Diabetes Mellitus Nursing Management Overview

Welcome to Unit 2, Diabetes Mellitus, Nursing Management, Part 1. There are two overall types of diabetes. You have diabetes mellitus and you have diabetes insipidus. Diabetes mellitus is much more common than diabetes insipidus, and diabetes mellitus is the diabetes we're focusing on in Unit 2. Diabetes mellitus literally means a sweet siphon. It's from Latin, which literally means to siphon through. and they would actually taste urine that long ago to diagnose. Thank goodness we don't have to do that today. So it was actually sweet urine because they have so much sugar. They have so much sugar in their blood, it spilled over into their urine. It was known in the 17th century as the pissing evil. Now that might make you giggle, but that's really a pretty good description because with hyperglycemia, you have so much sugar in your blood. It becomes this hyperosmolar situation. It causes, it's a hyperosmolar diuretic, and it forces the body to try to get rid of that sugar. And when it gets rid of the sugar, it gets rid of fluid because it's trying to literally void or pee out that sugar. So you end up losing fluids, electrolytes, and it would kill people. So it's a pretty good name. Now, diabetes insipidus, we're not going to talk about that, but just don't get those confused. This is quite rare. and it was called the bland siphon because urine would be really really bland because with diabetes insipidus you end up losing a ton of fluid so you just siphon out fluid fluid fluid not sugar but it's just fluid so some general information on diabetes so diabetes mellitus is a group of diseases characterized by hyperglycemia caused by defects in either one's secretion of insulin from the pancreas insulin action, so meaning that the pancreas can secrete insulin, but it doesn't work well, or both. It could also be related to poor cellular responsivity to insulin as well. So it's basically called glucose intolerance. This affects 25.8 million people in the US, and about one third of cases are undiagnosed. Now those people that are undiagnosed, that's important because if you don't know that you have diabetes, You can't really feel it until it gets out of control and it starts damaging and killing, well, it damages your blood vessels and then it starts killing your nerves. So they don't know they have a problem until they're losing feeling, until they're losing their vision, and maybe they end up with an infected necrotic ulcer on their foot and they end up with an amputation. And we're going to talk about that with chronic complications at the end of this unit. Prevalence is increasing. to some degree that is related to our sedentary lifestyle and our super high sugary diet and just taking in too much, even without too much sugar, we're still just taking in way too much. We're overloading our bodies with caloric intake and it's just putting too much stress on this poor little pancreas. Minority populations and older adults are disproportionately affected. So minority populations, that has to do with their culture and having just not been exposed to these high sugary processed foods that... First world countries are typically more exposed to, and so their metabolism just can't adjust as well as those of us, like say in our class, can, typically speaking, of course. And then lastly, the leading cause of death due to the high rate of cardiovascular disease in those with this condition, because like I had said before, hyperglycemia is extremely caustic to the blood vessels. And of course, if it hurts the blood vessels where you know it's going to hurt the heart and it causes a lot of cardiovascular damage. and disease in patients with diabetes mellitus. So further classifications of diabetes mellitus. Now there's two key types that we're going to talk about in this class. You have type 1, which is not the most common. It makes up about 5% to 10% of all those with diabetes. And then you have type 2. And this type of diabetes makes up the vast majority of those with diabetes. And we'll talk about the difference between these two. And then the overall prevalence of each will start to make a bit more sense. So type 1. A type 1 diabetic experiences destruction of pancreatic beta cells. Now, if beta cells are the cell in the pancreas that create insulin, and those cells are destroyed, or they're being destroyed, you're either going to slowly have a lessening amount of insulin that will ultimately result in... no insulin, so a relative absence of insulin production. This also leads to unchecked glucose production by the liver because when you have insulin in your bloodstream, Your alpha cells, which talk to the liver to help you regulate your blood sugar, they don't get the message that you're not having any glucose problems. So insulin actually helps regulate glucose release by the liver. So when you put those two together, so the beta cells aren't creating insulin. Insulin isn't telling the alpha cells that, hey, everything's okay, don't have the liver kick out any glucose. With both of those working together, they both contribute to a fasting hyperglycemia. So there's early onset diabetes that used to be known as juvenile diabetes, but now we know there's many more ways that someone can become diagnosed with type 1 diabetes. Just related to genetic predisposition, I've taken care of patients who are quite thin and otherwise looked relatively healthy and had type 2, and I've taken care of patients that I'm thinking, how on earth are you not a type 2 diabetic? Just with the reasons why we know people tend to develop type 2 diabetes. So it... it also has to do, it's not just lifestyle, but it's also just how genetically predisposed are you to it. Immunologic, sometimes our body will attack its own cells and that includes the beta cells. It might also be because of an environmental, such as a viral factor. I have a perfect example. One of my friends, her sister got a pretty nasty virus in her early twenties. It just so happened to attack her beta cells. And now she's a type one diabetic. She has no diabetes in her family. So she has no known. genetic predisposition, so it must be unknown, and also could just be the virus that she had. We don't know what virus. It was some sort of respiratory virus, and I guess it went systemic and attacked her beta cells, and now she's type 1. So type 2, this is more of impaired insulin secretion. With type 1, you had beta cell destruction, so slow destruction over time, which ultimately ended up in complete destruction. Now type 2 is just impaired herd. insulin secretion. So either impaired secretion through the beta cells, or it's just that the cells, your peripheral cells that are actually receiving the glucose are just not getting the message. And this is in relation to the fact that your cells, they're just basically so used to having so much sugar that they just down-regulate their little receptors that detect sugar and insulin, and they sort of become deaf to the message. They don't really hear it anymore. They don't have the receptivity anymore because they're used to so much sugar being in the blood. This is typically very slow and progressive and may go undetected for years because oftentimes people don't know they have a problem until they end up with long-term permanent nervous and blood vessel damage. It's also increasing because of the increase in obesity in children. So what are some risk factors for diabetes mellitus? This can include just a family history, so a genetic predisposition, obesity along with being over 30 years of age, just alone age of 45 years and older, minority population, so African-American, Hispanic, Native American, Asian, Pacific Islander, so that minority ethnicity, being previously identified as having an impaired glucose metabolism test, so like pre-diabetes. If you were a pre-diabetic at one point in your life. Even though maybe you've managed it, you're just at a higher risk now. Also having hypertension because it's just a vascular damage, meaning it might damage the pancreas and just damage that overall balance because it's damaging your blood vessels, the end little capillary small blood vessels. Also being hyperlipidemic or hyperdyslipidemia, so having high cholesterol. And then also having a history of gestational diabetes. or having a baby that was over nine pounds, just meaning they were for some reason receiving just too much energy from the mother and that might relate to a glucose metabolism issue.

