Diabetes

Diabetes Mellitus

Diabetes Mellitus (DM) – “a chronic, progressive disease characterized by the body’s inability to metabolize carbohydrates, fats, and proteins, leading to hyperglycaemia (high blood glucose level)” (Black & Hawks, 2009, p. 1062)

Epidemiology:
Pathophysiology Overview
According to Canadian Chronic Disease Surveillance System, “[i]n 2008/09, close to 2.4 million Canadians aged 1 yr and older were living w/ diagnosed diabetes (either type 1 or type 2)” making diabetes as one of the most common chronic diseases in Canada (Public Health Agency of Canada, 2011).

most common chronic disease among children and youth, particularly Type 2 since it has been on the rise globally for the last two decades (Public Health Agency of Canada, 2011)

In a decade (1998/99-2008/09), diabetes’ prevalence in Canada increased by 70% (Public Health Agency of Canada, 2011) More prevalent in males (5.4%) than females (4.4%) (Sanmartin & Gilmore, 2008)

Prevalence of Type 2 diabetes in lowest income group is 4.14X higher than in the highest income group in Canada (Dinca-Panaitescu et al., 2011)

Prevalence of diabetes were more than 4X higher among First Nations than among non-First nations people (Dyck et al., 2010)

Those w/ diabetes are over 3X more likely to be hospitalized w/ cardiovascular disease than individuals without diabetes (Public Health Agency of Canada, 2011)

11% of Canadian adults w/ diabetes were reported to have 2 or more other serious chronic conditions besides diabetes (Canadian Diabetes Association, 2008)

Glucose-regulating hormones (secreted by the pancreas’ Islets of Langerhans):
Alpha cells = secrete glucagon (↑ glucose) β –cells = secrete INSULIN (↓ glucose) delta cells = secrete somatostatin (inhibit release of glucagon + insulin to extend time of nutrient absorption by tissues)

Incretin – GI hormone that ↑ insulin release of β-cells

Glucose transporters = “special carriers” that help move glucose from blood into the cell

Glucogenesis – breakdown of glycogen to form glucose

Gluconeogenesis – breakdown of non-carbohydrate sources to form glucose

Diabetes Overview
TARGET CELLS

Summary of comparisons between Type 1 & Type 2 diabetes: | Type 1 | Type 2 | Also known as: | “juvenile-onset” or “insulin-dependent diabetes mellitus” (IDDM) | “adult-onset” or “non-insulin-dependent diabetes mellitus” (NIDDM) | Description: | Destruction of pancreatic β-cells by Islet cell antibodies leading to insulin deficiencyType1A = “autoimmune” – genetic predisposition or environmental factorsType1B = idiopathic | Insulin resistance – “resistance to biological activity of insulin in both the liver and peripheral tissues” (Black & Hawks, 2009, p. 1066) ex. due to defective insulin receptors Insulin production of inactive insulin, or impaired release of insulin d/t exhausted β-cells etc. | Age of Onset | Typically < 30 years of age | < 40 years of age | Pancreatic Function | Little to none | Insulin may be in low, normal, or high amounts | Clinical Presentation | Acute or rapidly progressive hyperglycemia w/ symptoms of polyuria, polydipsia, fatigue, sudden weight loss, slow wound healing, ↑appetite, blurred vision, thrush or genital infections, neuropathy, and ketoacidosis | Similar to Type 1 except more chronic and progressive symptoms | Genetic Predisposition | Yes | Yes, heredity applies | Environmental factors: | Virus infection (triggers autoimmune process) | ↓ physical activity, obesity (particularly central obesity) – “adipokines” (adipose tissue cells release these cytokines that have shown to cause cellular resistance to insulin) |
(Porth, 2007; Black & Hawks, 2009; Thevenod, 2008)

References

Black, J.M., & Hawks, J.H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (8th ed.). Philadelphia, PA: Saunders Elsevier.
Canadian Diabetes Association (2008). Canadian journal of diabetes: Canadian diabetes association 2008 clinical practice guidelines for the prevention and management of diabetes. Retrieved from: http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf
Dinca-Panaitescu, M., Dinca-Panaitescu, S., Bryant, T., Daiski, I., Pilkington, B., & Raphael, D. (2011). Diabetes prevalence and income: Results of the Canadian community health survey. Health Policy, 99(2), 116-123. doi:10.1016/j.healthpol.2010.07.018

Dyck, R., Osgood, N., Lin, T. H., Gao, A., & Stang, M. R. (2010). Epidemiology of diabetes mellitus among first nations and non-first nations adults. CMAJ : Canadian Medical Association Journal = Journal De l 'Association Medicale Canadienne, 182(3), 249-256. doi:10.1503/cmaj.090846

Thevenod, F. (2008). Pathophysiology of diabetes mellitus type 2: roles of obesity, insulin resistance and β-cell dysfunction. Retrieved from: http://content.karger.com/ProdukteDB/Katalogteile/isbn3_8055/_86/_40/fdiab19_02.pdf

Porth, C. M. (2007). Essentials of Pathophysiology: Concepts of Altered Health States. (2nd Edition). Philadelphia, PA: Lippincott Williams & Wilkins.

Public Health Agency of Canada (2011). Diabetes in Canada: facts and figures from a public health perspective. Retrieved from: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf

Sanmartin, C., & Gilmore, J. (2008). Diabetes-prevalence and care practices. Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Santé / Statistique Canada, Centre Canadien d 'Information Sur La Santé, 19(3), 59.

References: Black, J.M., & Hawks, J.H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (8th ed.). Philadelphia, PA: Saunders Elsevier. Canadian Diabetes Association (2008). Canadian journal of diabetes: Canadian diabetes association 2008 clinical practice guidelines for the prevention and management of diabetes. Retrieved from: http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf Dinca-Panaitescu, M., Dinca-Panaitescu, S., Bryant, T., Daiski, I., Pilkington, B., & Raphael, D. (2011). Diabetes prevalence and income: Results of the Canadian community health survey. Health Policy, 99(2), 116-123. doi:10.1016/j.healthpol.2010.07.018 Dyck, R., Osgood, N., Lin, T. H., Gao, A., & Stang, M. R. (2010). Epidemiology of diabetes mellitus among first nations and non-first nations adults. CMAJ : Canadian Medical Association Journal = Journal De l 'Association Medicale Canadienne, 182(3), 249-256. doi:10.1503/cmaj.090846 Thevenod, F. (2008). Pathophysiology of diabetes mellitus type 2: roles of obesity, insulin resistance and β-cell dysfunction. Retrieved from: http://content.karger.com/ProdukteDB/Katalogteile/isbn3_8055/_86/_40/fdiab19_02.pdf Porth, C. M. (2007). Essentials of Pathophysiology: Concepts of Altered Health States. (2nd Edition). Philadelphia, PA: Lippincott Williams & Wilkins. Public Health Agency of Canada (2011). Diabetes in Canada: facts and figures from a public health perspective. Retrieved from: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf Sanmartin, C., & Gilmore, J. (2008). Diabetes-prevalence and care practices. Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Santé / Statistique Canada, Centre Canadien d 'Information Sur La Santé, 19(3), 59.