hey everyone it's s register nurse rn.com and in this video I'm going to be going over diabetes malius this is part of a inlex review series on diabetes and what I'm want to be doing in this video is I'm going to be hitting the patho physiology and diabetes the complications the different types and the nursing assessment in the next video I'm going to be going over the nursing interventions and I'm going to hit really hard on the phological aspects of um taking care of a diabetic patients the education and the teaching and I'm going to give you some clever pneumonics on how to remember that stuff because it's a lot of stuff that you need to know for the inlex and your nursing lecture exams and then I'll be having some more videos coming out about dka hhns syndrome and all those things you need to know about diabetes so make sure you access the playlist the enderin playlist so you can get access to those videos now after this lecture be sure to go to my website register nurse rn.com and take the free quiz says a card should be popping up to test your knowledge on Diabetes okay so let's get started okay first let's talk about the key players in diabetes because if you understand what's going on normally in the body you're going to understand why the diabetic patient is having all of these issues so the big key players in diabetes is glucose insulin glucagon and the liver and all of these work together to help your body use glucose because the big issue with diabetes is an issue with insulin and um here in a second you'll see why that's an issue okay so first let's talk about glucose what is glucose glucose is sugar and your body loves sugar because your body needs it to survive and what sugar does is it enters into the cell or the glucose enters into the cell and fuels those cells so they can work but the catch is is that glucose cannot enter into your cell without the help of insulin so in order you eat all this sugar you take it in it enters your bloodstream but for glucose to actually go into yourself or your cell to use it has to have the help of insulin and if you don't have any insulin at all then you're not going to have the ability to use the glucose and the glucose is just going to hang out in your bloodstream and cause high blood sugars which reeks havoc on havoc on the body now um glucose is mainly stored in the liver in the form of glycogen which we'll go over in depth here in a second okay insulin what is insulin insulin is a hormone and it plays a huge role in helping us bring those blood sugar levels down because like I said it regulates the amount of glucose in your body it attaches lets glucose attach to it and it takes it inside that cell so you can use it and the big thing that you want to remember is that insulin is secreted by your pancreas by the beta cells of the pancreas in the insulates of the langerhan cell so if this area of the body the beta cells and the pancreas get damaged then you're in trouble you're not going to have any insulin production now let's talk about glucagon what is glucagon it works in the opposite of insulin insulin helps us bring our sugars down glucagon helps us increase our blood sugar so it helps with low blood sugar level lels and um what it does is it causes the liver because your liver will store this glucose um if you have extra glucose in the body the liver will take it and store it and turn it into glycogen and whenever glucagon is released it will cause that liver to release that glycogen that it's stored up and turn it into glucose so you can get that glucose in your body and increase your blood sugar levels now the liver that's our last key player the liver is very sensitive to insulin levels in your body it's whenever it senses that you have too high of insulin levels and you have high blood sugar levels it starts doing its job but if you have low insulin levels you have low blood sugar it also helps with that so it's very vital in helping us keep those levels nice and um normal so whenever you have high blood sugar and a high insulin level the liver will cause the body to absorb that extra glucose and will turn it into glycogen so you can use it later on but then say all of a sudden your glucose drops and your insulin levels will drop as well the liver will sense that and this will cause the liver to release those stores of the glycogen which will turn into glucose and increase your blood sugar so it helps with that now let's recap about the feedback loop what happens normally in the body and someone who does doesn't have diabetes and then let's talk about what's happening in someone with diabetes okay so you have high blood sugar you ate and drank a bunch of sugary stuff so what does your body do the pancreas says hey there's a lot of blood there's a lot of glucose in our body so we need to use that so the pancreas releases insulin and the insulin causes the glucose to enter into the cells and there may be some leftover and the leftover will go into the liver and the liver will store it for later and turn it into glycogen and then use it whenever you need it now say you have low blood sugar you've been working all day as a nurse and you have an eight so your blood sugar is level low is um level is low so what will your body do because it wants to help protect you the pancreas will release glucagon now remember glucagon works in the opposite of insulin and this will cause the liver to release glycogen remember all those stores that stored up from all that extra glucose and this will turn into glue glucose which will increase your blood sugar so that is what's happening in someone who doesn't have diabetes who has a normal healthy pancreas and they don't have insulin issues but what is happening to someone with diabetes okay what's happening is that the B you're eating all your sugar you're eating your food but the body cannot get to that sugar that glucose that you're eating and this is either due to there's no insulin present either those um beta cells in the pancreas were damaged or the body is resistant to insulin you um you're secreting insulin perfectly but those cells are like we don't want that and they're not receptive to that insulin so you can't use it and in type one there's no insulin present in type two the body is resistant to insulin which we'll go over in depth here in a second and whenever that happens because your body is not using glucose you get hyperglycemia