Definition Diabetes is heteregeneous grup of disease involving the disruption of the metabolism of carbohidrates, fats, and protein. Insuline Secretion and Function Insuline is hormone secreted by the beta cells of the islet of Langerhans in the pancreas. Insulin is essential for celular metabolism of protein and fats.Through an internal feedback mechanism that involves the pancreas and the liver, circulating blood glucose level are maintained at normal range of 60 to 110 mg/dL. Classification of Diabetes a. Type 1 Diabetes Mellitus (Insulin Dependent Diabetes Mellitus-IDDM) ···Insulin needed to [revent ketosis, 5-10 % of all diabetic patient have type 1, b. Type 2 : NIIDM (Non Insulin Dependent Diabetes Mellitus) Formerly called "maturity -onset or adult onset diabetes.", maybe controlled with diet and oral hypoglycemics or insulin. c. Type 3 : GDM (Gestational Diabetes Mellitus) Glucose intolerance during pregnancy in women who were not known diabetics prior to pregnancy, will be reclassified after birth, may need to be treated or may return to prepregnancy state and need no treatment. d. Type 4 : Diabetes secondary to another condition, such as : pancreatic disease, other hormonal imbalanceor drug therapy such as involving glucocorticoids. 4. Pathophysiology a. IDDM : absolute deficiency of insulin due to destruction of pancreatic beta cells by the interaction of genetic, immunologic, hereditary, or enveronmental factors. b. NIIDM : relative deficiency of insulin due to : - An islet cells defect resulting in a slowed or delayed response in the release of insulin to a glucose load. - or Reduction in the number of insulin receptors from continously elevated insulin level - or A postreceptor defect - or A major peripheral resistance to insulin induced by hypergliglycemia. Risk Factor a. Obisity b. Family history of diabetes c. Elderly d. Women whose babies at birth weighed more than 9 lb. e. History of autoimune disease. Insulin Therapy Insulin therapy involves the subcutaneous injection of short, intermediate or long actingat various times to achieve the desired effect. Short acting regular insulin can be given IV, There are about 20 insulins avalaible in the United States, mostly human insulin manufactured synthetically. Only about 6 % of diabetics are still using beef or pork insulin due to problem with immunogenicity. # References : 1. The Lippincot manual of nursing practice-----7th Edition, edited by Sandra M. Nettina. 2. Little, Brown's NCLEX-RN, Examination Review,edited by Sally L.Lagerquist.