Type 1 and 2 Diabetes Mellitus: Signs, Symptoms, and Treatment (Nursing)

00:01 So, what are symptoms of diabetes and how do we screen, how do we figure out if you've got diabetes? So, a lot of the clinical features for both type 1 and type 2 diabetes are actually going to overlap a little bit.

00:20 You might hear the term the 3 P's. So, in nursing school, we think of the 3 P's as courses we have to take, but when we're thinking of diabetes we really want to think about some clinical features and the 3 P's are going to be polyuria, polyphagia, and polydipsia. So that means you're going to be peeing too much, you're going to be eating too much, you're going to be drinking too much or large amounts of all of these. An additional feature that might happen is weight loss particularly in this type 1 diabetes because they cannot use the energy, the energy doesn't reach the cells, patients are just not able to gain weight. Past type 1 diabetes and into an emergent situation that can happen when you have diabetes is DKA and we will go into this in more detail in a later presentation, but it is important for you to know that signs and symptoms of DKA would include fruity smelling breath and abnormal breathing patterns so it's fast and deep. You'll hear the term Kussmaul breathing. So fast and deep breathing. If your patient becomes lethargic or confused and most patients with DKA complain of stomachache if they might have some vomiting. So those are signs in a type 1 diabetic that that diabetes is getting out of control and going into DKA. Another symptom that you might notice particularly in type 2 diabetes is nocturia. So, if you have a child that has not had difficulty with having to get up and go to the bathroom in the middle of the night or to urinate in the middle of the night or is all of the sudden bedwetting and they've never had trouble with bedwetting before, that is a little bit of a red flag and that could mean that they are developing diabetes. So, what kind of screening might you do particularly for type 2 diabetes. If you have a patient that is overweight and you have one or more of the following risk factors, then they need to be screened for type 2 diabetes. So if they're overweight and they have a first or second degree relative that has diabetes, if they are in a high risk racial ethnic group, if their mother had diabetes or gestational diabetes even if that resolved after the pregnancy, and/or there are any signs of insulin resistance and a sign of insulin resistance, for example, might be a clinical feature called acanthosis nigricans and that is a discoloration usually noticed on the neck of the patient that just the skin looks a little bit darker. Sometimes parents will describe this as they thought that they needed to give their child a bath and they tried to wipe off some dirt and it didn't wipe off and they noticed that the skin on the neck was a little bit darker. So that can be a sign of insulin resistance. So, how can you tell the difference between type 1 and type 2 diabetes? So, young adults that present with diabetes particularly type 2 as that can be a little bit more difficult to differentiate, we will often send off auto antibodies. So, if there is a presence of auto antibodies for diabetes, then the diagnosis for type 1 can be made. There is not usually auto antibodies present if you have type 2 diabetes. How about do you have an idea of when the typical onset for diabetes might be? What's the age of the patient that you would expect to show up with a diagnosis of diabetes? So it turns out that there are a couple of peaks for type 1 diabetes. Type 1 usually presents in younger years.

04:32 So, between 4 and 6 years is the first peak and about 55% of patients that are going to develop type 1 diabetes show up in this first peak. And then there's a second peak in later adolescence, somewhere between 12 and 14 years, about 45% of the patients that are going to develop type 1 diabetes show up as adolescents.

04:56 So, it's important to know that if you have a 4 or 5-year-old that has those 3 P's or has a big weight loss or something like that, that could definitely indicate that they are developing type 1 diabetes and the same with teenagers. So for type 2 diabetes, this used to be kind of considered a diagnosis of adulthood. Unfortunately, it's becoming more prevalent in adolescents. So adolescents that are having difficulty with their weight, if they have developed any of those indications like the acanthosis nigricans that indicate insulin resistance and/or they might develop these signs like the 3 P's, they may need to be seen by an endocrinologist and may have a diagnosis of type 2 diabetes. So it is important to note and this can be a little bit difficult. We have a tendency to think about anybody who needs insulin is a type 1 diabetic and type 2 diabetes doesn't need insulin. And that's not always the case. It is true that a type 1 diabetic is always going to need insulin replacement therapy, and type 2 diabetes doesn't often need insulin replacement therapy but they might, some of them do. So this doesn't completely differentiate between type 1 and type 2 diabetes. So in these presentations, we have discussed type 1 and type 2 diabetes. We have noted that there are some differences. There are a lot of similarities between these 2. And it's really important to remember that the most effective and safe treatment plan for diabetes is really going to take a collaborative effort between the client and the healthcare team. It really is going to take a lot of management for this is a lifelong disease.