where you have an elevated blood sugar in the body and it just hangs out now when glucose hangs out in your body this is not good it's not meant to do that so it starts to affect major organs of the body and the body says hey we need some energy these cells need to be able to work since we can't get the glucose we've got to burn energy some other way so it will start to burn fats ketones which are acids and this happens in your type one diab diabetics and whenever you're burning those fats and those acids it's throwing the whole body out of whack it's going to cause some major acid and base imbalances which we talked about in depth in metabolic acidosis and alkalosis or with the type 2 diabetics what's happening is that there is enough insulin there's just enough where your body is not receptive to it so it doesn't burn those fats but instead it doesn't use the carb so they're having issues with carbo carbohydrate metabolism now what causes diabetes malius the causes are separated into three different types you have type one type two and gestational so let's talk about type one okay type one remember this is where the patient does not have any insulin and what's happened is that those beta cells in the insulet of the langerhan which is in your pancreas have been destroyed they're not working properly at all so there is no insulin for this for this patient so in order for treatment they have to take insulin now this is not related to Lifestyle like with your type two diabetics this is either genetic autoimmune for instance um they got a virus that went in wed havoc on havoc on the body and the body attacked itself specifically those beta cells in the pancreas and it just doesn't work anymore now how do these patients present I would remember this this is important um these patients are going to be thin because they're burning all that fat off because the body needs energy so they're burning all those fats and ketones they're going to be young uh normally this happens in children and it's going to happen all of a sudden and there's going to be ketones present in the urine where the body is breaking down those fats now type two diabetics What's Happening Here the cells have quit responding to insulin so it's insulin resistant they don't care about the insulin and you can secrete insulin all day and they're not going to have anything to do with it and so what happens the glucose just hangs out in the body but it's like a catch 22 all this insulin is is being produced it's nice and fine but the cells just don't want anything to do with it but you still have all this glucose and the pancreas thinks you need more insulin because it senses that you have all this glucose still in the body so it starts to over secrete insulin and you start getting the condition called hyper insulin emia which will lead to metabolic syndrome so not good and treatment for this is normally the patient um they will the doctor will order diet and exercise that normally helps with that but if that's not successful they will start them on oral medications which we will cover in the next video in depth and um these patients normally don't take insulin but they may need insulin injections if um they're having lost stress on the body like with surgery or with infection so that's something just to keep in mind and this is generally type two diabetes is related to Lifestyle either due to being obese having a sanitary lifestyle a poor diet lots of colas things like that and genetic now how do these patients present what do they typically look like they're typically overweight um it happens over time they're usually adult age teenage age and um it's very rare for them to have ketones in the Y because remember back to this they don't have an issue with metabolizing the fats because there's just enough insulin but they have issues with metabolizing those carbohydrates now gestational just wanted to throw that in that is a that's another type and it's similar to your type 2 diabetes and this is where the cells are not receptive and it happens in pregnant women and it will usually go away after birth now let's look at the complications of diabetes and the nursing assessment first let's talk about complications okay complications with diabetes you can have hypogly cmia organ problems diabetic keto acidosis also called dka or hypoglycemic hyper osmolar non-ketotic syndrome which we will refer to as hhns so let me go over these in detail okay hypoglycemia this is the opposite of hyper glycemia hypo means low gly means glucose and emia means blood so we have low blood glucose in the blood usually it's around less than 60 milligram per Des now whenever patients have this this is usually a side effect from too much insulin or too much oral diabetic medication which we'll go over in the next video but they're going to present as being sweaty and clammy confused Li headed dizzy and double vision now to help you remember how to treat someone with hypoglycemia because you want to treat it fast and remember this saying I'm sweaty cold and clammy give me some candy so these patients who are H having hypoglycemia need a simple carb remember that um I remember a test question from nursing school and it gave us the glucose and it said what would be a treatment and what the option was simple carb complex carb and listed all these things but it's a simple carb of what they need and simple carbs are like your hard candies like Lifesavers um fruit juice graham crackers honey things like that that can hit the body body can absorb and take in and use now if the patient's unconscious they can't eat um normally in the hospital setting whatever the doctor orders you will give them a IV D50 okay now let's look at organ problems okay glucose think about it in our real life sugar if you get sugar on your hands it's really sticky the same concept can apply to whenever it gets you get way too much in the blood what it does is it causes AOS scerotic um issues where you're having um hardening of the vessels now what this does is this glucose enters into the blood glucose is naturally sticky so it's going to start to stick to those proteins of the vessels and they become hard and they form plaes and normally your vessels are nice and um pliable and they're not hard and when they're hard they don't work properly so let's think of all the systems in the body that are affected by hard vessels your heart you can