DIABETES

MELLITUS
NCM 116
METABOLISM & ENDOCRINE
BSN 3
 A group of
metabolic diseases Insulin

characterized by A hormone produced by the pancreas, controls the level of

glucose in the blood by regulating the production and
hyperglycemia storage of glucose.

resulting from DIABETIC STATE- the cells may stop responding to

defects in insulin insulin or the pancreas may stop producing insulin

entirely. This leads to hyperglycemia, which may result in
secretion, insulin acute metabolic complications such as diabetic

action, or both ketoacidosis(DKA) and hyperglycemic hyperosmolar

non-ketotic syndrome (HHNS).
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 Risk Factors for DM
• Family history of
diabetes
• Obesity Classification of Diabetes
• Type 1 diabetes(previously referred to as insulin-
• Race/ethnicity
dependent diabetes mellitus)
• Hypertension • Type 2 diabetes (previously referred to as non-
• History of gestational insulin-dependent diabetes mellitus)
diabetes or delivery of • Gestational diabetes mellitus
babies over 9 lbs • Diabetes mellitus associated with other conditions
or syndromes 3
 PHYSIOLOGY AND
PATHOPHYSIOLOGY OF Classification of DM and Related Glucose
DIABETES Intolerances

1. Transports and metabolizes 1. CURRENT CLASSIFICATION

glucose for energy • Type 1 (5%–10% of all diabetes)
2. Stimulates storage of glucose
in the liver and muscle (in the PREVIOUS CLASSIFICATIONS
form of glycogen) • Juvenile diabetes Juvenile-onset diabetes
3. Signals the liver to stop the
release of glucose Ketosis-prone diabetes Brittle diabetes Insulin-
4. Enhances storage of dietary fat dependent diabetes mellitus (IDDM)
in adipose tissue
5. Accelerates transport of amino CLINICAL CHARACTERISTICS
acids (derived from dietary • Onset any age, but usually young (<30yrs)
protein) into cells
• Usually thin at diagnosis; with recent weight
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loss
2. CURRENT CLASSIFICATION
• Type 2 (90%–95% of all diabetes: obese— 80% of type 2; nonobese—20% of type 2)
PREVIOUS CLASSIFICATIONS
• Adult-onset diabetes Maturity-onset diabetes Ketosis-resistant diabetes Stable diabetes Non–insulin-
dependent diabetes (NIDDM)
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
• Onset any age, usually over 30 years
• Usually obese at diagnosis
3. CURRENT CLASSIFICATION
• Diabetes mellitus associated with other conditions or syndromes
PREVIOUS CLASSIFICATIONS
• Secondary diabetes 5
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
• Accompanied by conditions known or suspected to cause the disease: pancreatic diseases, hormonal
abnormalities, medications such as corticosteroids and estrogen-containing preparations.
4. CURRENT CLASSIFICATION
• Gestational diabetes
PREVIOUS CLASSIFICATIONS
• Gestational diabetes
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
• Onset during pregnancy, usually in the second or third trimester
• Due to hormones secreted by the placenta, which inhibit the action of insulin
• Above-normal risk for perinatal complications, especially macrosomia (abnormally large babies)

