Diabetes Pathophysiology Paper

Kines 403 March 31st, 2012 Katelyn Cherry

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Disease Process Today, about 7% of the U.S population suffers from diabetes. Diabetes is a metabolic disorder that has the potential to affect the entire body. (Gulli, et al. 621). This disease arises when the body cannot control glucose levels in the blood. This disease has two different forms, Type I or Type II. Type I diabetes occurs when the body cannot produce insulin. In a recent study, it was found that this type of diabetes is characterized by a genetic predisposition that triggers a response by the bodys immune system. This causes interference within certain insulin producing cells in the pancreas. Type II diabetes occurs when the body is unable to use the insulin that was originally produced. This type of diabetes occurs when the amount of receptor sites for insulin decreases or there is defect within the receptor locations. The Type II form is typically linked to obese individuals (Medi-Info). In both Type I and Type II diabetes, the lack of insulin causes a decrease in the amount of glucose that can be carried across the cell membrane. In turn, the metabolism of lipids, carbohydrates, amino acids and proteins is disrupted, along with the storage of proteins in the muscles and fat in the adipose tissue. Because of these factors, this allows for an overproduction of glucose, thus blood glucose levels rise and hyperglycemia ensues (Medi-Info). Hypoglycemia, or low blood sugar, may also occur in individuals with diabetes. This develops in three different ways. First, when the glucose is taken up very rapidly, second, if glucose is released too slowly and finally, if too much insulin is introduced to the body. This generally occurs when an individual skips meals, takes too much insulin or drinks alcohol. If there is not enough glucose in the blood, glucose levels will fall, which will impair the functioning of the brain. Hypoglycemia is an acute condition that can be treated relatively fast as

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compared to hyperglycemia where it develops over time and may take hours or even days to treat. (Board). Affected Organ System The main organs that are affected due to diabetes consist primarily of the heart and blood vessels, kidneys, nervous system and eyes. Due to an increase in blood glucose levels, the cardiovascular system is at risk in individuals with diabetes. This is because the high blood sugar levels have a detrimental effect on lipids circulating throughout the bloodstream. This negative effect results in plaque buildup lining the blood vessel walls causing atherosclerosis, which is a precursor to a heart attack or stroke (Lind). The kidneys are also affected in people with diabetes because of the endless filtering of high glucose levels. This may eventually cause the kidneys to leak and may put the person at risk for renal disease (Lind). The nervous system may also be compromised in individuals with this condition. This is because nerve damage may be the product of high blood glucose levels. Automatic diabetic neuropathy is impairment within the bodys nervous system, which leads to loss of sexual functions, incontinence and the inability to produce sweat (Lind). Lastly, high blood sugar may also contribute to eye problems or even blindness. Glaucoma, a nerve disorder in the eye, may develop from high glucose levels. It is possible that this may cause a decrease in the amount of blood that enters the eye, resulting in blindness (Lind). Signs and Symptoms There are many signs and symptoms related to diabetes. Signs can be described as something that is physically seen, while symptoms are observed by the patient. According to the

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American Academy of Orthopedic Surgeons, the main symptoms of a hyperglycemic crisis include rapid, deep respirations, dehydration, a sweet and fruity odor on the breath, polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (excessive eating) or varying degrees of unresponsiveness (Gulli, et al. 625). Signs and symptoms of a hypoglycemic crisis include the following; shallow respirations, diaphoresis (sweating), altered mental status (aggression, confusion or unusual behavior), hunger, anxiousness, seizure, fainting, weakness on one side of the body or coma (Gulli, et al. 626). Treatment The main treatment that is available to alleviate the symptoms of diabetes associated with hypoglycemia is glucose. Glucose can be administered orally between the cheek and gum-line. One tube contains approximately 15 grams of a gel-like glucose. Diabetic emergencies may sometimes cause altered mental status, which may be mistaken for a drug overdose, poisoning, head injury or seizure. These types of emergencies may also mimic stroke symptoms, therefore, it is important to obtain vitals a SAMPLE history and perform a secondary assessment to determine the cause of the symptoms (PA Protocol, 702). Oral glucose administered by a trained EMT provider is crucial for someone suffering from symptoms related to a diabetic emergency. When arriving on scene, the EMT must follow all standard procedures and then check the patients airway, breathing and circulation to rule out any life threats. The EMT may call ALS (advance life services) at this time in case the patient begins to rapidly deteriorate. After checking airway, breathing and circulation, high-flow oxygen must be administered via a non-rebreathing mask at 15 L/min. If the patient does not tolerate the mask, a nasal cannula may be used with a flow rate of 4-6 L/min. While it is not mandatory, a

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pulse oximeter may be utilized to monitor oxygen saturation of the blood. The EMT should examine the patient for any evidence that may point to the suspected cause, such as, a medical alert identification tag, needle marks, head trauma, incontinence of urine, stroke or medicine containers. If the patient is still experiencing hypoglycemia induced symptoms, the EMT may administer one tube of oral glucose. (PA Protocol, 702). The EMT must first check the six rights pertaining to the medication. These rights include, the right medication, patient, dose, route, time, documentation and finally that the medication has not expired. Then, the EMT must place a small amount of oral glucose on a tongue depressor and remove the non-rebreathing mask from the patients mouth. The EMT may then deposit the oral glucose between the cheek and gums. Next, the EMT must instruct the patient to not swallow the glucose, but instead let it dissolve and then reapply the oxygen. It is important to remember that the glucose may only be given to patients who are able to swallow (Gulli, et al. 631). The EMT may continue to administer oral glucose until the patient has improved. After the first tube is given, the patient may be transported to the hospital. The EMT must assess vitals en route to the hospital every 15 minutes if the patient is stable or every 5 minutes if patient is unstable (PA Protocol, 702)

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Bibliography Board, A.D.A.M. Editorial. "Hypoglycemia." Hypoglycemia. U.S. National Library of Medicine. Web. 31 Mar. 2012. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001423/>. Gulli, Benjamin, Joseph A. Ciatolla, and Leaugeay Barnes. Emergency Care and Transportation of the Sick and Injured. Sudbury, MA: Jones and Bartlett, 2011. Print. Lind, Melissa. "What Organs Are Affected When Diabetes Occur?"LIVESTRONG.COM. 21 Aug. 2011. Web. 31 Mar. 2012. <http://www.livestrong.com/article/78198-organsaffected-diabetes-occur/>. "Medi-Info.COM." Diabetes Mellitus. Medi-Info. Web. 31 Mar. 2012. <http://www.mediinfo.com/diabetes-mellitus/>. PA DOH BLS Protocol. Protocol #702. Print. 28 Mar. 2012.

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