1. Diabetes Mellitus Overview
“Jeopardy”
Diabetes Mellitus
Overview
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2. OVERVIEW OF DIABETES MELLITUS
Definition
Chronic multisystem disease
Abnormal insulin production
Impaired insulin utilization
Both
Prevalence
In USA 20.8 m or 7% population
41 m have pre-diabetes
Over 6 m undiagnosed
5th leading cause of death/likely unreported
Long Term Complications
Leading cause of adult blindness, ESRD, and nontraumatic lower limb amputation
73% of adults with diabetes have hypertension
Heart disease death rates 2-4 times higher in adults with diabetes
Stroke risk is 2-4 higher among people with diabetes

3. ETIOLOGY AND PATHOPHYSIOLOGY
Current Theories
Genetic
Autoimmune
Viral
Environmental factors ( e.g. stress)
Primarily a disorder of glucose metabolism
Absent insulin supply
Insufficient insulin supply
Poor utilization of available insulin

4. ETIOLOGY AND PATHOPHYSIOLOGY CONT’D
Common classification of diabetes mellitus
Type I
Long-standing process body’s T-cells attack and destroy pancreatic beta cells
Occurs in people under 30 y/o(juvenile onset)
Auto antibodies to the islet cells cause 80-90% reduction of normal beta cell function
Genetic predisposition(HLA) and/or viral exposure
idiopathic
Type 2
Account for > 90% of patients with diabetes
Usually occurs in people over 35 y/o
80 -90% are over weight at time of diagnosis
Epidemic childhood obesity/ type 3 diabetes seen in children
Prevalence increases with age; ½ people diagnosed are over 55 y/o
Prevalence greater in some ethnic groups: African Amer., Asian Amer., Hispanic Amer., Native Amer.
Pancreas continues to produce some endogenous insulin; however insulin produced is insufficient or poorly utilized
Probably genetic bases, tendency to run in families
Four major metabolic abnormalities: insulin resistance, decreased endogenous insulin, inappropriate glucose development by the liver, and alteration in hormone production by adipose tissue

5. ETIOLOGY AND PATHOPHYSIOLOGY CONT’D
Pre-diabetes
Blood glucose levels are higher than normal, > 100 mg/dl; but not high enough to be diagnosed as diabetes, < 126 mg/dl when fasting
Most at risk of developing type 2 diabetes which usually develops in 10 years in the absence of lifestyle changes
Long-term damages to the body, especially heart and blood vessel may occur
Lifestyle changes can reduce the risk of diabetes
Gestational
Develops during pregnancy; occurs in 4 % of pregnancies
Detected at weeks of gestation; OGTT
Higher risk of cesarean delivery,, perinatal death, and neonatal complications
Normal blood glucose levels within 6 wks; increased risk of developing type 2 diabetes in 5-10 years
Secondary
Occurs due to another medical condition or treatment for a medical condition
Affects the function of the pancreas
Usually resolves when underlying condition is treated
Common classification of diabetes mellitus

6. CLINICAL MANIFESTATIONS
Type 1 Diabetes Mellitus
Polyuria
Polydipsia
Polyphagia
Weight loss
Fatigue
Ketoacidosis

7. CLINICAL MANIFESTATIONS
Type 2 Diabetes Mellitus
Often nonspecific
Appear gradually
Fatigue
Recurrent infections
Recurrent vaginal yeast/ Monilia infections
Prolonged wound healing
Visual changes

8. Clinical Manisfestations4
Overview1
Etiology & Patho2
3Types
Clinical Manisfestations4 1 2 3 4 5
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9. Overview : 1 point
Diabetes Mellitus is a chronic multisystem disease related to?
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What is abnormal insulin production, impaired insulin utilization or both ?

10. Overview : 2 points Describe the effect that DM has on Americans.
What is the fifth leading cause of death in the USA?

11. Overview : 3 points What are the long term complications of DM?
What is leading cause of adult blindness, end-stage renal disease, and nontraumatic lower limb amputation?

12. What is heart disease and stroke?
Overview : 4 points
Diabetes Mellitus is a major contributing factor for what other health problems?
What is heart disease and stroke?

13. What is two to four times higher among people with DM?
Overview: 1 point
What is the risk for stroke among persons with diabetes mellitus?
What is two to four times higher among people with DM?

14. Etiology: 2 points Current theories link the cause of diabetes ?
What is singly or in combination to genetics, autoimmune, viral and environmental factors (e.g. stress) ?

15. Etiology: 3 points Diabetes is primarily a disorder of ____?
What is glucose metabolism related to absent or insufficient insulin and/or poor utilization of available insulin?

16. What is the beta cells in the islet of Langerhans of the pancreas ?
Etiology: 4 points
Insulin is a hormone produced by______?
What is the beta cells in the islet of Langerhans of the pancreas ?

17. Etiology : 5 points
Under normal conditions, insulin is released in small pulsatile increments to stabilize the blood glucose levels at_____?
What is glucose range of approximately mg/dl (3.9 to 6.66 mmol/L) ?

18. What is glucagon, epinephrine, growth hormone and cortisol?
Etiology: 1 point
Other hormones work to oppose insulin and are referred to as counterregulatory hormones.
What is glucagon, epinephrine, growth hormone and cortisol?

19. Types of DM: 2 points
Formerly known as” juvenile onset” or “insulin-dependent” diabetes and most often occurs in people who are under age 30 years ?
What is type I diabetes?

20. Types of DM: 3 points
A condition in which blood glucose levels are higher than normal, > 100 mg/dl, but < 126 mg/dl when fasting , but not high enough for a diagnose of diabetes?
What is Prediabetes, also know as impaired glucose tolerance (IGT) or impaired fasting glucose?

21. What is type 2 diabetes mellitus?
Types of DM: 4 points
The most prevalent type of diabetes, accounting for over 90% of patients with diabetes?
What is type 2 diabetes mellitus?

22. What is gestational diabetes?
Types of DM: 5 points
It is detected at weeks of gestation, usually following an oral glucose tolerance test (OGTT) ?
What is gestational diabetes?

23. Types of DM: 1 point Secondary diabetes occurs in some people because?
What is another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels?

24. Clinical Manisfestation: 2 points
Rapid onset of type I diabetes initial manifestations are?
What are polyuria, polydipsia and polyphagia?

25. Clinical Manisfestation: 3 points
Often nonspecific and gradual onset of clinical manifestations for type 2 diabetes mellitus ____?
What is fatigue , recurrent infections, recurrent yeast or Monilia infections, prolonged wound healing and visual changes?

26. Clinical Manisfestation: 4 points
Clinical manifestations as a result of diagnostic studies for diabetes mellitus?
What is measurement of glycosylated hemoglobin, also known as hemoglobin A1C?

27. Clinical Manisfestation: 5 points
According to the American Diabetes Association a clinical manifestation of A1C of _____ is recommended ?
What is 7.0% or less for people with diabetes?

28. Daily Double! 10
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Computer Resource Specialist, Virginia Beach City Public Schools
Adjunct Professor, Tidewater Community College
As a team, decide how many of the points you already have you wish to wager. If you get the question correct, you will earn double the points you wagered. If you get the question incorrect, you will lose the points you wagered. Good luck!

29. Reference
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., O’Brien, P. G., and Bucher, L. (2007).Medical-surgical nursing: Assessment and management of clinical problems. St. Louis, Missouri: Mosby Elsevier