Diabetes Type 1 and 2: Comparison (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides Nursing Diabetes Type 1 and 2 Differences.pdf
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      Review Sheet Types of Diabetes Nursing.pdf
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      Reference List Medical Surgical Nursing and Pathophysiology Nursing.pdf
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    00:01 So let's do another comparison of Type 1 to Type 2.

    00:03 We're going to talk about onset, age at diagnosis, primary characteristics.

    00:08 We've got all these things for us to take a look at.

    00:12 I know how you feel about lists.

    00:13 When you look at this, you see, whew, a huge list of things.

    00:18 Don't worry about it.

    00:19 This is just a framework for you to kind of track along with me when you're going back and reviewing your notes, this will make much more sense because we're going to spend time right now going through it.

    00:30 Okay, so let's talk about onset.

    00:32 I love these pictures.

    00:34 I'm much more like the snail than I am the cheetah.

    00:37 But these are great animal ideas for you to keep in mind, what's the difference when it comes to onset? Type 1 seems it's very abrupt.

    00:46 Like the signs and symptoms just seem to hit one day.

    00:49 So even though the antibodies might be present for an extended period of time, the signs and symptoms that drive someone into get care come on like a cheetah.

    00:59 They are super fast in comparison to the type 2 diabetics.

    01:04 That's a very slow and gradual onset.

    01:09 So the patient may have the disease for like six and a half years before they're finally diagnosed.

    01:17 Type 1, Cheetah.

    01:19 Type 2, very slow and gradual onset but keep in mind as it's coming on slowly, it's still doing damage to your patient's body.

    01:31 Now, what about age at diagnosis? Type 1, generally tend to be younger.

    01:36 In fact, in the US, the most common ages around 14 years of age.

    01:40 Now usually, it's going to happen before 40.

    01:42 But remember, I even have a friend who is diagnosed at age 50.

    01:46 But predominantly, they're going to be diagnosed younger.

    01:51 Type 2 is more common in adults.

    01:53 But sadly, it's an increasing trend in children.

    01:57 Remember, this is modifiable.

    02:00 We can do things to slow the progression of this disease down if we're aware of the risk factors, and help patients intervene to mitigate, or treat those risk factors.

    02:12 Now, let's look at the primary characteristics.

    02:14 You'll see on type 1, we've got one bottle of insulin.

    02:17 On type 2, we have two bottles of insulin.

    02:22 So for type 1 or diabetic, remember they have absent or at the very best, minimal insulin.

    02:28 Not enough to control their blood sugar.

    02:31 Type 2, insulin is present initially.

    02:34 but then they start developing that insulin resistance.

    02:37 Now remember, patients who are overweight, their adipose tissue does some really funky things with cytokines and these other causes of inflammation and this can lead to insulin resistance.

    02:50 So eventually, over time, that pancreas is going to get really tired.

    02:56 So they may have started out putting out a lot of insulin because when they're resistant, the body is not using it, the pancreas keeps pumping it out, pumping it out, pumping it out, pump it out.

    03:05 So sometimes type 2 diabetic patients have really high levels of insulin, but it doesn't do them any good, because they are insulin resistant.

    03:14 Their body just can't use it.

    03:16 So they got all this insulin, and they got all this blood glucose, but they're not working together to get that energy source out of the bloodstream, and into the cells.

    03:25 Remember, the risk factor.

    03:27 We're talking about adipose tissue has makes extra hormones, cytokines, all these things that lead to inflammation and insulin resistance.

    03:36 So we've talked about onset.

    03:37 One is fast, Type 1.

    03:40 One is slow, Type 2.

    03:44 Primary characteristics like another insulin or just a tiniest dab of it, that's type 1.

    03:50 Type 2, its variable.

    03:53 Depends on where you are in the progression of the disease.

    03:55 They're going to have insulin initially, they might even have increased amounts of insulin but eventually that pancreas is going to tucker out, and they're not going to be making insulin as the disease progresses.

    04:06 Let's compare the differences to insulin as treatment between type 1 and type 2.

    04:11 Now for type 1, it's essential for life.

    04:13 If you're a type 1 diabetic, you have to be on insulin to survive.

    04:19 Type 2, again, it's variable.

    04:21 They may not need insulin initially, but as the disease progresses, they may move toward the need for insulin.

    04:28 Keep in mind, I know I keep hammering this, but this is where we can really help the patients stay off insulin, working on those lifestyle factors becoming more active, careful about your diet, can delay the need to go on to insulin.

    04:44 Now, the antibodies and environmental factors in type 1 and type 2 are a little bit different.

    04:49 Type 1 diabetics, they have this islet cells or antibodies that are often present when they develop type 1 diabetes.

    04:56 Type 2, they don't have these antibodies but that makes sense because we know that type 1 is an autoimmune, often an autoimmune response, or following a virus, that's why they've got the antibodies.

    05:10 Type 2 develops more from lifestyle, adipose tissue, they have the cytokines and all of those other factors that cause insulin resistance in type 2.

    05:20 So that's something I want you to have very clear in your mind.

    05:24 Why type 1 diabetics have antibodies and why type 2 diabetics generally do not.

    05:30 Now let's compare the typical body presentation of a type 1 diabetic versus a type 2 diabetic.

    05:37 Now a type 1 diabetic may be thin, normal or obese.

    05:41 But type 2 diabetics generally tend to be a little overweight or obese.

    05:45 They may also be normal because you can still develop type 2 diabetes with a normal weight.