It's from Latin, which literally means to siphon through. and they would actually taste urine that long ago to diagnose. Thank goodness we don't have to do that today. So it was actually sweet urine because they have so much sugar. They have so much sugar in their blood, it spilled over into their urine.

It was known in the 17th century as the pissing evil. Now that might make you giggle, but that's really a pretty good description because with hyperglycemia, you have so much sugar in your blood. It becomes this hyperosmolar situation. It causes, it's a hyperosmolar diuretic, and it forces the body to try to get rid of that sugar.

And when it gets rid of the sugar, it gets rid of fluid because it's trying to literally void or pee out that sugar. So you end up losing fluids, electrolytes, and it would kill people. So it's a pretty good name.

Now, diabetes insipidus, we're not going to talk about that, but just don't get those confused. This is quite rare. and it was called the bland siphon because urine would be really really bland because with diabetes insipidus you end up losing a ton of fluid so you just siphon out fluid fluid fluid not sugar but it's just fluid so some general information on diabetes so diabetes mellitus is a group of diseases characterized by hyperglycemia caused by defects in either one's secretion of insulin from the pancreas insulin action, so meaning that the pancreas can secrete insulin, but it doesn't work well, or both. It could also be related to poor cellular responsivity to insulin as well. So it's basically called glucose intolerance.

This affects 25.8 million people in the US, and about one third of cases are undiagnosed. Now those people that are undiagnosed, that's important because if you don't know that you have diabetes, You can't really feel it until it gets out of control and it starts damaging and killing, well, it damages your blood vessels and then it starts killing your nerves. So they don't know they have a problem until they're losing feeling, until they're losing their vision, and maybe they end up with an infected necrotic ulcer on their foot and they end up with an amputation.

And we're going to talk about that with chronic complications at the end of this unit. Prevalence is increasing. to some degree that is related to our sedentary lifestyle and our super high sugary diet and just taking in too much, even without too much sugar, we're still just taking in way too much.

We're overloading our bodies with caloric intake and it's just putting too much stress on this poor little pancreas. Minority populations and older adults are disproportionately affected. So minority populations, that has to do with their culture and having just not been exposed to these high sugary processed foods that...

