NR566 Chapter 33 Complete Study Guide

CHAPTER 33: DIABETES MELLITUS

 Clinical S/Sx
o T1DM- abrupt, although insulin secretion decline begins long before the symptoms
develop.
 Classic manifestations (new onset):
 Polydipsia
 Polyuria
 Wt loss
 Hyperglycemia
 Ketonemia or ketonuria
 DKA = classic s/sx + fruity-smelling breath + drowsiness/lethargy + vomiting
 Silent (asymptomatic) incidental discovery

o T2DM
 Polydipsia
 Polyuria
 Hyperglycemia

 Risk Fx and Associated complications
o T1DM
 Genetic
 abnormalities at six genetic loci
 mutation of the hepatic transcription factor (HNFP-1 alpha) on
chromosome 12
 defective glucokinase molecule on chromosome 7p
 Autoimmune- destruction of islet cells -> beta cells destruction
 Environmental- toxins, food antigen, viral infection
 Race- idiopathic T1DM is common among African American or Asian American.

o T2DM
 Obesity
 Race- native americans, Asian americans, latinos, pacific islanders, african
americans
 Sedentary lifestyle
 Hypertension
 Dyslipidemia
 Family hx- 15% if both parents have T2DM
 Gestational hx
 Age
 Genetics- have strong influence- chromosome arm 7q – insulin resistance

o COMPLICATIONS (all types):
 Microvascular
 Eyes, heart, kidneys, nervous system
 Retinopathy with potential loss of vision
 Nephropathy leading to renal failure

,  Peripheral neuropathy with risk of:
o Foot ulcers
o Amputation
o Charcot’s joint
 Autonomic neuropathy with:
o GI, GU, CV s/sx
o sexual dysfunction may occur.


 Macrovascular
 Atherosclerotic conditions which increases the risk of HTN,
abnormalities in lipid metabolism, abnormalities of platelet function,
and periodontal disease:
o Cardiovascular
o Peripheral vascular
o Cerebrovascular

 Diagnostic Criteria
o Pre-diabetes
 BG too high to be considered normal BUT does not meet criteria for DM
 Impaired glucose tolerance (IGT) or Impaired fasting glucose (IFG)
 IFG 100-125 mg/dL
 IGT 140-199 mg/dL
 HbA1c 5.7% - 6.4%
 At risk for diabetes and CVDs and may have insulin-resistance syndrome

o T1DM and T2DM
 4 tests used:
 Acute symptoms of DM + casual plasma glucose ≥ 200mg/dL
 Fasting plasma glucose (FPG) >126 mg/dL- most reliable
 2-h post-load plasma glucose in an oral glucose tolerance test ≥
200mg/dL
 HbA1c ≥ 6.5%

 Tests should be:
 confirmed on a subsequent day, unless (+) overt clinical s/sx
 preferrable to confirm with the same test OR one that is considered
more predictive
 If a repeated test is below the diagnostic criteria -> REPEAT TEST in 3-
6months.