This document provides information about diabetes, including the differences between type 1 and type 2 diabetes, risk factors, potential complications, symptoms, and treatments. Key points include:
- Type 1 diabetes is an autoimmune disease where the body destroys insulin-producing cells, while type 2 is linked to lifestyle factors like obesity and lack of exercise.
- Risk factors for type 2 diabetes include age, family history, obesity, high blood pressure, and poor diet/lack of exercise.
- Potential complications include acute hyperglycemia, diabetic ketoacidosis, and Acanthosis nigricans (darkened skin patches).
- Symptoms can include increased thirst, frequent urination, fatigue, weight loss, and
5. Type 2 Risk Factors
● Age
● Obesity
● Family history
● High blood pressure (hypertension)
● High cholesterol (hyperlipidemia)
● Poor diet
● Lack of physical activity
6. Genetics of Diabetes
● BOTH type 1 and type 2 diabetes have a genetic component
○ Type 1 more so than type 2
● This means that if your Family have the disease YOU are more likely to
have it
● In our case both the patients siblings were positive for type 2 diabetes
● Assignment for next class: Find out if anyone in your family has diabetes
8. Acute hyperglycemia
● A sudden-onset, elevated blood sugar (>180mg/dL)
● A specific finding that commonly presents in patients with diabetes in
hypovolemic shock
● Symptoms:
○ Increased thirst
○ Headache
○ Difficulty concentrating
○ Blurred vision
○ Frequent urination
○ Fatigue
○ Weight loss
9. Diabetic Ketoacidosis
● Acute complication of diabetes
○ Evolves rapidly → usually over 24 hours
○ Usually triggered by another event → infection, inadequate
insulin therapy, compromised water intake
● Mild hyperglycemia, ketoacidosis
● Symptoms: Excessive urination (polyuria), excessive
thirst (polydipsia), weight loss
○ May develop hyperventilation, abdominal pain, and possible
neurologic symptoms
● Treatment: Correct fluid and electrolyte imbalance,
provide insulin diabetes.org/dka
10. Acute Hyperglycemia + Diabetic Ketoacidosis →
Kussmaul Breathing
● https://www.youtube.com/watch?v=raEKXVfuWTo
○ This video demonstrates Kussmaul breathing and tells a little bit about other breathing
patterns
● Kussmaul breathing is a deep, labored breathing pattern that indicates
that the body or organs have become too acidic, as is seen in diabetic
ketoacidosis (DKA).
11.
12. Acanthosis Nigricans
● Velvety, dark (hyperpigmented) areas on skin
○ Most often in neck and shoulder area
● Risk factors/correlations
○ Obesity
○ Family history
○ Malignancy/tumor (rare)
○ Endocrine and metabolic disorders → especially related to insulin
● Correlation with obesity and Type II diabetes
● May be genetic → implicated genes usually result in insulin resistance
● Treatment: Benign condition, so treat the underlying cause
○ Make sure to evaluate for underlying condition that may be causing acanthosis nigricans
http://www.healthtipsever.com/eating-sugar-
cause-acanthosis-nigricans/
13. What are the Symptoms for our Case? What do you
think is causing them?
15. Causes of low blood pressure
1. Hypovolemia AKA decreased blood volume
2. Low cardiac output AKA decreased amount of blood pumped from the
heart per unit time
3. Low arterial tone AKA increased vasodilation/ widened blood vessels
https://www.quora.com/Does-Yoga-help-
in-low-blood-pressure
16. Hypovolemia Findings
● Low arterial blood pressure
○ < 120/80 is commonly the clinical definition, but hypertensive individuals can be
hypovolemic well above these levels
● Low urine volume - trying to conserve volume
● Elevation of BUN and creatinine concentration (Urine Tests) - indicates low GFR
○ Kidneys are not filtering blood as efficiently because the blood pressure is low
● Increased heart rate: > 20 bpm increase from baseline
● Delayed capillary refill
○ > 20 bpm increase in heart rate and delayed capillary refill are very specific for
significant hypovolemia
● Dizziness and lightheadedness, especially upon standing (called orthostatic hypotension)
○ Sensitive for significant hypovolemia
17. Why does a low blood pressure cause an increased
pulse?
● Low blood pressure (hypotension) is sensed by the pressure receptors
(baroreceptors) located in arteries of the neck
○ Aorta and Carotid sinus
● The brain increases sympathetic (Fight or flight) output and decreases
parasympathetic (rest or digest) output to compensate and keep the body
well perfused
● Sympathetic output leads to the release of norepinephrine, a
neurotransmitter from the brain that causes an increase in heart rate
(reflex tachycardia)
18. How Hypovolemia Causes Hypotension
Blood vessels are just tubes; the more they are filled, the more pressure what
is in them (blood) will have. Imagine a hose- more water traveling through
means more pressure. When you have less blood (hypovolemia), the blood
will exert less pressure.
https://www.hxbenefit.com/hypovolemia.html
19. How Low Cardiac Output Causes Hypotension
Cardiac Output= Heart Rate x Stroke Volume
Cardiac Output= number of heart beats x the amount of blood being pumped
with each beat
So cardiac output decreases either in lower heart rate or less blood being
pumped. In either case it means that less blood is being pushed through the
blood vessels and there will therefore be a lower pressure
20. How Low Arterial Tone Causes Hypotension
When the heart is pumping at the same volume, the wider the arteries the
lower the blood pressure. Vasodilation (wider blood vessels) would be
decreased vascular tone while vasoconstriction (narrower blood vessels)
would be increased vascular tone.
Imagine spitting water through a straw
Vs
Spitting the same amount of water through a
garden hose
https://www.cvphysiology.com/Blood%20Flow/BF002
22. What is BMI?
● Body Mass Index -> estimates amount of body fat on a person
● BMI = weight (in kg) ÷ (height)2 (in m)
● Ranges:
○ Normal: 18.5 - 25 kg/m2
○ Underweight: <18.5
○ Overweight: 25 - 30
○ Obese:
■ I: 30-35
■ II: 35-40
■ III: >40 → severe
What is your BMI?
https://patient.info/doctor/bmi-calculator-calculator
23. Is BMI a good measure?
● Generally speaking, yes
○ It provides a good screening test → it is easy and quick to calculate and is cheaper than
many tests that involve more direct measures of fat
○ It is generally well correlated with body fat
○ Classifications are based on risk of cardiovascular disease
● Challenges in interpretation
○ Slight variation by age, sex, and ethnicity
○ Only uses weight to measure fat levels → may be misleading in muscular individuals or
people with dense bones
■ May underestimate fat in older individuals who have lost muscle
● What was our patients BMI?
25. Why are mucous membranes dry in Type 2
Diabetes? How is this evaluated?
High blood sugar levels often result in dry mouth. Do your research and try to
figure out what causes this?
Look into how you assess mucous membranes. How can you tell that they’re
dry?
28. Why are these diagnoses in the
differential?
Do your research and consider which signs and symptoms fit each diagnosis.
Which rule it out?
(We’ll add an update on this next month)
29. Other possibilities in the differential diagnosis
1. Anaphylaxis
2. Hypothyroidism
3. Pancreatitis
4. CHF
Consider reasons that these may cause the patient’s symptoms. Why are they
less likely?
Diabetic ketoacidosis is a possibility, but further testing is needed.
*Dyspnea or shortness of breath may be called platypnea
*Hypopnea is abnormally slow or shallow breathing
Pay special attention to the breathing patterns in red!
Look up information for the questions in red
*These diagnoses fit the patient’s low blood pressure, high pulse rate, diarrhea, nausea, vomiting, and excessive thirst/urination.
