# Diabetes Mellitus --- **Diabetes Mellitus** is a [[disease]] where there is an problem in the body of regulating [[blood glucose|blood sugar]] levels in the body due to an inability to produce or effectively use [[insulin]], a hormone that allows cells to use the sugar. (Technically [[diabetes insipidus]] is a rare form of diabetes that doesn't actually affect insulin, but ADH. Basically everything in this note talks about the insulin kind, so disregard all of that for insipidus—it's its own thing.) Diabetes can be diagnosed from testing [[blood glucose|blood sugar]], but that's not always reliable, so an [[hemoglobin A1c]] test can be used to see how someone's blood sugars have been on average for the previous several weeks. They can also do something called an Oral Glucose Tolerance Test (OGTT) or do a [[urinalysis]] to test for sugar (sugar should be completely reabsorbed in the kidneys, unless it reaches the [[tubular reabsorption#Transport Maximum|transport maximum]], which it shouldn't be doing.) ## Complications A lot of the complications of diabetes arise from prolonged high blood sugar, which raises the viscosity of the blood, which over time damages the very small [[capillaries]] around the body. Another contributing factor is that high blood sugar increases [[hypertension|blood pressure]], which is also damaging over time. - Impaired [[oxygen saturation|perfusion]] is pretty much an all around problem, where the capillaries are damaged. - Impaired [[healing]] comes from this impaired perfusion, especially in the lower extremities. This is why sometimes an [[amputation]] has to happen to the toes, feet or even the whole leg. - **Diabetic retinopathy** is a condition where the capillaries of the [[eyes|retina]] become damaged and cause worsening vision or blindness. - [[Diabetic nephropathy]] is when the prolonged high blood pressure damages the [[kidneys]]. - **Peripheral neuropathy** is when you loose feeling in your extremities, caused when the capillaries supplying the nerves become damaged. - Factor in the impaired healing and it makes it very important for people with diabetes to take care of their feet. Some people can step on a nail and not even notice until they see a trial of blood, and then that wound takes forever to heal. - [[diabetic ketoacidosis]] or DKA when the body is forced to use non-carb sources for energy and all the ketone byproducts ## ABCs of Diabetes Control the **ABCs** of **diabetes control** are a set of steps one can take to manage their diabetes (all types). - [[hemoglobin A1c|A1c]] - Blood Pressure hyperosmotic - Healthy Cholesterol hyperlipidemia goes hand in hand as well ## Types - [[type 1 diabetes mellitus]], sometimes called **insulin-dependent** diabetes, is where the body cannot *produce* enough insulin, and patients rely on exogenous forms of insulin (i.e. shots) - type 1.5, kind of rare, let's not get into it right now. - [[type 2 diabetes mellitus]], sometimes called **insulin-resistant**, is where the body cannot effectively use the insulin it does produce, because it overproduces it quite often. - [[gestational diabetes]] is a diabetes that sometimes occurs when a person is pregnant, where the hormones of pregnancy make it hard for the body to take in insulin....I think this is to help get the baby plenty of sugar. - usually goes away but also puts you at higher risk for type 1 and type 2 ## Patient Education A diagnosis of diabetes is a pretty big deal, and involves lifestyle changes that will last for the patients entire life. [[health teaching|patient education]] should, as always, meet the patient where they are. **Level One**—Basic survival information: - [[blood glucose]] monitoring - [[insulin]] administration - home medication - hypoglycemia prevention **Level Two**—Additional information for home management - Diabetic diet management - Sick-day guidelines - Foot checks **Level Three**—Education to improve lifestyle - lifestyle - [[exercise]] - [[insulin]] adjustment - [[stress]] management ## Complications ![[lecture notes - DKA vs HHS.png]] in both: - [[hyperglycemia]] - loss of fluids - NA and K may be high, low or normal - swings in potassium is a big risk - cardiac [[arrhythmia]]s ___