First world countries are typically more exposed to, and so their metabolism just can't adjust as well as those of us, like say in our class, can, typically speaking, of course. And then lastly, the leading cause of death due to the high rate of cardiovascular disease in those with this condition, because like I had said before, hyperglycemia is extremely caustic to the blood vessels. And of course, if it hurts the blood vessels where you know it's going to hurt the heart and it causes a lot of cardiovascular damage. and disease in patients with diabetes mellitus. So further classifications of diabetes mellitus.

Now there's two key types that we're going to talk about in this class. You have type 1, which is not the most common. It makes up about 5% to 10% of all those with diabetes.

And then you have type 2. And this type of diabetes makes up the vast majority of those with diabetes. And we'll talk about the difference between these two. And then the overall prevalence of each will start to make a bit more sense.

So type 1. A type 1 diabetic experiences destruction of pancreatic beta cells. Now, if beta cells are the cell in the pancreas that create insulin, and those cells are destroyed, or they're being destroyed, you're either going to slowly have a lessening amount of insulin that will ultimately result in... no insulin, so a relative absence of insulin production. This also leads to unchecked glucose production by the liver because when you have insulin in your bloodstream, Your alpha cells, which talk to the liver to help you regulate your blood sugar, they don't get the message that you're not having any glucose problems. So insulin actually helps regulate glucose release by the liver.

So when you put those two together, so the beta cells aren't creating insulin. Insulin isn't telling the alpha cells that, hey, everything's okay, don't have the liver kick out any glucose. With both of those working together, they both contribute to a fasting hyperglycemia. So there's early onset diabetes that used to be known as juvenile diabetes, but now we know there's many more ways that someone can become diagnosed with type 1 diabetes.

Just related to genetic predisposition, I've taken care of patients who are quite thin and otherwise looked relatively healthy and had type 2, and I've taken care of patients that I'm thinking, how on earth are you not a type 2 diabetic? Just with the reasons why we know people tend to develop type 2 diabetes. So it...

it also has to do, it's not just lifestyle, but it's also just how genetically predisposed are you to it. Immunologic, sometimes our body will attack its own cells and that includes the beta cells. It might also be because of an environmental, such as a viral factor.

I have a perfect example. One of my friends, her sister got a pretty nasty virus in her early twenties. It just so happened to attack her beta cells.

And now she's a type one diabetic. She has no diabetes in her family. So she has no known. genetic predisposition, so it must be unknown, and also could just be the virus that she had. We don't know what virus.

It was some sort of respiratory virus, and I guess it went systemic and attacked her beta cells, and now she's type 1. So type 2, this is more of impaired insulin secretion. With type 1, you had beta cell destruction, so slow destruction over time, which ultimately ended up in complete destruction. Now type 2 is just impaired herd. insulin secretion. So either impaired secretion through the beta cells, or it's just that the cells, your peripheral cells that are actually receiving the glucose are just not getting the message.

And this is in relation to the fact that your cells, they're just basically so used to having so much sugar that they just down-regulate their little receptors that detect sugar and insulin, and they sort of become deaf to the message. They don't really hear it anymore. They don't have the receptivity anymore because they're used to so much sugar being in the blood.

This is typically very slow and progressive and may go undetected for years because oftentimes people don't know they have a problem until they end up with long-term permanent nervous and blood vessel damage. It's also increasing because of the increase in obesity in children. So what are some risk factors for diabetes mellitus?

This can include just a family history, so a genetic predisposition, obesity along with being over 30 years of age, just alone age of 45 years and older, minority population, so African-American, Hispanic, Native American, Asian, Pacific Islander, so that minority ethnicity, being previously identified as having an impaired glucose metabolism test, so like pre-diabetes. If you were a pre-diabetic at one point in your life. Even though maybe you've managed it, you're just at a higher risk now. Also having hypertension because it's just a vascular damage, meaning it might damage the pancreas and just damage that overall balance because it's damaging your blood vessels, the end little capillary small blood vessels. Also being hyperlipidemic or hyperdyslipidemia, so having high cholesterol.

And then also having a history of gestational diabetes. or having a baby that was over nine pounds, just meaning they were for some reason receiving just too much energy from the mother and that might relate to a glucose metabolism issue.

Transcript for:Diabetes Mellitus Nursing Management Overview

Transcript for:
Diabetes Mellitus Nursing Management Overview