Alterations in Pancreatic Function: Type 1 and 2 Diabetes Mellitus (Nursing)

00:00 Hi. My name is Amy and I'm a pediatric nurse practitioner. So, we're going to be talking about diabetes mellitus type 1and type 2 and how you can differentiate between those 2. So, what is diabetes? I know that you probably hear a lot about diabetes in your nursing program and this is a really complex topic. So, we're going to go over some of the highlights of diabetes and talk about how this impacts pediatric patients. So, type 1 diabetes mellitus is an absolute insulin deficiency.

00:39 This means that the pancreas does not produce insulin. So, in this slide you have this picture, where on the left you have your pancreas and you can see that that arrow indicates that you are not creating insulin in the pancreas and that goes over toward the right side of your screen where you see a blood vessel that's surrounding a cell. Now, normally you would want to see insulin going into the blood vessel, hitting a receptor, and making all of that blood sugar that's in the blood cell go in to the cell so the cell could use that for energy. In this case, however, what you're noticing is that there's no insulin so there's no hormone on able to move into the cell and the cell cannot use it for energy. So, this happens usually due to autoimmune destruction of beta cells. The beta cells are the cells in the pancreas that produce the insulin. Now in type 2 diabetes, we have some variable degrees of insulin resistance and insulin deficiency. So, type 2 diabetic patients do have some insulin, but it's definitely not working the way it should. In this picture on the side, you'll notice that there is beta cells. They are producing some insulin. You see in that arrow that insulin is moving over toward that blood vessel and it is making its way to the receptor. But in this case, that receptor is blocked or for some reason is not able to allow that blood sugar to move in to the cell. There is a phenomenon called glucotoxicity. This often happens in type 2 diabetic patients and this can happen when you already have high blood sugar then that high blood sugar really impairs the pancreas. It keeps that pancreas from producing insulin and that just causes your blood sugar to go higher and higher.

02:37 So it's really kind of a nasty feedback loop where the glucose itself is keeping the insulin from working as well as it should and you just get higher and higher blood sugar. So, if you were to take a guess, do you think there are more cases of type 1 diabetes or type 2 diabetes? So it turns out that there are many more cases of type 2 diabetes. Approximately 90% of all diabetic patients are going to have type 2 diabetes. So, the remaining amount, around 5-10% of diabetic patients are going to be type 1. Now, notice 5-10% doesn't completely get you to that 100% so there are a few patients that are technically not going to be type 1 or type 2. The remainder are caused by some very specific pathophysiologic factors that we are not going to be covering in today's presentation. We're focusing on type 1 and type 2 diabetes.

03:46 So in children and adolescents, it is important to note that you are more often going to see type 1 diabetes than type 2 diabetes. Type 2 has generally been considered kind of an adult disease, although we are starting to see that happen more often in adolescents. Cases of both types of diabetes are actually on the rise. We are not entirely sure why this is the case in the instance of type 1 diabetes. For type 2 diabetes, cases are on the rise often because the rates of obesity and some other risk factors that we'll discuss here in a moment are also on the rise. So, what can cause diabetes? In the case of both type 1 and type 2 diabetes, you might have some genetic susceptibility. Now, for type 1 in particular, there are certain things that are going to make you more likely to develop a diagnosis of type 1 diabetes.

04:54 So, you can see that if both of your parents are affected, that blue bar is much larger than if just your mother or just your father were affected. So if you have no family history, for example, you only have about a 0.4% chance of developing type 1 diabetes. If your mother is affected, you have a 1-4% chance.

05:15 If it's your father that's affected, a 3-8% chance. So if both of your parents are affected as you noted that blue bar gets larger and your percentage risk jumps up to 30%. If you have a sibling who is not a twin that has diabetes, then the risk is 3-6%. If you have a dizygotic twin, your chance is 8%; and a monozygotic twin, your chance jumps up to 30%. So if there are identical twins, you're going to have a higher risk for type 1 diabetes. So what about type 2 diabetes? There are some risk factors for type 2 diabetes as well that are not quite as related to some of these genetic factors and they include obesity. There are certain ethnicities that are at higher risk for type 2 diabetes, age, and pubertal status. So older adults are more likely to have type 2 diabetes and post pubertal people are more likely to develop type 2 diabetes, and your sex. So, what are symptoms of diabetes and how do we