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Chapter Objectives

After reading this chapter, the student will be able to:

  1. Differentiate between the two major classifications of diabetes mellitus.

  2. Understand the etiology of type 1 and type 2 diabetes mellitus.

  3. Recognize the signs and symptoms, adverse effects, and complications of diabetes mellitus.

  4. Understand basic glucose metabolism and how insulin affects diabetes mellitus control.

  5. Recognize and identify appropriate blood glucose levels for an individual with diabetes.

  6. Recognize the benefits of diet and exercise for an individual with diabetes.

  7. Identify and recognize the different devices for insulin administration and injection.

  8. Differentiate between the types, onset, duration, and peak action of insulin.

  9. Differentiate between the types and responses of oral antidiabetic agents for treatment of diabetes mellitus.

  10. Recognize the adverse effects of insulin and oral antidiabetic agent therapy.

Chapter Outline

  • Definition of Diabetes

  • Glucose Metabolism

  • Type 1 Diabetes Mellitus

  • Type 2 Diabetes Mellitus

  • Management of Diabetes

    • Glucose Monitoring

    • Diet and Exercise

    • Insulin Administration

    • Insulin Injection Devices

  • Insulin Types

    • Rapid-acting Insulin

    • Short-acting or Regular Insulin

    • Intermediate-acting Insulin

    • Long-acting Insulin

    • Combination Insulin Products

  • Insulin Therapy Adverse Effects

    • Hypoglycemia

    • Diabetic Ketoacidosis

    • Local Skin Reactions

  • Oral Antidiabetic Agents

    • Alpha-Glucosidase Inhibitors

    • Biguanides

    • Meglitinides

    • Thiazolidinediones

    • Sulfonylureas

    • What to Tell the Athlete

  • Discussion Topics

  • Chapter Review

According to the American Diabetes Association, approximately 34.2 million people in the United States have diabetes.1 It is estimated that 1.5 million people are diagnosed each year (Table 4–1). Diabetes is the seventh leading cause of death with an overall cost to society of approximately $327 billion.

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Table 4–1 Characteristics of Types 1 and 2 Diabetes


Type 1

Type 2

Age of onset


Usually >35 years



Gradual over years

Family history

Usually negative

Usually positive



Unknown—strong genetic association, obesity, sedentary lifestyle


Polyurea, polyphagia, polydipsia, weight loss, ketosis, blurred vision, slow-healing sores, tingling in feet

Can be asymptomatic for years; have similar symptoms to those of type 1 diabetes, including tiredness and dry, itchy skin

Body weight

Usually underweight or normal

Overweight or obese

Insulin levels

Reduced or deficient

Normal or slightly decreased


Insulin, diet, exercise

Diet, exercise, oral antidiabetic agents

Complications from diabetes include blindness, kidney disease, heart disease, stroke, impotence, and nontraumatic lower limb amputations (Box 4–1). Individuals from specific ethnic backgrounds, such as Latinos, African Americans, Native Americans, Asian Americans, and Pacific islanders, are at a higher risk of developing diabetes. Obesity is also a risk factor.

BOX 4–1 Complications of Diabetes

  • Retinopathy

  • Nephropathy

  • Neuropathy

    • Peripheral

    • Autonomic

  • Cardiovascular

    • Atherosclerosis

    • Myocardial infarction

    • Hypertension

    • Dyslipidemia

  • Vascular

    • Peripheral vascular disease

    • Stroke

  • Ketoacidosis

  • Skin and connective tissue disorders

  • Insulin resistance

  • Hyperinsulinemia

  • Impotence

  • Nontraumatic amputations

  • Dental disease

  • Pregnancy complications


The term diabetes mellitus stems from the Latin words diabetes, meaning “siphon,” and mellitus, meaning “sweet.” Diabetes ...

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