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Diabetes Mellitus - Facts
¾ The incidence and prevalence of diabetes are on the rise worldwide
¾ Type 1 diabetes
¾ Type 2 diabetes
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Type 1 Diabetes Mellitus
¾ previously known as Insulin Dependent Diabetes Mellitus (IDDM)
¾ results in hyperglycaemia
Aetiology Pathophysiology
¾ Type 1 diabetes is thought to be ¾ Catabolic disorder leading to a
the result of breakdown of fats & proteins &
an elevation in BGL’s
¾ a gene-environment interaction,
¾ Absolute absence of insulin leads
¾ with the strongest genetic risk to lipolysis, & the conversion of
markers in the HLA region of fatty acids to ketones
chromosome 6.
¾ Excess ketones leads to
ketoacidosis
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Type 2 Diabetes Mellitus
¾ Type 2 DM previously known as NIDDM or mature onset diabetes.
T2DM -
Aetiology Pathophysiology
¾ Family history and obesity are the ¾ Type 2 diabetes is a chronic
most important risk factors. condition
¾ Results from
¾ Impaired beta cell function and
insulin secretion
¾ Peripheral insulin resistance
¾ Increased hepatic glucose
production
University of Western Sydney 2009 8
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T2DM
Insulin Impaired Beta Cell Function
Resistance Pathophysiology Pathophysiology
¾ Begins before onset of symptoms ¾ Can arise from:
¾ Genetic decrease in beta cell
¾ Occurs in muscle, fat and liver cells mass
¾ Increased beta cell apoptosis
¾ Beta cell exhaustion
¾ Casues include:
¾ Chronic hyperglycaemia
¾ Genetics
¾ Chronic elevation of free fatty
¾ Ageing
acids
¾ Sedentary lifestyle
¾ Amyloid deposition in the beta
¾ Central obesity cell
¾ Polydipsia
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Diabetes Mellitus - Signs & Symptoms
¾ Polyphagia
¾ Depletion of cellular stores of carbohydrates, fats, and protein results in cellular
starvation and a corresponding increase in hunger in T1DM only.
¾ In T1DM weight loss occurs because of body tissue wasting as fats & proteins
are used for energy.
Diabetes Mellitus
Complications
¾ Chronic hyperglycaemia leads to:
¾ Microvascular disease
¾ Macrovascular disease.
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Diabetes Mellitus
Microvascular Complications
¾ Retinopathy
¾ Capillary structure undergoes alterations in blood flow, leading to;
¾ Retinal ischaemia
¾ Microaneurysm formation
¾ Neovascularisation
¾ Scarring
¾ Retinal detachment
¾Nephropathy
¾A disease of the kidneys characterised by the presence of albumin in the urine,
hypertension, oedema and progressive renal insufficiency.
Diabetes Mellitus
¾Amputation
¾Cerebrovascular accident
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Type 1 Diabetes Mellitus
Hyperosmolar Hyperglycaemic
Diabetic Ketoacidosis (DKA) Non-Ketotic Syndrome
(HHNKS):
¾ Hyperglycaemia (BSL > 15 ¾ severe hyperglycaemia >34
mmol/L
mmol/L)
¾ absence of ketonaemia &
¾ Bicarbonate (< 15 mEq/L) ketoacidosis (due to some insulin
availability)
¾ Polydipsia
¾ Polyuria
Diabetes Mellitus
Blood Tests Criteria for Diagnosis
¾ fasting blood glucose test ¾ Symptoms + casual plasma
¾ fast 8 - 12 hrs glucose of >11.1 mmol/L
¾ glucose level measured
¾ glycated haemoglobin
¾ Test A1C
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Diabetes Mellitus - Drug Therapy
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Diabetes Mellitus - Drug Therapy
References
¾ AIH&W. (14th November 2006).Diabetes link to the world diabetes day,
14 November 2006 fact sheet. Retrieved on 4th July, 2007, from
www.aihw.gov.au/diabetes/index.cfm
¾ Black, J. M., & Hawks, J. (2005). Medical-surgical nursing: Clinical
management for positive outcomes (7th ed.). Philadelphia:W.B.
Saunders.
¾ Brown, D., & Edwards, H. (Eds.). (2008). Lewis’s medical-surgical
nursing assessment and management of clinical problems. (2nd
ed.). Sydney: Elsevier.
¾ Bryant, B., Knights, K., & Salerno, E. (2007). Pharmacology for health
professionals (2nd ed.). Sydney: Mosby/Elsevier (Australia).
¾ Chang, E., Daly, J., & Elliot, D. (2006). Pathophysiology applied to
nursing practice. Sydney: Elsevier (Australia).
¾ Guthrie, R. A., & Guthrie, D. W. (2004). Pathophysiology of diabetes
mellitus. Critical Care Nursing Quarterly ,27(2), 113-125.
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References
¾ Lehne, R. A. (2007). Pharmacology for nursing care (6th ed.).
Philadelphia:Saunders
¾ Lemone, P., & Burke, K. (2008). Medical surgical Nursing : Critical
thinking in client care (4th. ed.). Upper Saddle River, New Jersey:
Prentice - Hall.
¾ Marieb, E. N. (2007). Human anatomy and physiology (7th ed.). California:
Benjamin/Cummings.
¾ Porth, C. M. (2005). Pathophysiology: Concepts of altered health states
(7th ed.). Philadelphia: Lippincott.
¾ Public Health Division, The health of the people of New South Wales –
Report of the chief health officer. Sydney NSW Department of Health.
Retrieved on 4th July, 2007, from
www.health.nsw.gov.auchoindex.htm
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