Diabetic Patient

Lev, MSN, RN, NP · Sep 25, 2016

Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology

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CCU BSN RN · Oct 22, 2016

Insulin is what takes glucose and helps it pass through the cell wall, from the blood into the individual cell, essentially. So without insulin, you have a lot of glucose in your blood, but it can't make it into your cells to do you any good. They call it 'starvation in the midst of plenty'. So just think about sugar. Sugar water is thick, sticky. Same with sugary blood.

The long term complications of hyperglycemia are from blood vessels being occluded and lack of blood flow/tissue perfusion to the end-organ in question. The complications are split up into microvascular complications and macrovascular complications.

Anything from CVAs, MIs, Nephropathy, Neuropathy, Retinopathy- all from diabetes.

There are also immediate complications of severe hyperglycemia, DKA for example.

MandieClick · Oct 22, 2016

As a nursing student, and a TID myself your post prompted this long time lurker to create an account lol!

Hyperglycemia (for me a high blood sugar starts at 150 mg/dL):

In the most simplistic senses think about syrup. It's extremely viscous and loaded with sugar. Blood with to much sugar is just like syrup in the blood stream. The blood cannot flow properly, and it also has a hard time moving gaseous wastes (like CO2). This breathing pattern is called Kussmaul Respiration. CO2 cannot properly leave the blood, and diffuse across the lungs during DKA. Due to the blood's high viscosity the gaseous wastes cannot diffuse across the capillaries in the lungs, and causes this irregular breathing pattern. During a DKA the body is being overpowered by CO2. Now imagine the heart trying to pump syrup around the body. Hyperglycemia causes poor circulation because the thicker blood viscosity.

The sugar crystals in the blood build up and cut away at the thin epithelial lining in blood vessels. Imagine someone using (albeit an extreme example by any means!) sugar scrubs on their skin. This is abrasive and rubs away the hard flaking layers of the epidermis. Imagine this in the many blood vessels throughout the body. This causes a lot of damage over time and the scar tissue that results reduces the blood flow to areas with smaller blood vessels like the feet. The body then compensates by creating smaller less substantial blood vessels to at least try to get more blood to the area where it has been cut off. This is why there are so many UTID and TIID with so many varicose veins . Eventually the body can no longer supply the proper amount of blood to these areas and the nerve cells become clogged as to much sugar will permeate in due to it's abrasive abilities. Destroying nerve fibers and the lack of blood flow causes the nerves to no longer be fed so overtime the lack of nutrients and abundance of glucose injuries cause irreparable damage, so they essentially atrophy and die. This leads to Neuropathy, Retinopathy, and other circulation issues/nerve damages. This also applies to organ damage as well.

You can pretty much ask yourself this and it will make the Hyperglycemia part a little clearer, "What would happen to my body if the blood became more like syrup?" The more sugar the higher the viscosity of the blood. This is why during a DKA T1D become extremely dehydrated because the blood is basically syrup.

The Body essentially needs insulin to keep the cells from starving to death. Without insulin the body will die because it no longer can use glucose to create ATP. You can also think about dropping a cell into a hypertonic solution. The body is struggling to maintain homeostasis but it cannot.

Hypoglycemia (For me the a hypo starts at around 65 mg/dL):

Think about this as the exact opposite from the higher viscose blood. Think about the syrup becoming watered-down! There isn't enough glucose to support the cells so the blood becomes thin and very water like. Essentially the body has to much insulin so the cells are quickly using up all the glucose in the blood because there is a lot of insulin to open the glucose channels in the cells to be able to take up an over abundance of glucose. The blood starts running out of glucose, and in a TID the body seems slower/does not to react by correcting this itself by releasing stores of glucagon from the liver.

Due to the fact that a TID must externally control the conditions with insulin therapy it is easy to overdose on insulin if one is not careful. In my own experience, I dose the insulin AFTER a meal instead of before a meal (I take shots) because if I accounted for everything on my plate, but couldn't finish the plate there is a high probability I will have a low blood sugar about an hour or two after a meal. I can usually guess by my blood sample before I even stick it to the strip's reservoir by the thickness/thinness of it, and it is pretty accurate.

There are also other things to consider that most people do not really learn about for TIDs, but really should! Pseudohypoglycemia, Chronic Hyperphagia in UTID, IBS/IBSD, gastroparesis, strokes and boy does that list go on! UTIDs are also susceptible for dementia due to the damage from hyperglycemia. Here is some also more interesting info as well. Insulin causes an increased risk for Brain tumors, but can be a double edged sword because insulin helps chemotherapy pass the blood-brain barrier.

There is also thing now about Alzheimer's being linked to a possible, Type III Diabetes!

Unfortunately however I've also noticed that when I suffer from hyperglycemia, and go into DKA, ER Physicians, and other healthcare workers treat all diabetes as Type II. Last time I was in DKA they kept trying to get pills to help me regulate my blood sugar after an insulin drip. I said these wont help me, kindly reminded them I was a TID, and refused. The "Diabetic Diet," there was incredibly sugary and loads of carbs it was completely deplorable. Luckily I've learned to bring my own insulin from home to the hospital just in case something like this pops up again. If you get any diabetic patient, please please, PLEASE don't assume they are type II because they have diabetes. I know type I is rare... but they are most certainly not the same. Lol sorry for my mini-rant it's just something that Physicians seem to forget exists unless they are Endos, or TIDs themselves. In fact the stay at the Hospital was even kind of traumatizing because of their lack of knowledge :cry:

* UTID= Uncontrolled Type I Diabetic; TID = Type I DIabetic; TIID = Type II Diabetic

lol if you read this whole thing congrats, and thanks for your time â™¥

Did I help? Can I get a Sugar-Free cookie? :woot: