Diabetes Mellitus

Question	Answer
What is Diabetes Mellitus?	A chronic endocrine disorder which affects the production and effectiveness of the hormone insulin.
Describe type 1	Autoimmune - it usually affects children and young people. No insulin is produced at all since the immune system destroys Beta cells in pancreas. Can only be controlled with Insulin injections.
Describe type 2	Acquired disease, usually over 40s - the insulin doesn't work, meaning both insulin and blood glucose will rise. Can be controlled with diet and medication such as Gliclazide and/or insulin
List the symptoms of diabetes	Excessive thirst & hunger Frequent urination (polyuria) Ketones on urinalysis Fatigue Weight loss
What tests are done for diabetes diagnosis?	Glucose tolerance test or HbA1C
Name both types of vascular complications	Microvascular affects small blood vessels Macrovascular affects large blood vessels
Name three types of microvascular conditions	Retinopathy - blurry vision and/or blindness Nephropathy - kidney disease Neuropathy - pain or tingling in the extremities (commonly in feet)
Name three types of macrovascular conditions	Cerebrovascular disease Coronary heart disease Peripheral vascular disease
Name three things that happen in diabetic retinopathy	Neovascularisation - new blood vessels are created. Microaneurisms and exudate - the blood vessels leak and/or burst, causing fluid to fill the vitreous humour interfering with light entering the eye. Cotton wool spots - nerve damage in the eye.
What process can newly diagnosed patients go through?	Grief process: Denial Anger Bargaining Depression Acceptance
What are "normal" blood glucose levels?	Between 4-7mmol/L
Describe the process of a hypo	Low blood glucose levels. In people with type 1, the insulin they've injected continues to work, even though blood glucose is too low.
Describe the symptoms of a hypo	Feeling shaky, sweating, hunger, tiredness , blurred vision, lack of concentration, headaches, feeling tearful, stroppy or moody, going pale
Name 3 things you can do to help a hypo	Give sugary drink or jelly babies if patient able to eat. Check bg levels after 10 mins Give more food with complex carbs, fruit or a sandwich.
What is a hyper?	Blood glucose levels are too high Blood glucose levels greater than 7.0 mmol/L when fasting Blood glucose levels greater 11.0 mmol/L 2 hours after meals
Name 4 potential causes for a hyper	Missing a dose of diabetic medication, tablets or insulin Eating more carbohydrates than body and/or medication can manage Being mentally or emotionally stressed (injury, surgery or anxiety) Infection
Name 4 signs of a hyper	Regular/above-average urination Weakness or feeling tired Increased thirst/hunger Vision blurring
Name 1 serious complication of a hyper	Diabetic Ketoacidosis
What is DKA and who does it affect?	Diabetic ketoacidosis (DKA) is a dangerous complication when the body starts running out of insulin. Particularly affecting people with type 1 diabetes, DKA may also affect those with type 2 diabetes.
What happens during DKA?	This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source, producing toxic ketones as a result of this.
Name 2 things to help diagnose DKA	High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. If levels are consistently above 15mmol/l should check for ketones. Ketones in the blood/urine. Ketones are easily detected by a simple urine or blood test, using strips available on prescription.
There are eight symptoms that show when someone is in DKA. Can you recall them all?	Frequently passing urine Thirst Feeling tired and lethargic Blurry vision Abdominal pain, nausea, vomiting Breathing changes (deep sighing breaths) Smell of ketones on breath (likened to smell of pear drops) Collapse/unconsciousness.
What 2 things are used to treat DKA?	Administering intravenous fluids to correct dehydration. Insulin is also required to instantly suppress the ketone bodies that the body manufactures. (these two are often titrated)
What 2 things must be considered when treating diabetic patients?	Cultural & religious beliefs (fasting during Ramadan, for example)
What factors can affect the care of a teenage patient?	Drugs and alcohol - uppers act as an appetite suppressant and combined with dancing leads to a severe hypo. Cannabis can stimulate the appetite leading to hypers.
Name 1 important resource in the treatment of diabetes	National Service Framework (NSF) for Diabetes in Wales (2002)
Name 4 key words in treatment and management of diabetes	High quality care Patient empowerment Quality of life NSF for Diabetes

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	Created by Kirsty Jayne Buckley over 8 years ago