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5. CURRENT CLASSIFICATION
• Impaired glucose tolerance
PREVIOUS CLASSIFICATION
• Borderline diabetes
• Latent diabetes
• Chemical diabetes
• Subclinical diabetes
• Asymptomatic diabetes
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
• Oral glucose tolerance test value between 140 mg/dL (7.7 mmol/L) and 200 mg/dL (11 mmol/L)
• Impaired fasting glucose is defined as a fasting plasma glucose between 110 mg/dL (6 mmol/L) and
126 mg/dL (7 mmol/L). 7
6. CURRENT CLASSIFICATION
• Prediabetes
PREVIOUS CLASSIFICATION
• Previous abnormality of glucose tolerance (PrevAGT)
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
Current normal glucose metabolism Previous history of hyperglycemia (eg, during pregnancy or
illness)
7. CURRENT CLASSIFICATION
• Prediabetes
PREVIOUS CLASSIFICATION
• Potential abnormality of glucose tolerance (PotAGT)
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS - No history of glucose intolerance 8
TYPE 1 DIABETES
A metabolic disorder characterized by an absence of insulin production
and secretion from autoimmune destruction of the beta cells of the islets
of Langerhans in the pancreas. Formerly called insulin-dependent,
juvenile or type I diabetes.
TYPE 2 DIABETES
A metabolic disorder characterized by the relative deficiency of insulin
production and a decreased insulin action and increased insulin
resistance. Formerly called non-insulin-dependent, adult-onset, or type II
diabetes.
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CLINICAL MANIFESTATIONS
• THREE 3Ps”: Polyuria, Polydipsia, and Polyphagia
• Fatigue
• Weakness
• Sudden vision changes
• Tingling or numbness in hands or feet
• Dry skin
• Skin lesions
• Wounds are slow to heal
• Recurrent Infections
• Type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal
pains, if DKA has developed 10
ASSESSMENT
The Patient With Diabetes
• History
Symptoms related to the diagnosis of diabetes:
Symptoms of hyperglycemia
Symptoms of hypoglycemia
Compliance with prescribed dietary management plan
Adherence to prescribed exercise regimen
Compliance with prescribed pharmacologic treatment
Use of tobacco, alcohol, and prescribed and over-the-counter medications/drugs
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Physical Examination
Blood pressure
Body mass index
Fundoscopic examination
Foot examination and Skin examination
Neurologic examination
Vibratory and sensory examination using monofilament
Deep tendon reflexes
Oral examination

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Laboratory Examination
HgbA1C (A1C)
Fasting lipid profile Test for microalbuminuria
Serum creatinine level
Urinalysis
Electrocardiogram
Need for Referrals
Ophthalmology
Podiatry
Dietitian
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Diabetes educator
Five components of diabetes management:
• Nutritional management
• Exercise
• Monitoring
• Pharmacologic therapy
• Education

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NUTRITIONAL MANAGEMENT
• Providing all the essential food constituents (eg, vitamins, minerals) necessary for optimal nutrition
• Meeting energy needs
• Achieving and maintaining a reasonable weight
• Preventing wide daily fluctuations in blood glucose levels, with blood glucose levels as close to normal
as is safe and practical to prevent or reduce the risk for complications
• Decreasing serum lipid levels, if elevated, to reduce the risk for macro vascular disease
Meal Planning and Related Teaching
• CALORIC REQUIREMENTS
Calorie-controlled diets are planned by first calculating the individual’s energy needs and caloric
requirements based on the patient’s age, gender, height, and weight.

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• CALORIC DISTRIBUTION
Carbohydrate foods have the greatest effect on blood glucose levels because they are more quickly
digested than other foods and are converted into glucose rapidly.
• The Food Guide Pyramid (type 2 diabetes) who have a difficult time complying
with a calorie-controlled diet.
The food pyramid consists of six food groups:
1. bread, cereal, rice, and pasta
2. fruits;
3. vegetables;
4. meat, poultry, fish, dry beans, eggs, and nuts;
5. milk, yogurt, and cheese; and (6) fats, oils, and sweets
6.fats, oils, and sweets 16
Glycemic Index – How much a given food raises the blood glucose level compared
with an equivalent amount of glucose
• Combining starchy foods with protein- and fat-containing foods tends to slow their
absorption and lower the glycemic response.
• In general, eating foods that are raw and whole results in a lower glycemic response
than eating chopped, puréed, or cooked foods.
• Eating whole fruit instead of drinking juice decreases the glycemic response
because fiber in the fruit slows absorption.
• Adding foods with sugars to the diet may produce a lower glycemic response if
these foods are eaten with foods that are more slowly absorbed.

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 EXERCISE
Benefits
Exercise is extremely important in managing diabetes because of its effects on lowering blood glucose
and reducing cardiovascular risk factors.
Exercise lowers the blood glucose level by increasing the uptake of glucose by body muscles and by
improving insulin utilization.
Weight lifting, can increase lean muscle mass, thereby increasing the resting metabolic rate.
These effects are useful in diabetes in relation to losing weight, easing stress, and maintaining a feeling
of well-being.
Exercise also alters blood lipid levels, increasing levels of high-density lipoproteins and decreasing total
cholesterol and triglyceride levels

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 General Precautions for Exercise in Diabetics
• Use proper footwear and, if appropriate, other protective equipment.
• Avoid exercise in extreme heat or cold.
• Inspect feet daily after exercise.
• Avoid exercise during periods of poor metabolic control.

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