get heart disease it's going to on those coronary arteries make them hard blood flow is going to be narrow and there's also some plaques that can form can cause an MI my cardial infarction Strokes um a lot of strokes happen with that weakening of those vessels um hypertension again you have stiff hard vessels that's going to increase um resistance on your vessels causing hypertension neuropathy um decrease wound healing again that is because um you're you have decreased compromis circul from those hardening of those vessels you can't get all that um all those cells there to work to help heal that wound so they will have slow wounds on their feet especially on their feet eye trouble and infections okay let's look at diabetic keto acidosis dka now in the other videos coming up in this series we're going to go in depth about dka treatments and all that and we're going to actually compare it with hhns because people get these two conditions confused but let me help break it down for you so you can understand a little bit okay dka this happens in your type one diabetics it's super rare to happen in type two it's type one so keep that in mind and another issue with this is they are burning ketones let the name help you out diabetic keto acidosis okay remember what we were talking about diabetes type one they don't have any insulin insulin helps glucose go into the cell for energy so the body's like hey we don't have anything for energy so we've got to start burning fats ketones so what happens is that the body is burning those ketones like crazy and this is causing um acids to iner into the blood whenever those ketones break down and then you're getting some acid base imbalances this is lifethreatening they need to be treated and how your patient's going to present they're going to have extremely high blood sugars and they're going to be very thirsty and they're going to have the cosmal breathing remember that that's because all that acid build up in the body respiratory system is trying to blow blow off that acid by those deep long um breaths rapid breaths and they can also have the acetone breath which is like that fruity smell in their breath and that's just because of all those ketones breaking out now let's let's look at hhns okay this happens typically in your type 2 diabet diabetics and part of HHS the n stands for non-ketotic so there is no breakdown of ketones in this because remember with type two diabetes they have just just enough insulin where they don't have to break down the fats instead they have carbohydrate issues so um what you're going to have is no burning of the ketones you're just going to have um dehydration the patient going to be very dehydrated they're going to be thirsty and they're going to have mental status changes and their blood sugars are going to be crazy high but there's going to be no Ketone issues now how is a patient going to present to you um whenever you're assessing them what signs and symptoms are they going to have okay you want to remember for this these are typically test questions okay the three PS for hypoglycemia because the issue with diabetes is they have high blood sugars so the three PS which are polyuria polydipsia and polyphasia okay what's polyura polyurea is where poly means many um Uria means urine so they're having frequent urinations they are peeing a lot they're getting a lot of um urine output why is this happening okay this happen happens because of the rule of Osmosis remember in our hyperonic isotonic hypotonic video and we talked about osmosis this is where water likes to be where there's a higher concentration so it's going to move to higher concentration lower concentration higher concentration and what's happened is there's all this glucose in your blood and the cells in inside the cells there's water and the water's like hey all the glucose is in the blood let's move out of the cell and go into the bloodstream so you have all this water shifting into the blood that causes a lot of fluid so what system of the body gets rid of extra fluid the kidneys so the kidneys start putting out all this extra fluid you have but also whenever the kidneys is doing that one of the roles is that it reabsorbs glucose but there's way too much glucose in the blood so the kidneys can't cope with this so they start leaking glucose so you're going to see glycose uad that means you're going to see glucose in their urine next they're going to have poly dipsia and this plays into the polyurea all these play off of each other so poly dipsia poly means many dipsia means thirst drinking so um they're going to be very thirsty and this is because of the polyera because they're putting out all this fluid the body's like hey we got to keep drinking to keep hydrating ourselves because we're putting out all this water and then the polyphasia that means they're very hungry they're just constantly craving food and this ties back to burning all the fats all those ketones um the body needs the energy because it can't get to the glucose so the body's like hey we've got to eat keep eating food so we can keep burning this energy and these three PS are mainly seen in your type one diabetics okay now let's look at another pneumonic remember the word sugar this is what you're going to see in both the type one and the type two okay s for slow wound healing again that's because of that glucose being sticky hardening those vessels so you have decreased per Fusion to help heal those wounds the U blurry blurry vision again that's because the damage to the eyes with all that glucose a glyco Uria that's where the kidneys can't cope with all that extra glucose so it leaks into the um urine a for acetone breath that is mainly seen in your type ones and that's because of the burning of the ketones it gives off that fruity smell of the breath R for rashes on the skin and repeated yeast uh infe in women because yeasts love glucose if you have too much glucose yeast is going to build up and they have repeated vaginal infections of yeese okay so that is about diabetes malius now don't forget to take that free quiz a um you should get the card or it's down in the description below and be sure to check out that other video where I'm going over the nursing interventions where I'm covering covering the phological aspects of treatment of diabetes and thank you so much for watching and please consider subscribing to this YouTube Channel