Diabetes Mellitus (DM): also see Diabetes Insipidus (DI)

Inadequate insulin secretion from pancreas or insensitivity to insulin leads to:
-Increased blood glucose
-Increased glucose in urine
-Increased urine output (polyuria)
-Increased drinking (polydipsia)

Statistics:

Prevalence is 6.2% (US stats)
Incidence is 1 million new cases/year

Complications:

-Heart disease (2 – 4 fold increase)
-Stroke (2 – 4 fold)
-Blindness (leading cause of adult blindness)
-Neural (60 – 70 % mild – severe impairment
-Kidney disease (leading cause of end stage renal disease)
-Amputation (60% on non-traumatic amp.)
-Pregnancy complications

 

 

Clinical signs:

Laboratory test:

Type I DM (insulin-dependent)
Type II DM (insulin-independent)

-Juvenile onset diabetes
-Due to loss of insulin production
-Requires insulin

Treatment:

  • Insulin (fast/short acting; slow/long acting; intermediate;)
    -Subcutaneous injection
    -Continuous infusion pump
  • Monitor glucose
-Adult onset diabetes (often associated with obesity)
-Insulin levels are high but not high enough
-Insulin resistance
-Boost insulin production or reduce insulin demand through life style modifications

Treatment:

  • Diet (complex carbs, fiber, and protein)
    -Reduces the demand for insulin
  • Exercise
    -Increases uptake of glucose by skeletal muscle by increasing sensitivity to insulin
  • Oral hypoglycemic drug
    -Stimulate the beta cells of pancreas to release insulin (glyberide)
    Reduce insulin resistance (metformin)

Complications of Diabetes:

Acute Chronic
  • Insulin induced-hypoglycemia (insulin shock)
    -Error in insulin dose (too much)
    -Skipping a meal following insulin dose
    -Exercising
    -Vomiting

Symptoms (impaired neurologic function)
-Inability to concentrate
-Slurred speech
-Lack of coordination
-Staggering
-Symptoms are often mistaken as alcohol intoxication

  • Acute Hypoglycemia
    Symptoms (stimulation of sympathetic NS)
    -Sweating
    -Tachycardia
    -Pallor (from vasoconstriction)
    -Tremor
    -Anxiety
    -Loss of consciousness, seizure, death

Treatment:
Conscious
Fruit juice, honey, candy, sugar
Unconscious
Intravenous glucose
Do not administer anything by mouth

  • Diabetic Ketoacidosis

Acute (several days rather than hours)
Caused by
Inadequate insulin
Infection
Stress
Underdosing
Food or alcohol binge
Results in hyperglycemia & mobilization of lipids

Symptoms related to dehydration, metabolic acidosis, electrolyte imbalance
-Metabolic acidosis (ketoacidosis)
-Rapid respirations
-Acetone breath (sweet, fruity)
-Lethargy
-Unconsciousness if pH falls (ketoacids bind to bicarbonate)





 Chronic means years

Due to chronic hyperglycemia:

  • Vascular (eyes, kidneys, extremities
  • Neural
  • demyelination of peripheral n. numbness
  • Autonomic ns incontinence, impotence
  • Infections

see also Diabetic neuropathy:

Death of peripheral neurons caused by the pathophysiology of DM

Scientific journal reference (2004)

 

1