 Hello and welcome to Nursing School Explained. Today we'll cover diabetes. So in general, diabetes is a metabolic disorder that causes the blood sugar levels in the body to rise because of lack of insulin. Now we have to distinguish between type 1 and type 2 diabetes, but in order to do that, let's first review the homeostasis of normal blood sugar control. So typically when the blood sugar rises, when we eat something, the beta cells of the pancreas secret insulin that's therefore released from the pancreas and the cells can then take up the glucose and excess glucose gets stored in the liver as glycogen. When all this happens, serum blood glucose levels decrease and we come back to homeostasis. Now in terms of low blood sugar, so for some reason the blood sugar goes low and that's for anybody, not just patients with diabetes. The alpha cells from the pancreas secret glucagon which causes the liver to release, that's what glycogen that we've put away earlier, in the process called gluconeogenesis and therefore blood sugar is raised and homeostasis is back in effect. So now for diabetes, there's basically a lack of insulin and the reason that that happens is different in type 1 and type 2. In type 1 diabetes we are dealing with an autoimmune disorder against the beta cells of the pancreas and sometimes it can be caused by a viral infection. And so the patient's body will attack its own pancreas and the beta cells and therefore they are unable to secret insulin. So now we have all that nice blood sugar floating around in the bloodstream but we don't have any insulin so that cell uptake is not happening and the glycogen cannot be stored either. So for type 1 diabetes, typically it's younger people but it can be also triggered at older so maybe people in their 20s and 30s and signs or symptoms are the three P's. Polyuria, Polydipsia and Polyphagia. So let's think about this. If we have these high levels of glucose circulating in the bloodstream and we have absolutely no insulin available because the beta cells have been destroyed in the pancreas, then the glucose will just circulate inside the bloodstream but that enzyme, that insulin that will usually help to drive it into the cell so it can be used for cellular metabolism or be stored in the liver is just not happening. So we have this thick glucose now that's circulating in the patient's bloodstream. Now the patient is going to be very hungry because they're not able to use the glucose that's circulating in the bloodstream, it just cannot enter the cells. Hence the polyphagia. Polydipsia because think about the blood of the patient becoming really thick saturated with glucose so it's going to be very thick and the patient is going to feel thirsty wanting to kind of thin out that blood by increasing their thirst and increasing their water consumption. And then because that happens so the blood is very thick full of glucose and then the kidneys are going to have to filter all that and the glucose molecules are pretty large molecules that can cause some damage at the kidney itself and we'll get into the complications later on. But also because those large molecules are circling in the bloodstream it's causing osmotic diuresis causing the patient to urinate a lot. So polyuria, polydipsia and polyphagia. Again think about what's happening in the body, what mechanism is disturbed in terms of pathophysiology and that way the signs and symptoms will make sense. Now because the patient is unable to absorb that glucose that's circulating in the bloodstream they're going to feel weak, they're going to have weight loss and they might go into ketoacidosis. And that is a process that happens when the cells are unable to break down the glucose that we take in by mouth. And now the body is looking for a different energy source and that can be fat or proteins or muscle that's been broken down and the byproduct here are fatty acids leading to ketoacidosis. So the treatment in type 1 diabetes because we absolutely have no insulin available is insulin. That's the only treatment for type 1s. Now complications for type 1 diabetes are hypoglycemia. So what if the blood sugar goes low and the patient has no insulin so we need to educate our patients for the signs and symptoms of that. As well as diabetes ketoacidosis, DKA, which I just explained over here and watch a separate video about DKA, how it happens and also treatment options for that. And then chronic complications will cover those a little bit more when we discuss type 2 diabetes. Now in type 2 diabetes, it's usually caused by family history, sedentary lifestyle, patients who are overweight or obese are at higher risk as well as poor diet. So this basically now the pancreas is working on overdrive. So this is not a pancreas that does not, the beta cells are still intact but because the beta, the pancreas is working on overdrive because of this continued intake of the poor diet sedentary lifestyle. So the glucose is not being taken up as normal and the pancreas is working on overdrive, overdrive, overdrive, eventually it'll just wear out. It might still secrete a little bit of insulin but not enough to break down all the glucose that's circulating in the bloodstream. And sometimes that means that the patient may not have any signs and symptoms. A lot of times diabetes type 2 is diagnosed on a regular physical exam when routine labs are drawn or if there's a suspicion, maybe there's a foot also that's not healing or there's a lot of polyuria, any of these symptoms going on. But that wouldn't be more in terms of the patient having complications already. Now for treatment for type 2 diabetes, there are many, many oral and injectable medications available. And I wrote down here Glucophage or Metformin which is typically used as the first line for newly diagnosed type 2 diabetic and then plus minus insulin. Depending on how well the beta cells of the pancreas are functioning still, the patient may or may not need insulin. Typically if the patient is newly diagnosed, they'll start them on one oral medication, maybe add a second one later, see how they're doing, monitor them. And then eventually if they're non-compliant then they might need insulin added to their medication regimen. Complications