    05:50 But if we're talking about the general population, what you're most likely to see is a patient who is overweight with type 2 diabetes.

    05:59 All right, got your pencils ready.

    06:01 Now let's do some fun.

    06:02 We've got some medical terminology for you and I want to talk about the symptoms.

    06:06 With type 1 diabetes, you're gonna see a lot of Poly.

    06:10 Well, the prefix Poly means many.

    06:12 So let's write these in.

    06:14 Work your way down with me as I talk about these words.

    06:17 Polydipsia means thirst.

    06:20 So someone who is a type 1 diabetic, if their blood sugar is not controlled, they're going to be very thirsty.

    06:26 Polyuria means a lot of urine, because their blood sugar is high, it's out of control.

    06:32 The body is going to be dumping fluids into that intravascular space, and they're going to be peeing, and peeing, and peeing.

    06:39 Polydipsia very thirsty.

    06:41 Polyuria lots of urine.

    06:44 Polyphagia has to do with swallowing.

    06:47 When we say someone is dysphagic, they're having difficulty with swallowing.

    06:53 If they're polyphasic, they are not having any problems swallowing.

    06:57 In fact, they're very, very hungry.

    07:00 The reason a type 1 diabetic is hungry is because they can't use the energy in their bloodstream.

    07:05 They can't get it into their cells.

    07:07 So that's why they feel hungry.

    07:09 Their body is trying to tell them you need to eat, when really what a type 1 diabetic needs it needs to get energy into the cells.

    07:18 Type 2 diabetes may have no symptoms.

    07:20 So, look at type 1, we've got all these symptoms really thirsty, peeing a lot, really hungry, losing weight without even trying kind of thing.

    07:30 But over here, maybe silent may not have any symptoms.

    07:35 Now type 1 diabetics are going to be really tired.

    07:38 We talked about that unexplained weight loss.

    07:41 Again, that goes back to they can't get the energy out of their bloodstream and into their cells.

    07:47 That's why they're tired.

    07:48 Their cells don't have energy.

    07:50 The unexplained weight loss, when you can't get glucose out of the bloodstream and into the cell, the body is going to go after fat.

    07:58 And that's why clients with type 1 diabetes often have unexplained weight loss, they're not trying to lose weight, and yet they do.

    08:06 Type 2 diabetics are real tired also.

    08:09 Same thing, they can't get that energy into their cells, because their blood sugar is high it is not as high as a type 1 initially, but their blood sugar is high.

    08:20 They keep having these recurrent infections.

    08:24 Do you know, I've seen clients that the way we figured out they had type 2 diabetes is they just happen to mention, "You know, it got ingrown toenails and I have them all the time." That was a trigger in a clinic for us to draw a hemoglobin A1c.

    08:39 Sure enough, this patient had type 2 diabetes.

    08:43 So this person had recurrent ingrown toenails getting infected, but it can be lots of other types of yeast infections, stress, other things that are going on.

    08:54 If they're recurring, that's a really big red flag for type 2 diabetes.

    08:59 Now, they may also have the poly is drinking a lot, thirsty, peeing and a lot those types of things.

    09:04 But those are usually very classic symptoms for type 1.

    09:08 They can also be present in type 2, but I want you to know for sure they're present in type 1, because untreated, their blood sugar shoots up faster and higher.

    09:19 This slide is a little different.

    09:21 Look, there's not differences as much in comparing the complications of type 1 and type 2.

    09:27 See, this is where you really get to play a role.

    09:31 This is all about glucose control.

    09:34 The more we can control a diabetic type 1 or type 2 more we can keep their blood sugar closer to normal, the less complications are going to have.

    09:44 If I have a type 1 diabetic, who can maintain strict blood glucose control, they may have less complications and a type 2 who cannot keep their blood sugar under control.

    09:56 It's all about how often is that blood sugar elevated on a regular basis and what kind of damage is that doing? Because like we've got an eye, a brain, a kidney, and the heart of there to remind you, diabetes or high glucose damages all of these systems.

    10:12 Now particularly keep in mind it does damage to vascular, to blood supply, and to the nurse.

    10:19 This can become problematic, especially putting the patient at risk for heart attack or stroke.

    10:25 So it hits your eyes, your brain, your kidneys, and your heart equally for type 1 and type 2.

    10:31 Remember, it's all about maintaining as close to normal blood sugar as possible.

    About the Lecture

    The lecture Diabetes Type 1 and 2: Comparison (Nursing) by Rhonda Lawes, PhD, RN is from the course Diabetes Type 1 and 2: Introduction and Risk Factors (Nursing).

    Included Quiz Questions

    1. They are insulin resistant.
    2. They produce little or no insulin.
    3. Beta cells stop producing insulin.
    4. Beta cells produce too much insulin.
    1. Administration of insulin.
    2. Losing weight.
    3. Active lifestyle.
    4. Diet modifications.
    1. Type 1 diabetes symptoms are abrupt.
    2. Type 2 diabetes has a slow or gradual onset.
    3. Type 1 diabetes symptoms appear gradually.
    4. Type 2 diabetes may not be diagnosed for years.
    5. Type 1 diabetes antibodies may be present for an extended period.
    1. Polydipsia
    2. Polyphagia
    3. Unexplained weight loss
    4. Recurrent infections
    5. Polyuria
    1. Eyes
    2. Kidneys
    3. Heart
    4. Nerves
    5. Liver

    Author of lecture Diabetes Type 1 and 2: Comparison (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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