Diabetes Mellitus Nursing notes
Description
▪ Diabetes is a chronic disease, which occurs when the pancreas does not
produce enough insulin, or when the body cannot effectively use the insulin it
produces. This leads to an increased concentration of glucose in the blood
(hyperglycaemia).
▪ Type 1 diabetes (previously known as insulin-dependent or childhood-onset
diabetes) is characterized by a lack of insulin production.
▪ Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes)
is caused by the body’s ineffective use of insulin. It often results from excess
body weight and physical inactivity.
▪ Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.
Causes
The cause of diabetes depends on the type.
Type 1 diabetes
▪ Is partly inherited, and then triggered by certain infections, with some evidence
pointing at Coxsackie B4 virus. A genetic element in individual susceptibility to
some of these triggers has been traced to particular HLA genotypes (i.e., the
genetic “self” identifiers relied upon by the immune system). However, even in
those who have inherited the susceptibility, type 1 DM seems to require an
environmental trigger. The onset of type 1 diabetes is unrelated to lifestyle.
Type 2 diabetes
▪ is due primarily to lifestyle factors and genetics.
The following is a comprehensive list of other causes of diabetes:
▪ Genetic defects of β-cell function
▪ Maturity onset diabetes of the young
, ▪ Mitochondrial DNA mutations
▪ Genetic defects in insulin processing or insulin action
▪ Defects in proinsulin conversion
▪ Insulin gene mutations
▪ Insulin receptor mutations
▪ Exocrine pancreatic defects
▪ Chronic pancreatitis
▪ Pancreatectomy
▪ Pancreatic neoplasia
▪ Cystic fibrosis
▪ Hemochromatosis
▪ Fibro calculous pancreatopathy
▪ Endocrinopathies
▪ Growth hormone excess (acromegaly)
▪ Cushing syndrome
▪ Hyperthyroidism
▪ Pheochromocytoma
▪ Glucagonoma
▪ Infections
▪ Cytomegalovirus infection
▪ Coxsackievirus B
▪ Drugs
▪ Glucocorticoids
▪ Thyroid hormone
▪ β-adrenergic agonists
▪ Statins
TYPE I VERSUS TYPE 2 DIABETES
PE I (IDDM) TYPE 2 (NIDDM)
Age of onset Usually younger than 40 Usually older than 40
Body weight Thin Usually overweight
Symptoms Sudden onset Insidious onset
Insulin produced None Too little, or not effective
Insulin requirements Exogenous insulin required May require insulin
Pathophysiology
Description
▪ Diabetes is a chronic disease, which occurs when the pancreas does not
produce enough insulin, or when the body cannot effectively use the insulin it
produces. This leads to an increased concentration of glucose in the blood
(hyperglycaemia).
▪ Type 1 diabetes (previously known as insulin-dependent or childhood-onset
diabetes) is characterized by a lack of insulin production.
▪ Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes)
is caused by the body’s ineffective use of insulin. It often results from excess
body weight and physical inactivity.
▪ Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.
Causes
The cause of diabetes depends on the type.
Type 1 diabetes
▪ Is partly inherited, and then triggered by certain infections, with some evidence
pointing at Coxsackie B4 virus. A genetic element in individual susceptibility to
some of these triggers has been traced to particular HLA genotypes (i.e., the
genetic “self” identifiers relied upon by the immune system). However, even in
those who have inherited the susceptibility, type 1 DM seems to require an
environmental trigger. The onset of type 1 diabetes is unrelated to lifestyle.
Type 2 diabetes
▪ is due primarily to lifestyle factors and genetics.
The following is a comprehensive list of other causes of diabetes:
▪ Genetic defects of β-cell function
▪ Maturity onset diabetes of the young
, ▪ Mitochondrial DNA mutations
▪ Genetic defects in insulin processing or insulin action
▪ Defects in proinsulin conversion
▪ Insulin gene mutations
▪ Insulin receptor mutations
▪ Exocrine pancreatic defects
▪ Chronic pancreatitis
▪ Pancreatectomy
▪ Pancreatic neoplasia
▪ Cystic fibrosis
▪ Hemochromatosis
▪ Fibro calculous pancreatopathy
▪ Endocrinopathies
▪ Growth hormone excess (acromegaly)
▪ Cushing syndrome
▪ Hyperthyroidism
▪ Pheochromocytoma
▪ Glucagonoma
▪ Infections
▪ Cytomegalovirus infection
▪ Coxsackievirus B
▪ Drugs
▪ Glucocorticoids
▪ Thyroid hormone
▪ β-adrenergic agonists
▪ Statins
TYPE I VERSUS TYPE 2 DIABETES
PE I (IDDM) TYPE 2 (NIDDM)
Age of onset Usually younger than 40 Usually older than 40
Body weight Thin Usually overweight
Symptoms Sudden onset Insidious onset
Insulin produced None Too little, or not effective
Insulin requirements Exogenous insulin required May require insulin
Pathophysiology
