Diabetes Mellitus Presentation Notes

Objectives

• All exam questions derived from objectives listed.

Type 1 Diabetes

• Autoimmune disorder: Body attacks the pancreas.
• No insulin production: Life-threatening, requires insulin injections.
• Early diagnosis: Typically diagnosed at a younger age, patients are often thin at the time of diagnosis.
• Symptoms: High blood glucose, weight loss, hunger due to cells not receiving energy.

Type 2 Diabetes

• Insulin resistance: Body makes insulin but isn't sensitive to it.
• Later diagnosis: Typically diagnosed after age 30.
• Symptoms: Elevated blood glucose, similar complications as Type 1.
• Treatment: Can include insulin and/or other medications.

Carbohydrate Metabolism

• Normal Process: Carbs break down into glucose, glucose enters the bloodstream, pancreas releases insulin to help glucose enter cells.
• In Diabetes: Glucose stays in the bloodstream due to lack of insulin or insulin resistance, leading to high blood glucose.

Treatment Goals

• Blood glucose control: Maintain as close to normal as possible.
• A1C Goal: Keep Hemoglobin A1C around 7% (average blood glucose ~ 150 mg/dL).
• Additional Health Control: Manage cholesterol and blood pressure to reduce cardiovascular risk.
• Regular Screening: Foot exams, eye exams, dental visits to check for complications like ulcers, retinopathy, gum disease.

Oral Medications for Type 2 Diabetes

1. Metformin
   • Mechanism: Decreases liver glucose production, increases glucose uptake by cells.
   • Effectiveness: Reduces fasting blood glucose by 60-70 mg/dL (A1C reduction: 1.5-2%).
   • Adverse Effects: Nausea, vomiting, diarrhea, potential for lactic acidosis.
   • Special Considerations: Avoid in patients with kidney/liver issues or those undergoing contrast dye scans.
2. Glipizide
   • Mechanism: Increases insulin release from the pancreas.
   • Effectiveness: Reduces A1C by 1-2%.
   • Adverse Effects: Hypoglycemia, diarrhea, gas, jitteriness.

Injectables

Insulin

• Administration: Subcutaneous injection (not taken orally).
• Type 1 Diabetes: Required for survival, administered using the basal-bolus method.
• Basal Insulin: Provides steady insulin over 24 hours (e.g., Lantus, Levemir).
• Bolus Insulin: Provides spikes of insulin with meals (e.g., Novolog, Humalog).
• Adverse Effects: Hypoglycemia, weight gain, possible injection site reactions.

Complications of Diabetes

Microvascular Complications

• Affect small blood vessels: Eyes, kidneys, nerves.
• Irreversible but progression can be slowed with glucose control.

Macrovascular Complications

• Affect large vessels: Heart attack, stroke, peripheral vascular disease.
• Peripheral Vascular Disease: Can lead to limb amputation due to poor blood flow and infection risk.

Summary

• Type 1 Diabetes: Must receive insulin therapy.
• Type 2 Diabetes: Managed with diet, oral medications, insulin, or a combination.
• Importance of Control: Poorly controlled diabetes leads to severe health issues.