🍬 Lecture 5
Diabetes & Hormones
DM1 vs DM2, DI, SIADH, insulin types, DKA vs HHNK, Hb A1C.
DM Types
| Type 1 DM | Type 2 DM | DI | SIADH | |
|---|---|---|---|---|
| Key | No insulin, juvenile, ketosis-prone | Insulin resistant, adult | Low ADH → polyuria | Excess ADH → oliguria |
| Treatment | DIE: Diet, Insulin, Exercise | DOA: Diet(#1), Oral meds, Activity | Fluid/ADH replacement | Fluid restriction, Lasix |
| Fluid | Deficit | Deficit | Deficit | EXCESS |
📌
Hb A1C = best long-term glucose indicator (90-day avg). Normal <6 | Borderline = 7 | Out of control >8
Insulin
| Insulin | Onset | Peak | Duration | Notes |
|---|---|---|---|---|
| Regular (R) | 1 hr | 2 hrs | 4 hrs | CLEAR — can give IV |
| NPH (N) | 6 hrs | 8–10 hrs | 12 hrs | CLOUDY — NEVER IV |
| Lispro | 15 min | 30 min | 3 hrs | Give WITH meal |
| Glargine (Lantus) | Slow | NO PEAK | 12–24 hrs | ONLY safe at bedtime |
🧪 Mixing Insulin — RN Rule
Inject air into N, then R. Draw up R first, then N.
(Think: RN — Regular before NPH)
(Think: RN — Regular before NPH)
Complications
| Hypoglycemia | DKA (Type 1) | HHNK (Type 2) | |
|---|---|---|---|
| Looks like | DRUNK + SHOCK (cold/clammy, tachy, low BP) | Dry/warm, Kussmaul, acetone breath | Severely dehydrated |
| #1 cause | Too much insulin | Acute viral URI 2 wks prior | Severe dehydration |
| Treatment | Sugar + starch/protein. Unconscious: Glucagon IM or D50 IV | Regular Insulin IV + fluids 200mL/hr | FLUIDS FIRST |
| Mortality | Low if treated | Lower (fast response) | HIGHER (presents late) |
📖 Notes for Dummies
🧠 Think of it this way…
Diabetes is about sugar and insulin not working together. Insulin is the KEY that opens the door to your cells so sugar can get in. Without the key (Type 1) or if the locks are broken (Type 2), sugar floats in the blood causing damage everywhere.
🗝️
Type 1 vs Type 2:
Type 1: Pancreas makes NO insulin → must have it to live (DIE without it)
Type 2: Body ignores insulin → can start with diet and pills (DOA)
Type 1: Pancreas makes NO insulin → must have it to live (DIE without it)
Type 2: Body ignores insulin → can start with diet and pills (DOA)
🍬
Low blood sugar = DRUNK in SHOCK:
Brain runs out of sugar → acts drunk (slurred, staggering) + goes into shock (cold, clammy, fast heart).
Fix FAST: sugar + protein. Unconscious? Glucagon IM at home, D50 IV in hospital.
Brain runs out of sugar → acts drunk (slurred, staggering) + goes into shock (cold, clammy, fast heart).
Fix FAST: sugar + protein. Unconscious? Glucagon IM at home, D50 IV in hospital.
🍋
DKA vs HHNK:
DKA (Type 1): Burns fat → ketones (acetone breath), Kussmaul breathing. Treat with insulin IV.
HHNK (Type 2): No ketones, just DEHYDRATED. Blood sugar so high it's like syrup. REHYDRATE FIRST!
DKA (Type 1): Burns fat → ketones (acetone breath), Kussmaul breathing. Treat with insulin IV.
HHNK (Type 2): No ketones, just DEHYDRATED. Blood sugar so high it's like syrup. REHYDRATE FIRST!
📝 Real-life scenarios:
🏃 Patient exercises → acts like extra insulin → decrease dose + give snack
🤒 Patient is sick → stress raises sugar → still needs insulin even if not eating
🌙 Safe at bedtime → only Glargine (Lantus) — no peak = no overnight hypoglycemia
📅 Best sugar report card → Hb A1C (90-day average)
🏃 Patient exercises → acts like extra insulin → decrease dose + give snack
🤒 Patient is sick → stress raises sugar → still needs insulin even if not eating
🌙 Safe at bedtime → only Glargine (Lantus) — no peak = no overnight hypoglycemia
📅 Best sugar report card → Hb A1C (90-day average)