1. Type 2 DM Etiology – The pancreas cannot produce enough insulin for body ’ s needs – Impaired insulin secretion

2. Type 2 DM Weakened Beta cells Due to over use – High glucose intake – “ Insulin Resistance ” The target cells have decreased sensitivity to insulin

3. Risk Factors for Type 2 DM Family history Age Obesity Gestational diabetes or large baby Hypertension High fat diet Lack of exercise High carb. Diet

5. Insulin and Type 2 DM Don ’ t all require insulin 1/3 will at some time need to take insulin Seldom get Ketoacidosis (enough insulin to prevent high levels of fat metabolism)

6. Type 1 vs. Type 2 Etiology – Auto-immune – Idiopathic Age of onset – Usually < 30 Percent of diabetics – 5-10% Etiology – Overused/tired Age of onset – Usually > 40 Percent of diabetics 85-90%

7. Type 1 vs. Type 2 Onset – Rapid less than 1 yr Body wt at onset – Normal to thin Insulin production – None Insulin injections – Always Onset – Gradual – years Body wt at onset – 80% overweight Insulin production – Not enough Insulin injections – Sometimes

8. Type 1 vs. Type 2 Ketones – Children/adolescence – Stress – Pregnancy Management – Insulin – Diet – Exercise Ketones – Unlikely problem Management – Diet (wt. Loss) – Exercise – Possibly oral hypoglycemic meds – Possibly insulin

9. Gestational Occurs during pregnancy 2 nd -3 rd trimester Screening 24-28 weeks Extra metabolic demands triggers onset

10. GDM #1 complication  Macrosomia Controlled with diet and insulin (no oral meds) Generally glucose level return to normal after delivery Predisposes to – type 2 diabetes

11. What type of diabetes does Jonny have? Jonny is a 11 year old male child. He is a thin youth at 75 lbs and 4’6” tall. He suddenly became very ill and his mother brought him to the ER. He was complaining of weakness, nausea & vomiting and blurred vision. He reported having to urinate a lot. His vital signs were pulse:125; Respirations 28; BP: 80/40. – Type 1

12. NCLEX Question The antepartum patient is being routinely screened for gestational diabetes by administering 50 mg of glucose and testing the woman’s blood sugar in an hour. The patient asks for the normal glucose values an hour after taking the glucose. The nurse replies: A.“It should be less than 140 or we do further testing.” B.“Anything under 105 is acceptable.” C.“We like to see a result between 130 and 165.” D.“It is different for each individual.”

13. Other specific types of Diabetes Mellitus Beta-cell genetic defect Endocrinopathies Pancreatitis Cystic Fibrosis Drug or chemical induces diabetes (steroids)

14. S&S of Diabetes Mellitus Definition: – A group of disorders characterized by chronic Hyperglycemia 3 P ’ s – Polydipsia – Polyuria – Polyphagia

15. S&S of Hyperglycemia Neuro – Fatigue – C/O headache – Dull senses – Stupor – Drowsy – Loss of Consciousness – Blurred Vision

16. S&S of Hyperglycemia Cardiovascular – Tachycardia – Decreased BP – (Dehydration) Respirations – Kussmaul's respirations – Sweet and fruity breath – Acetone breath

17. S&S of Hyperglycemia Gastro-intestinal – Polyphagia – (Decreased hunger in late stages) – N/V – Abd. Pain – Polydipsia – Dehydration

18. S&S of Hyperglycemia Genital-urinary – Polyuria – Nocturia – Glycosuria Skeletal-muscular – Weak

19. S&S of Hyperglycemia Integumentary – Dry skin – Flushed face – Hypothermia

20. Small Group Questions Mr. McMillan is a 50 year old client brough into the ER with extreme fatigue and dehydration. After the MD sees him the nurses asks Mr. McMillan some additional questions. Based on the clients answers the nurse requests that the MD add a glucose level to the lab work. The results are 800mg/dL.

21. Small group questions What question did the nurse most likely ask? Why was Mr. McMillan fatigued? Why was he dehydrated?