1. Type 1
   1. What is type 1 diabetes mellitus?
      1. no insulin production
      2. caused by an autoimmune response that attacks beta cells
   2. What are the risk factors of T1DM?
      1. Genetics
      2. Family History
   3. What are the characteristics of T1DM?
      1. early onset
      2. weight loss
      3. thin at diagnosis
      4. glycosuria
   4. What are the treatments for T1DM?
      1. insulin
   5. What are the symptoms of T1DM?
      1. sudden onset
      2. 3 P's
         1. polyuria
         2. polydipsia
         3. polyphagia
      3. Sudden weight loss
      4. Ketoacidosis
      5. Glycosuria
      6. Fatigue
      7. Weakness
      8. Vision changes
      9. DKA
2. Type 2
   1. What is T2DM?
      1. the body does not produce enough insulin
      2. the insulin that is produced is not effective
   2. What are the risk factors of T2DM?
      1. Family hx
      2. Obesity
      3. Inactivity
      4. Age
      5. HTN
      6. High HDL and cholesterol
   3. What are the characteristics of T2DM?
      1. gradual onset
      2. diagnosed in adulthood usually
   4. What are the treatments for T2DM?
      1. exercise
      2. diet
      3. oral antidiabetics (metformin)
      4. maybe insulin
   5. What are the symptoms of T2DM?
      1. slow onset
      2. may have the 3 P's
      3. fatigue
      4. weakness
      5. vision changes
      6. numb hands or feet
      7. dry skin
      8. frequent infections
      9. vaginal yeast infections
3. What are the diagnosis criteria for diabetes?
   1. 3 P's
   2. Unexplained weight loss (type 1)
   3. fasting BG 126+ mg/dL
      1. no caloric intake for 8 hours
   4. random BG of 200+
   5. hgbA1C 6.5% +
      1. blood sugar over the past 3 months
4. Medical Management
   1. How does nutrition therapy affect DM?
      1. Weight loss
      2. Reduces calories
      3. Reduces BP
      4. Reduces lipids
   2. How does exercise affect DM?
      1. ↓BG
      2. ↓ cardio risk factors
      3. make sure they have a snack and BG monitor → hypoglycemia
   3. Monitor
      1. frequent monitoring of BG
         1. When should they check their BG?
            1. before meals
            2. before snacks
            3. before bedtime
      2. Frequent monitoring of ketones
   4. Pharmacological
      1. What kind of drugs are used for T2DM?
         1. Oral antidiabetics (metformin)
      2. What kind of drugs are used for T1DM?
         1. Insulin
5. Hypoglycemia
   1. What are the lab values for hypoglycemia?
      1. BG less than 70 mg/dL
      2. Severe: less than 40 mg/dL
   2. What are the sx of mild hypoglycemia?
      1. diaphoresis
      2. tremor
      3. tachy
      4. palpitations
      5. nervousness
      6. hunger
   3. What are the sx of moderate hypoglycemia?
      1. poor concentration
      2. headache
      3. lightheaded
      4. confusion
      5. slurred speech
      6. double vision
      7. drowsy
   4. What are the sx of severe hypoglycemia?
      1. seizure
      2. LOC
      3. coma
      4. death
   5. What is the treatment for hypoglycemia in an alert pt?
      1. 15-20 G of a fast acting carb
         1. wait 15 minutes
            1. 15 g of carb + protein
   6. What is the treatment for hypoglycemia in an unconscious patient? (home setting)
      1. 1 mg of glucagon IM
         1. regains consciousness in about 20 minutes
   7. What is the treatment for hypoglycemia in an unconscious patients? (hospital setting)
      1. 20-50cc of D50 IV push
         1. regains consciousness in about 5 minutes
6. Insulin Therapy
7. Long Term Complications
   1. What organs are affected by DM?
      1. cardiovascular
         1. How is the CV system affected by DM?
            1. ↑MI
            2. ↑CAD
            3. ↑TIA
            4. ↑strokes
            5. ↑PAD
      2. renal
         1. How is the renal system affected by DM?
            1. excessive BG can damage the tiny blood vessels in the glomeruli
            2. this can leak to ESKD
      3. neuro
         1. How is the nervous system affected by DM?
            1. excessive BG damages the blood vessels and makes then stiff, which can lead to a stroke
            2. Peripheral Neuropathy
            3. tingling, numbness, and loss of sensation in the feet especially
            4. !FOOT CARE!
      4. eyes
         1. How does are the eyes affected by DM?
            1. Diabetic Retinopathy
            2. excessive BG damages blood vessels of the retina
            3. blindness, cataracts, glaucoma
8. What are some considerations for a diabetic patient undergoing surgery?
   1. periods of stress = higher BG
   2. Pre-op
      1. frequent BG monitoring
      2. insulin held for BG less than 200
   3. NPO
      1. dextrose to prevent hypoglycemia
      2. try to get then off NPO as soon as possible
   4. increased risk of infection and slow wound healing
9. What are some considerations for a diabetic patient who is hospitalized?
   1. hyperglycemia due to stress
   2. prolonged stay
   3. increased infection risk
   4. increased mortality
10. Insulin Therapy
    1. How does insulin affect the body?
       1. promotes glucose uptake by cells
       2. provides glucose storage as glycogen
       3. prevents fat + glycogen breakdown
       4. increases protein synthesis
    2. What are the types of Insulin?
       1. Rapid Acting
          1. What is an example of rapid acting insulin?
             1. Lispro
             2. Onset within 15-30 minutes
             3. Peak is around 30 min-2.5 hrs
             4. Duration is 3-6 hrs
       2. Short Acting
          1. What is an example of short acting Insulin?
             1. Regular
             2. can be given IV!
             3. given 15 min before a meal
       3. Intermediate Acting
          1. What is an example of intermediate acting insulin?
             1. NPH
             2. onset 1-2 hrs
             3. peak 6-14 hrs
             4. duration is 16-24 hrs
       4. Very long Acting
          1. What is an example of very long acting insulin?
             1. Glargine and Detemir
             2. "peakless"
             3. absorbed over 18-24 hrs
             4. CANNOT BE MIXED!
    3. What is the insulin sliding scale?
       1. BG-100/given #