Diabetes mellitus pathophysiology and nursing nclex lecture review on diabetes type 1 and diabetes type 2. Diabetes mellitus is where a patient has insufficient amounts of insulin to use the blood glucose in the body. Therefore, the patient will experience extreme hyperglycemica. In this lecture, I highlight the key players in diabetes mellitus, causes, different types of diabetes (type 1, type 2, and gestational), complications, and nursing assessment of the diabetic patient.

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What is diabetes mellitus? Diabetes mellitus is when there’s too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split into type 1, type 2, as well as a couple other subtypes, including gestational diabetes and drug-induced diabetes.

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Diabetes refers to a group of conditions characterized by a high level of blood glucose, commonly referred to as blood sugar. Too much sugar in the blood can cause serious, sometimes life-threatening health problems.
There are two types of chronic diabetic conditions: type 1 diabetes and type 2 diabetes. Pregnant women may acquire a transient form of the disease called “gestational diabetes” which usually resolves after the birth of baby. Pre-diabetes is when the blood sugar level is at the borderline: higher than normal, but lower than in diabetics. Prediabetes may or may not progress to diabetes.
During food digestion, carbohydrates – or carb – break down into glucose which is carried by the bloodstream to various organs of the body. Here, it is either consumed as an energy source – in muscles for example – or is stored for later use in the liver. Insulin is a hormone produced by beta cells of the pancreas and is necessary for glucose intake by target cells. In other words, when insulin is deficient, muscle or liver cells are unable to use or store glucose, and as a result, glucose accumulates in the blood.
In healthy people, beta cells of the pancreas produce insulin; insulin binds to its receptor on target cells and induces glucose intake.
In type 1 diabetes, beta cells of the pancreas are destroyed by the immune system by mistake. The reason why this happens is unclear, but genetic factors are believed to play a major role. Insulin production is reduced; less insulin binds to its receptor on target cells; less glucose is taken into the cells, more glucose stays in the blood. Type 1 is characterized by early onset, symptoms commonly start suddenly and before the age of 20. Type 1 diabetes is normally managed with insulin injection. Type 1 diabetics are therefore “insulin dependent”.
In type 2 diabetes, the pancreas produces enough insulin but something goes wrong either with receptor binding or insulin signaling inside the target cells. The cells are not responsive to insulin and therefore cannot import glucose; glucose stays in the blood. In other words, type 2 diabetics are “insulin resistant”. Here again, genetic factors predispose susceptibility to the disease, but it is believed that lifestyle plays a very important role in type 2. Typically, obesity, inactive lifestyle, and unhealthy diet are associated with higher risk of type 2 diabetes. Type 2 is characterized by adult onset; symptoms usually appear gradually and start after the age of 30. Type 2 diabetes accounts for about 80 to 90% of all diabetics. Management focuses on weight loss and includes a low-carb diet.
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