Diabetes Type 1 and 2: Introduction (Nursing)

00:01 Hi, welcome to our video series on diabetes.

00:04 In this portion of the video series, we're going to talk about how type 2 diabetes is diagnosed and what is prediabetes? Now before we get rolling, I know you've probably heard this word a hundred times in your course prerequisites and in nursing school.

00:20 But let's make sure we're all on the same page.

00:23 Diabetes is a disorder of glucose metabolism.

00:27 You know, in order to use glucose for energy inside my cells, I've got to get the glucose moved from my bloodstream into my cell.

00:36 Now there's a disorder in type 2 diabetes.

00:40 See, they may have insulin, but their body just can't use it they are insulin resistance.

00:46 And that's the difference between Type 2, and Type 1.

00:49 Type 1 really doesn't have any insulin.

00:52 Type 2 may have insulin, they just don't use it very efficiently.

00:56 And eventually even type 2 diabetics are probably going to run very low on insulin that's available.

01:02 So what happens? Well, the patient develops high blood sugar.

01:07 That's what hyperglycemia is.

01:09 So it's so high that it's going to cause damage to the patient.

01:12 So it requires treatment.

01:14 So when you're thinking about diabetes, recognize it's a disorder of glucose metabolism.

01:20 That's the problem.

01:22 In type 2, they have insulin, they just may not be able to use it very efficiently.

01:27 And insulin is what helps get glucose from the bloodstream into the cell.

01:32 Well, this develops into a chronic disease that impacts multiple systems.

01:37 Now, look at the top there you see a picture of your kidney, an eye, and the heart.

01:41 That's to help you remember that diabetes can affect all three of these systems.

01:48 So what bridges the gap? That's kind of an odd name and diabetes, isn't it? Well, we have people who have normal glucose homeostasis, they're able to eat food, their blood sugar goes up, they take that blood sugar out of their bloodstream put it into their cells, they maintain a normal glucose blood level.

02:07 Type 2 diabetics have high blood sugar.

02:10 Prediabetes is the period before the patient is in, let's say, full blown type 2 diabetes.

02:17 When we say that, that means that they cannot control their blood sugar's very well.

02:23 So in prediabetes, the blood glucose levels are elevated above normal, but they're not high enough to meet the diagnostic criteria for type 2.

02:31 So look at the numbers we put in the screen there for you.

02:34 You see, normal glucose is less than 5.7%.

02:37 Now these values refer to hemoglobin A1c.

02:41 This gives us an idea of what the average blood sugar was for this patient over the last two to three months.

02:48 So normal is less than 5.7%.

02:51 Prediabetes, you're going to be 5.7% up to 6.4%.

02:56 But type 2 diabetes diagnosis is greater than or equal to 6.5%.

03:02 So you see it matters.

03:04 If your patient is, you know, 5.8 ish in their 5.75%, they're right at the lower end of prediabetes.

03:11 But if their blood sugar, their hemoglobin A1c is bumping up against 6.3, 6.4 they are much closer to developing type 2 diabetes.

03:21 Now long term damage can occur right in that middle section.

03:25 So even in prediabetes, the patient can be experiencing damage to their body, to their heart, their blood vessels, even before they're diagnosed officially with type 2 diabetes.

03:36 Now, I want to look at when healthcare team what do they do when they're going to diagnose a patient after they've moved from prediabetes to type 2 diabetes.

03:45 Let's look at the criteria they evaluate.

03:48 Now remember, this is usually a gradual onset.

03:52 Did you realize that some reports say the average person has had type 2 diabetes for up to six and a half years before they're diagnosed.

04:02 So they've been a type 2 diabetic, they just didn't get diagnosed.

04:06 So think about the amount of damage that is possible in their body before they're even know that they have an actual problem.

04:14 Because see that patient is going to experience elevated high blood glucose without any symptoms.

04:20 So they won't feel it, they won't know it necessarily, but they're still having the damage occur, whether they're aware of it, or not.

04:28 So the symptoms that we recognize may not even appear until 50 to 80% of the pancreas is beta cells are damaged.

04:36 So now we're way far along in the process.

04:40 This is an example of why wellness is so important.

04:43 Why patients need regular visits with their healthcare provider so that they can identify these risk factors and screen for them early.

04:50 You want to avoid that six and a half years of damage when we could start treating it and intervening much earlier.

04:58 So let's look at four criteria they are used to diagnose diabetes by the healthcare team.

05:04 First, is hemoglobin A1c.

05:07 The patient doesn't have to fast for this because remember, it's an average of what the blood sugar is over the past two to three months.

05:14 Now the next one also deals with blood sugar, but the patient has to fast before this lab work is drawn.

05:21 So both of these are blood tests.

05:23 The first one, tells me the average blood sugar over the first two to three months.

05:27 The second one, tells me what their blood sugar was in that moment after they fasted.

05:34 Now the third test, again, we're talking about blood sugar, but this is two-hours after a meal.

05:39 So this is a plasma glucose level greater than 200 after a meal.

05:45 The fourth test, this is just a random plasma glucose, we will note what time the patient ate.

05:51 But if you just randomly check it when they're in the office, and it's greater than 200, that's another one of the criteria.

05:58 So putting these four together is a pretty solid diagnosis.

06:02 Now, we can actually diagnose diabetes usually with just a hemoglobin A1c, but these are other three criteria that help solidify that case.