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Mark Klimek Lecture Notes

Lecture 5

DIABETES

Error of glucose metabolism-cannot metabolize glucose for whatever reason Glucose- primary fuel source and without that cells die=bad

***Diabetes Insipidus- totally different. Polyuria, polydipsia, leading to dehydration due to low ADH which looks a lot like diabetes mellitus which is why they share the same first name

Best way to remember- like diabetes mellitus only just with the fluids- due to a low ADH- ask do you have a low urine output or low urine output? Both have high urine output

Opposite syndrome of diabetes Insipidus= SIADH=syndrome of inappropriate ADH Diabetes mellitus has polyuria and polydipsia SIADH is the opposite so pt would have oliguria and not be thirsty because they are retaining water (gain weight suddenly)

Urine output of 200 ml per hr for 3 hours and a normal blood glucose? Diabetes Insipidus

Urine output of 200 ml per hour for 3 hours and a blood glucose of 280? Diabetes mellitus

10 cc of urine out in 3 hours and a normal blood glucose? SIADH Insulin lowers the blood glucose What is the relationship between amount of urine and specific gravity?

• inverse
• the less the urine out the higher the specific gravity
• urine value goes up the specific gravity is low

Which would have fluid volume deficit?

• low fluid in the body and high output= DM & DI

Who would have fluid volume excess?

-SIADH 1 / 2

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Diabetes type 1 & 2

Type 1 Insulin dependent K-ketosis prone

Type 2- -Not insulin dependent -Not ketosis prone

Signs and Symptoms Polyuria- high urine output Polydipsia thirsty Polyphagia- increase swallowing- eating a lot – increased bleeding after a tonsillectomy

Treatment 1) Type 1 without treatment can DIE D-diet (least important, count carbs, do checks and give insulin accordingly, just lay off refined sugars) I-Insulin (most important) E- exercise

2) Type 2 without treatment end up DOA D-diet (most important, some dr. like for it to be controlled with diet alone) O-oral hypoglycemic A-activity

DIET INSULN AND EXERCISE

• calorie restriction (type two- restrict calorie)

b) Need 6 small feedings a day (split 1800 calories into 6 meals to keep glucose

levels and avoid peaks- blood glucose will stay more normal

Example. Type 2 diabetic best diet to follow

a) Restrict calories

b) Divide food into 6 feedings a day

Answer: restrict calories is most important

Best: narrow it down to 2 and think it through- “I will do this one and not do that one and flip it around”- pick the answer you like better

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