for acute is again hypoglycemia because that certainly can happen. And then HHS, Hyperosmotic Hyperglycemic Syndrome. And again watch the video where I compare DKA and HHS and discuss the pathophysiology and treatment of those. Chronic complications of diabetes and that applies to type 1 as well as type 2 are micro and macro vascular. So micro vascular affects the very, very small blood vessels of the kidneys, eyes and nerves. So that will be nephropathy, retinopathy and neuropathy. And that basically happens because there's these large glucose molecules that are circulating in the patient's bloodstream affecting the kidneys, the small blood vessels of the eyes as well as the nerves and can cause some damage there over time. And if really if it's been untreated, if the patient is constantly hyperglycemic, they might have kidney damage leading to end-stage renal disease requiring the patient on being on dialysis. Retinopathy can lead to blindness and then neuropathy can lead to other complications of the periphery, mostly the legs because the patient does not have the sensation that there's maybe hydro cold or sore that's developing and then they go untreated and then they have foot ulcer complications. And complications chronically also happen on a macro vascular level so that's more of the large blood vessels and that is because of this whole poor diet sedentary lifestyle over weight obesity plaque builds up. And those patients are at high risk for increased cholesterol as well and therefore those macro vascular complications include coronary artery disease, CVA stroke, MI heart attack and peripheral vascular disease. Now diagnostic tests for type 1, 2, 1 and 2 diabetes are the same. So there are basically three different or four different options. First of all is a fasting blood sugar of greater than 126 is a diagnosis of diabetes. Hemoglobin A1C greater than 6.5 and hemoglobin A1C is a blood test that monitors the molecule of A1C that's attached to the hemoglobin, so to the red blood cell that measures the average blood sugar over that life cycle of the red blood cell, so 120 days, three months. So the hemoglobin A1C gives us the good average to see how well has the patient been managing their diabetes over the last several months or three months. And the third option is a random blood glucose or a two hour oral glucose tolerance test greater than 200. And this is something that a lot of times they'll use in the obstetrical setting. If the mom is at risk for developing gestational diabetes because of other things, but for the most part fasting blood sugar hemoglobin A1C are typically the diagnostic tests that we look that we use. So now let's look at nursing care as it applies to diabetes. So educate with an exclamation mark. Patients with diabetes have a lot of educational needs because especially in type two there has been a life long history of these poor habits that we need to really emphasize lifestyle changes for them to be able to manage their diabetes and prevent those long term micro and macro vascular complications. So I wrote down here blood glucose controls or medications. All these different oral and injectable type two diabetes medications are going to have a plethora of different side effects and indications and things the patient has to watch out for. So education is going to be very important. They certainly need to alter or modify their diet. So heart healthy diet as well as increase their activity level. And we also need to encourage or educate the patients on how to manage their blood sugars during times of illness. That mostly pertains to type one diabetics because in times of illness blood sugar tip levels will typically increase. And so then there needs to be a plan on how to manage the diabetes so the patient can overcome the illness and get better sooner by managing the diabetes and the blood sugars and keeping them at a normal level. Certainly we have to educate the patients on signs and symptoms of low and high blood sugars. And there's a couple of mnemonics that I like. So for hypoglycemia it means cool and clammy. So that will be the signs and symptoms and a lot of times confusion. Cool and clammy needs some candy. And then for high blood sugar the acronym is hot and dry sugar high. So when the patient is sweating and they're kind of hot but they're hot and very dry and dehydrated. That's when the blood sugar is high because of all these reasons that we talked about here with the three Ps. Then they will require regular eye and foot exams to prevent these complications and make sure that measures are taken to prevent foot ulcers and eye damage and that can lead to blindness. As well as regular follow up visits not only to check the hemoglobin A1C but also to follow up on their kidney function. Because that's really one of the most detrimental complications if the patient has complete renal failure they will need to be placed on dialysis and that's a major, major impact on their lives. We also need to educate them to control their blood pressure and cholesterol levels. We'll educate them on medication side effects that we already discussed. As well as complications that diabetes can lead to. And then most patients will need to be on or will be on aspirin some sort of a hypertension medication and a statin. And that's pretty much standard of care because we know that typically over a long time long term diabetes can lead to these complications and to prevent them we want to make sure we get the patient's platelets a little bit thinned out so we alter the platelet function to decrease the risk of that plaque formation as well as control their blood pressure that's going to add to the risk of stroke and macrovascular complications and then statins again to control their cholesterol level. So thank you for watching this video on diabetes. Please also refer to the videos on diabetic ketoacidosis as well as hyperosmolar hyperglycemic syndrome which are the complications of type 1 and type 2 that can be pretty significant. Subscribe, share, also refer to my Instagram page at nursing school explained to follow up on any additional videos that I'll be posting. Thank you very much for watching nursing school explained. We'll see you next time.