Diabetes Mellitus

Front 1

Three Major Components of the endocrine system:

Back 1

Glands
Hormones
Receptors

Front 2

Endocrine Glands:

Back 2

Pineal gland
Hypothalamus
Pituitary gland

Thyroid gland
Parathyroid gland

Thymus gland

Adrenal glands

Pancreas

Gonads:
Ovaries & Testes

Front 3

What function does the Pancreas perform?

Back 3

It performs both endocrine (inward secretion) and exocrine (outward secretion) functions
Two pancreatic islets (islets of Langerhans), or hormone-producing areas, are evident among the pancreatic cells that produce the pancreatic digestive juice

Front 4

Alpha Cells of the pancreas perform what action?

Back 4

Secrete Glucagon
Glucagon raises blood sugar level (BSL)

Front 5

Beta Cells of the pancreas perform what action?

Back 5

Secrete Insulin
Insulin lowers blood sugar level (BSL) and allows sugar to move from blood to inside of cell

Front 6

Define Hypoglycaemia:

Back 6

Glucose is a necessary metabolic fuel for the brain and a constant supply is critical for normal neurological function. Low blood glucose levels (BGL) know as hypoglycaemia, is defined as <4.0 mmol/L and this can occur in patients with, or without a history of diabetes.

Front 7

Define Hyperglycaemia:

Back 7

Hyperglycaemia is defined as a blood glucose level (BGL) greater than 16 mmol/L. In the diabetic patient hyperglycaemia can present as Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycaemia syndrome (HHS).

Front 8

Definition of Diabetes Mellitus

Back 8

A disease in which the body cannot produce insulin or cannot use insulin to its fullest potential. It is characterised by high blood glucose levels

Front 9

Aetiology of Diabetes Mellitus

Back 9

There are 3 types - Type 1, Type 2 & Gestational Diabetes

Type 1 Diabetes Mellitus (IDDM)
is characterised by a loss of insulin producing beta cells of the islates of langerhans in the pancreas, leading to a defificentcy of insulin. The main cause is T-cell mediated autoimmune attack.

Type 2 Diabetes Mellitus (NIDDM)
Is characterised by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand.

Gestational Diabetes resembles type diabetes, involving a combination of inadequate insulin secretion and responsiveness. It occurs in about 2-5% of all pregnancies and may improve or disappear after delivery and 20-50% of these women develop type 2 diabetes later in life.
Untreated it can harm the mother and foetus, which include high birth weight, congenital heart disease, CNS abnormalities, skeletal muscle malformation, inhibit surfactant production and cause respiratory distress syndrome.

Front 10

Pathophysiology of Diabetes Mellitus

Back 10

Insulin is the principle hormone that regulates uptake of glucose from the blood into most cells. Insulin is released into the blood by beta cells found in the islates of langerhans in the pancreas, in response to an increased BSL after eating.

Insulin is also the principle control signal for conversion of glucose to glycogen for internal storage in the liver.

The hormone glucagon acts in the opposite manner to insulin, by conversion of glycogen to glucose when glucose levels fall.

The effects of insulin insufficiency of insulin resistance is high levels of blood glucose.

Front 11

Methods of controlling Type 2 diabetes

Back 11

it is usually first treated by increasing physical activity, decreasing carbohydrate intake, losing weight & treatment with oral anti-diabetic drugs.

Oral medication may eventually fail due to further impairment of beta cells insulin secretion, at this point insulin therapy is necessary to maintain normal or near normal glucose levels.

Front 12

Acute and chronic complications commonly associated with diabetes mellitus

Back 12

Acute complications include hypoglycaemia, ketoacidosis or hyperglycaemia if the disease is not adequately controlled

Chronic complications include cardiovascular disease, chronic renal failure, retinal damage (which can lead to blindness), nerve damage, and microvascular damage, which may cause impotence and poor healing.

Front 13

Signs and Symptoms of Hypoglycaemia

Back 13

Irritability or aggressive behaviour
Tachycardia with a bounding pulse
pale, cold, clammy skin
BSL <4
Occasional unconsciousness
behaviour mimicking intoxication or CVA
Weakness, headache
lack of coordination
seizure

In children hypoglycaemia may be a presenting feature of illness and may manifest simply as lethargy with a history of poor feeding.

Front 14

Signs and Symptoms of hyperglycaemia

Back 14

Fever
nausea, vomiting
deep, rapid respirations, fruity odour on breath
excessive thirst
dehydration
tachycardia
BSL>16 mmol/L

Front 15

Treatment for hypoglycaemia

Back 15

Basic Cares
O2
Able to take oral glucose - glucose gel
Unable to take oral glucose - Glucagon IM/ Glucose 10% IV

Front 16

Treatment for hyperglycaemia

Back 16

Basic Cares
O2
IV Access
Hartman's if dehydrated
notify receiving facility
Transport to definitive care