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Title:

Diabetes

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Diabetes Mellitus. Metabolic disease. Characterized by ... Type II Diabetes. Inadequate insulin production. Increased tissue resistance to insulin effects ... – PowerPoint PPT presentation

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Title: Diabetes


1
Diabetes
  • Temple College
  • EMS Professions

2
Glucose
  • Required as fuel for cellular metabolism
  • Brains need for glucose parallels its demand for
    oxygen

3
Insulin
  • Hormone
  • Produced by Islets of Langerhans in pancreas
  • Required for sugar to enter most cells
  • Brain does not require insulin to use sugar

4
Pancreas
  • Located in retroperitoneal space
  • Produces, releases
  • Digestive enzymes into duodenum
  • Insulin, glucagon into blood

5
Islets of Langerhans
  • Alpha cells
  • Glucagon
  • Raises blood sugar
  • Beta cells
  • Insulin
  • Lowers blood sugar

6
Diabetes Mellitus
  • Metabolic disease
  • Characterized by inadequate, absent insulin
    production

7
Type I Diabetes
  • No insulin production
  • Takes insulin injections

8
Type II Diabetes
  • Inadequate insulin production
  • Increased tissue resistance to insulin effects
  • Controlled with
  • Diet
  • Oral medications
  • Diabeta, Diabinese, Dymelor, Glucotrol,
    Micronase, Orinase, Tolinase, Glucophage
  • Insulin injections as disease progresses

9
Problems in Diabetes
10
Blood Sugar Imbalance
  • Hyperglycemia
  • Diabetic ketoacidosis (DKA)
  • Hyperosmolar coma
  • Hypoglycemia

11
Hyperglycemia
  • Causes
  • Failure to take insulin
  • Overeating, eating wrong diet
  • Stress (fever, infection, emotional stress)

New-onset diabetics usually present with an
episode of hyperglycemia
12
Diabetic Ketoacidosis
  • Usually Type I diabetic (no insulin)
  • Blood sugar rises
  • Kidneys try to remove excess sugar
  • Urine production increases (polyuria)
  • Patient becomes volume depleted
  • Thirst (polydypsia)
  • Tachycardia
  • Hypotension
  • Dry skin, mucous membranes

13
Diabetic Ketoacidosis
  • Cells cannot burn sugar patient experiences
    hunger (polyphagia)
  • Cells burn fat as alternative fuel
  • Acidic ketone bodies produced
  • Patient tries to correct acidosis exhales CO2
  • Rapid, deep breathing (Kussmaul respirations)
  • Exhaled ketone bodies produce nail-polish remover
    or fruity breath odor

14
Diabetic Ketoacidosis
  • Volume depletion
  • Ketone body production (ketoacidosis)

15
Hyperosmolar Coma
  • Usually Type II diabetic (inadequate insulin)
  • Blood sugar rises
  • Kidneys try to remove excess sugar
  • Urine production increases (polyuria)
  • Patient becomes volume depleted
  • Thirst (polydypsia)
  • Tachycardia
  • Hypotension
  • Dry skin, mucous membranes

16
Hyperosmolar Coma
  • Cells continue to burn sugar
  • Acidic ketone bodies not produced
  • Nail-polish remover or fruity breath odor not
    present

17
Hyperosmolar Coma
  • Severe volume depletion
  • NO ketone body production

18
Hyperglycemia
  • Management
  • Support ABCs
  • Treat for hypovolemic shock
  • Transport
  • When in doubt, give sugar!

19
Hypoglycemia
  • Causes
  • Insulin overdose
  • Normal insulin use without eating
  • Over-exercise

20
Hypoglycemia
Pale, cool skin sweating nausea tachycardia
Is that why hypoglycemia sometimes is called
Insulin Shock?
21
Hypoglycemia
  • Insulin shock isnt really shock
  • Patient just looks shocky because of
    epinephrine adrenals are releasing

22
Hypoglycemia
  • Can occur in non-diabetics
  • Most common cause EtOH on
    empty stomach
  • A patient is never, just drunk

23
Hypoglycemia Management
  • Conscious patient
  • Give sugar orally
  • Unconscious patient
  • Support ABCs
  • Get ALS back-up for IV glucose
  • When in doubt, Give Sugar!

24
Ask All Diabetics
  • Have you eaten today?
  • Have you taken your medication today?
  • When in doubt, give Sugar!

25
Other Diabetes Complications
  • Atherosclerosis
  • Myocardial infarction
  • CVA
  • Peripheral vascular disease
  • Blindness
  • Renal failure

26
Other Diabetes Complications
  • Diabetic Neuropathy
  • Gangrene
  • Increased silent myocardial infarction risk

27
Silent MI
  • Acute MI in diabetic can present without chest
    pain
  • May resemble flu
  • Manage sick diabetics as if critically ill
    until proven otherwise
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