Care of Clients with Diabetes Mellitus

Review of Anatomy and Physiology

PANCREAS

HORMONES:
 INSULIN BY BETA CELLS
 GLUCAGON BY ALPHA CELLS

Pancreas secretes 40-50 units of insulin daily in two steps:

 Secreted at low levels during fasting ( basal insulin secretion)
 Increased levels after eating (prandial)
 An early burst of insulin occurs within 10 minutes of eating
 Then proceeds with increasing release as long as hyperglycemia is
present

Insulin
 Insulin allows glucose to move into cells to make energy
 Inhibits glucagon activity

Insulin (normal values)

CPG <200 mg/dL

FPG <100 mg/dL

OGTT <140 mg/dL

HbA1c <5.7%
DIABETES MELLITUS is a chronic disorder of carbohydrate, protein, and
fat metabolism resulting from insulin deficiency or abnormality in the use
of insulin.

Epidemiology
 The number of people with diabetes has risen from 108 million in
1980 to 422 million in 2014.
 The global prevalence of diabetes* among adults over 18 years of
age has risen from 4.7% in 1980 to 8.5% in 2014 (1).
 Diabetes prevalence has been rising more rapidly in middle- and low-
income countries.
 Diabetes is a major cause of blindness, kidney failure, heart attacks,
stroke and lower limb amputation.
 In 2016, an estimated 1.6 million deaths were directly caused by
diabetes. Another 2.2 million deaths were attributable to high blood
glucose in 2012**.
 Almost half of all deaths attributable to high blood glucose occur
before the age of 70 years. WHO estimates that diabetes was the
seventh leading cause of death in 2016.
 Healthy diet, regular physical activity, maintaining a normal body
weight and avoiding tobacco use are ways to prevent or delay the
onset of type 2 diabetes.
 Diabetes can be treated and its consequences avoided or delayed
with diet, physical activity, medication and regular screening and
treatment for complications.
TYPE I
 Formerly known as INSULIN DEPENDENT DIABETES MELLITUS
(IDDM)
 Auto immune (Islet cell antibodies)
• Early introduction of cow’s milk and cereals
• Intake of medicine during pregnancy
• Indoor smoking of family members
 Destruction of beta cells of the pancreas →little or no insulin
production
 Required daily insulin admin.
 May occur at any age, usually appears below age 15
TYPE II
 Formerly known as Non-Insulin Dependent Diabetes
 Probably caused by:
• Disturbance in insulin receptors in the cells
• Decreased number of insulin receptors
• Loss of beta β-cell responsiveness to glucose leading to slow or ↓
insulin release by the pancreas
• Occurs overage 40 but can occur in children
• Common in overweight or obese
• With some circulating insulin present, often do not require insulin

Other Specific Types

A. Genetic defects of β-cell function
B. Genetic defects in insulin action
C. Disease of the exocrine pancreas
D. Endocrinopathies
E. Drug or chemical induced
F. Infections
G. Uncommon forms of immune-mediated diabetes
H. Other genetic syndromes sometimes associated with diabetes

Gestational diabetes (GDM)

 A type of diabetes that is first seen in a pregnant woman who did not
have diabetes before she was pregnant.
 Some women have more than one pregnancy affected by gestational
diabetes.
 Gestational diabetes usually shows up in the middle of pregnancy.
Pre-Diabetes
 Impaired fasting glucose (IFG)
– FPG- 100-125mg/dL
 Impaired glucose tolerance
(IGT)
OGTT 140-199mg/dL
 • HbA1c 5.7-6.4%

Risk factors for type 1 diabetes

 Family history.
 Environmental factors. 
 The presence of damaging immune system cells (autoantibodies). .
 Geography. 

Risk factors for pre diabetes and type 2 diabetes

 Weight
 Inactivity.
 Family history.
 Race
 Age
 Polycystic ovary syndrome
 High blood pressure
 Abnormal cholesterol and triglyceride levels