manage “sick” diabetics as if critically ill until proven otherwise