Diabetes mellitus

16. glycosylated hemoglobin test or HbA1c.
Glucose molecules in the blood normally become attached to
hemoglobin molecules –
hemoglobin will then become glycosylated (HbA1c).
When blood sugar becomes higher, more of the hemoglobin
becomes glycosylated.
The glucose remains attached to the hemoglobin for the life of
the red blood cell, or about 2 to 3 months..
The glycosylated hemoglobin test shows what a person's
average blood glucose level was for the 2 to 3 months before
the test.

20. For a quick blood sugar boost , during hypoglycemia:
1.a piece of fruit, like a banana, apple, or orange.
2.2 tablespoons of raisins.
3.15 grapes.
4.1/2 cup apple, orange, pineapple, or grapefruit
juice.
5.1/2 cup regular soda (not sugar-free)
6.1 cup fat-free milk.
7.1 tablespoon honey or jelly.
8.15 Skittles.

21. DIABETES MELLITUS
Type 1 DM
90% of cases immune related
Destruction in pancreatic B cells
IDDM, juvenile onset
Type 2 DM
Encompasses > 90% of diabetics
80% are obese
Circulating endogenous insulin is insufficient for needs
NIDDM, adult onset

23. DIABETES MELLITUS – TYPE 1
• Polyuria, polydipsia, polyphagia
• Paresthesias may be present at diagnosis
• Particularly subacute presentation
• Temporary and clear with insulin replacement
• Ketoacidosis
• With stress or withdrawal of insulin
• Exacerbates dehydration and hyperosmolality
• Anorexia, nausea and vomiting
• Altered level of consciousness
• Depends upon degree of hyperosmolality

25. DIABETES MELLITUS – TYPE 2
• Greater risk with increased age
• Usually > age 40
• Increased incidence in young people
• 90% concordance with identical twins
• There is a relative deficiency of insulin
• Large incidence of insulin resistance
• Nonketotic hyperglycemia with stress
• Can at times develop ketoacidosis

26. DIFFERENCE BETWEEN TYPE 1 AND
TYPE 2

29. DIABETES MELLITUS - PRESENTATION
Type 1 Type 2
Polyuria and thirst ++ +
Weakness or fatigue ++ +
Polyphagia with weight loss ++ -
Recurrent blurred vision + ++
Vulvovaginitis or pruritus + ++
Peripheral neuropathy + ++
Nocturnal enuresis ++ -
Often assymptomatic - ++

57. DIABETES MELLITUS
• Somogyi Effect
• Nocturnal hypoglycemia leads to release of
counterregulatory hormones
• Hyperglycemia by morning
• Must decrease evening insulin dose
• Dawn Phenomenon
• Reduced tissue sensitivity to insulin usually between
5am and 8am
• Leads to early morning hyperglycemia
• Increase evening insulin dose

58. •If the blood sugar level is low at 2 a.m. to 3 a.m.,
suspect the Somogyi effect.
•If the blood sugar level is normal or high at 2 a.m. to 3
a.m., it's likely the dawn phenomenon.

71. Diabetic ketoacidosis (DKA)

72. 4 MOST COMMON SIGNS OF DKA

86. 1.Risk for Unstable Blood Glucose Level
2.Deficient Knowledge
3.Risk for Infection
4.Risk for Disturbed Sensory Perception
5.Powerlessness
6.Risk for Ineffective Therapeutic Regimen
Management
7.Risk for Injury
8.Imbalanced Nutrition: Less Than Body
Requirements
9.Risk for Deficient Fluid Volume
10.Fatigue
11.Risk for Impaired Skin Integrity

87. Pancreas transplantation is the only
method that can offer normal blood sugar
control long-term because it replaces the
insulin secreting beta cells found in the
pancreatic islets.

88. Types of Pancreas
Transplant
Pancreas Transplant Alone
(PAT)
Simultaneous Pancreas and Kidney
Transplantation (SPK)
Pancreas After Kidney Transplantation
(PAK)

89. Con’t
Islet after Kidney Transplant – no surgical
procedure
Islet Transplant – no surgical procedure
but requires Immunosuppresant

90. Pancreas Transplant Alone (PAT)
 Candidates are patients who are suffering from frequent life-
threatening hypoglycemic attacks, night-time hypoglycemic
unawareness, extreme fluctuations in blood sugar levels or
rapidly worsening diabetic complications such as retinopathy,
neuropathy and gastroparesis.
for long-term immunosuppressive therapy with its associated
side effects including worsening kidney function.
offered to diabetic patients who have normal or near-normal
kidney function so as not to cause premature kidney failure.

92. Simultaneous Pancreas and Kidney
Transplantation (SPK)
 with severe kidney disease with less than 20 percent of
function or who are on dialysis are eligible to receive a
kidney and pancreas transplant at the same time from
the same deceased donor.
 Provide many years of kidney and pancreas graft
survival.
 Patients in need of both pancreas and kidney
transplants receive priority on the waiting list.

93. Pancreas After Kidney Transplantation
(PAK)
 undergone a successful kidney transplant but continue to
suffer from progressive diabetic complications or worsening
glucose control, a subsequent pancreas transplant is a
viable option to become insulin-independent.
 For patients who both need pancreas and kidney
transplants
 kidney transplant is done first to stop / prevent the need for
dialysis.
 With improved long-term function of the donated kidney.

94. Islet after Kidney Transplant – no surgical
procedure

95. islet transplantation

101. /

109. ?