This document discusses diabetes symptoms, diagnosis, and the difference between type 1 and type 2. It explains that diabetes is caused by the body's inability to properly use or produce insulin to control blood sugar levels. Common symptoms include lightheadedness, blurry vision, and hyperglycemia. Diagnosis involves testing the A1C level, which measures average blood sugar over time, and fasting plasma glucose. A diagnosis of diabetes is made if A1C is 6.5% or higher, fasting plasma glucose is 126 mg/dL or higher, or oral glucose tolerance test results meet or exceed the diagnostic threshold.

1. Diabetes Symptoms and
Diagnosis

2. Introduction to Diabetes
- Diabetes : group of disorders where the body’s ability to use and
control blood sugar is impaired
- Around 30 Million Adults in the US have diabetes
- ¼ of these people do not know they have diabetes
- Number of cases of diabetes in US has tripled in last 20 years
- In the US, it is the 7th Leading cause of death
- Leading cause of Kidney failure in US
https://www.cdc.gov/diabetes/basics/diabetes.html

3. Symptoms
- A sign of the existence of something, especially of an undesirable situation
- Used in all levels of health care: Nurses, Doctors, Techs and Mid-Level
Providers
- Learning how to pattern symptoms to diseases is a staple of health care

4. Our Patient: 28-YEAR-OLD WOMAN WITH
LIGHTHEADEDNESS
- She came to the ED today with the following symptoms:
- Tachycardia, Hypotension, Light-Headedness, Blurry Vision, No Fevers, No
Chills, No Night Sweats, No Chest Pain, No Dyspnea, Hyper/Hypoglycemia
- We will break all these down one by one and explain why they are important

5. Symptoms versus No-Symptoms
- Lack of symptoms is important ex) Chest Pain vs No Chest Pain
- Chest Pain could be a heart attack (myocardial infarction), broken ribs or
ruptured aneurysm
- Remember: Our patient came in with light-headedness, as I will explain later a heart attack
could cause light-headness
- But… doesn’t have chest pain, therefore a heart attack is unlikely...whew

6. Rules of the Game
- We are going to play some powerpoint jeopardy
- Please take the questions seriously and don't cheat. Studies show that Q&A
is one of the best ways to learn information rapidly and efficiently.

7. Hypotension and Light-Headedness
What is hypotension?
What are the causes of hypotension?
What are some symptoms that are associated with hypotension?

8. Hypotension and Light-Headedness
Hypotension: Defined as blood pressure at or below 90/60 mmHg
Hypotension is usually happens when you lose too much blood/fluid or when your
heart isn’t pumping hard enough. Hypotension is usually associated with light-
headedness and dizziness, because your brain isn’t receiving enough blood.
In our patient’s case, because her blood sugar is so high, her kidneys are working
hard to get rid of it in her urine. When her kidneys do this, they also end up
excreting in excess of water in her urine, causing low blood pressure.

9. Challenge Round: Dyspnea and Tachycardia
- What does dyspnea and tachycardia mean?
- What diseases might cause tachycardia?
- What everyday activities might cause tachycardia?
- What diseases might cause dyspnea?

10. Tachycardia and NO Dyspnea
Tachy = Fast and Cardia = Heart so… Fast Heart or elevated heart rate
- Technically defined as greater than 100 bpm
- Causes: Exercise, Pulmonary Embolism, Heart Attack
- Also can be caused in response to hypotension - the heart tries to compensate for low
blood pressure by working harder
Dys = Difficulty and Pnea = Lung so… Difficulty Breathing
- Causes: Congestive Heart Failure, Pneumonia or any other disease
involving the lungs
Summary: Our patients heart is working hard to compensate for low blood pressure
caused by lost volume (see previous slide) but isn’t having difficulty breathing

11. Hyper/Hypoglycemia
Hyperglycemia- elevated blood glucose levels (discussed further in diagnosis)
Hypoglycemia- low blood glucose levels.
Insulin is produced when blood glucose levels are elevated. Thus causes cells to
take up glucose, thus reducing blood glucose levels back to normal.

12. NO - Night Sweats, Fevers or Chills
What is night sweats (Don’t overthink it)? What are fever? How about chills?
Can you think of any disease that might cause any of these?

13. Night Sweats, Fevers And Chills
Fever: Defined as a body temperature above 39.4 degrees celsius
- It is an indication that the body is fight a foreign agent
- Examples: Cancer, Infections (Bacterial, Fungal, Viral or Parasitic) or Autoimmune Disease
Chills: Non-specific sign of illness generally not feeling well
Night Sweats: Sweating at night, often a symptom of cancer
Summary: Our patient did NOT have any of these symptoms and is therefore
unlikely to be suffering from any of these disease

14. Questions
- What is the physiological difference between type 1 and type 2 diabetes?
- What lab tests are important for diagnosis and why?
- How is diabetes diagnosed?
- What lab values are important?
- What are normal blood glucose and A1C levels?

15. Type 1 vs Type 2 diabetes

16. Functions of the pancreas in diabetes
- Pancreas has beta cells that produce
insulin (hormone that lowers blood
sugar)
- Type 1 diabetes: autoimmune
destruction of beta cells→ cannot
make insulin→ uncontrolled blood
glucose levels
- Type 2 diabetes: pancreas still
produces insulin, but cells are
resistant to its production→
uncontrolled blood glucose levels

17. Diagnosis
- A1C- measures average blood glucose levels
- FPG= fasting plasma glucose
- OGTT=oral glucose tolerance test
ADA (American Diabetes Association) criteria for the diagnosis of diabetes
1. A1C ≥6.5%.
OR
2. FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours.
OR
3. Two-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT.
OR
4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose
≥200 mg/dL (11.1 mmol/L).

18. A1C
- A1C measures how much
glucose is attached to red
blood cells (glycosylation).
- A1C levels are elevated in
diabetes due to
hyperglycemia

19. Normal A1C and fasting plasma glucose

20. Helpful links and videos
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes