Lecture Notes: Diabetes Mellitus - Pathophysiology and Complications

Overview

• Presenter: Registered Nurse RN
• Focus: Pathophysiology, types, complications, and nursing assessment of diabetes mellitus.
• Upcoming content: Nursing interventions, patient education, and related conditions like DKA and HHNS.

Key Players in Diabetes

• Glucose
  • Sugars ingested are converted to glucose.
  • Enters cells with insulin's help to provide energy.
• Insulin
  • Hormone secreted by beta cells of the pancreas.
  • Facilitates glucose entering cells, lowering blood glucose levels.
• Glucagon
  • Hormone that raises blood glucose by converting liver-stored glycogen to glucose.
• Liver
  • Sensitive to insulin; stores excess glucose as glycogen.
  • Helps maintain blood sugar balance.

Normal Feedback Loop

• High Blood Sugar
  • Insulin is released, allowing glucose to enter cells.
  • Excess glucose stored in the liver as glycogen.
• Low Blood Sugar
  • Glucagon is released, prompting liver to release glucose from glycogen stores.

Diabetes Pathophysiology

• Type 1 Diabetes
  • No insulin production due to beta cell destruction.
  • Requires insulin treatment; often diagnosed in youth.
  • Symptoms: Thin, young, ketones in urine.
• Type 2 Diabetes
  • Insulin resistance; cells do not respond to insulin.
  • Lifestyle-related, managed with diet, exercise, and sometimes medication.
  • Symptoms: Often overweight, gradual onset, rare ketones in urine.
• Gestational Diabetes
  • Occurs in pregnancy; insulin resistance similar to type 2.
  • Often resolves after birth.

Complications of Diabetes

• Hypoglycemia
  • Low blood sugar (<60 mg/dL).
  • Symptoms: Sweaty, clammy, confusion, dizziness.
  • Treatment: Simple carbohydrates; D50 IV if unconscious.
• Organ Problems
  • Long-term high glucose levels can cause atherosclerosis.
  • Risk of heart disease, neuropathy, poor wound healing, strokes.
• Diabetic Ketoacidosis (DKA)
  • Mainly in type 1; lack of insulin leads to fat breakdown and ketone production.
  • Symptoms: High blood sugar, thirst, deep breathing, fruity breath.
• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
  • Occurs in type 2; severe dehydration, no ketone breakdown.
  • Symptoms: Very high blood sugar, mental status changes.

Nursing Assessment

• Signs and Symptoms
  • Three Ps: Polyuria, Polydipsia, Polyphagia.
    • Polyuria: Frequent urination due to osmotic diuresis.
    • Polydipsia: Thirst due to fluid loss.
    • Polyphagia: Hunger because of energy deficit.
  • SUGAR Mnemonic:
    • S: Slow wound healing
    • U: Blurry vision
    • G: Glycosuria
    • A: Acetone breath
    • R: Repeated yeast infections

Conclusion

• Upcoming videos will focus on interventions, medications, and detailed explanations of conditions like DKA and HHNS.
• Suggested action: Take the free quiz on diabetes at registerdnerseRN.com and check out related educational content.