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46 Cards in this Set
- Front
- Back
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What is diabetes mellitus?
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-multisystem disease
-abnormal insulin production or impaired ability to utilize insulin or -BOTH |
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What month is national diabetes month?
What is the webite for the diabetes association? |
November
www.diabetes.org |
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statistics on diabetes
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-5th leading cause of death in US
-leading cause of heart disease, stroke, adult blindness & nontraumatic lower limb amputation -20% of age 65 + have DM -17 million in US have DM -$98 billion annually, (med expenses) directly related to DM |
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Etiology of diabetes
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exact cause is unknown, thought to be one of the following or a combination:
-genetic -autoimmune -viral -environmental obesity stress |
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Tyes of diabetes
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ADA recognizes 11 different classification of DM
We will focus on the most frequent forms: -type 1 -type 2 -gestational |
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What is insulin?
Where is it made? What does it do? |
Insulin is a hormone.
It is produced by the B cells in the islets of Langerhans of the pancreas. Insulin promotes glucose transport from the bloodstream across cell membrane to the cytoplasm of the cell. Insulin facilitates normal glucose range of 70-120mg/dl |
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Normal insulin metabolism
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Insulin increases after a meal
-stimulates storage of glucose as glycogen -inhibits gluconeogenesis -enhances fat depostition in adipose tissue -increases protein synthesis |
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What are the causes of type 1 DM
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-genetic predisposition
-related to human leukocyte antigens (HLA's) -exposure to a virus |
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Onset of type 1 DM
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Manifestations develop when the pancreas can no longer produce insulin
-rapid onset of symptoms -present at ER w/ketoacidosis Symptoms include weight loss, polydipsia, polyuria, polyphagia |
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Stats on type 1 DM
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-formerly known as juvenile DM or insulin-dependant DM
-most often occurs in ppl under 30 -peak onset between ages 11-13 -1 to 1 1/2 times higher in whites than non whites -progressive destruction of pancreatic b cells -autoantibodies cause a reduction of 80-90% of normal b cell function before manifestations occur |
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Diabetic ketoacidosis DKA
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-occurs in the absence of exogenous insulin
-life threatening condition -results in metabolic acidosis |
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Stats on type 2 DM
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-accounts for 90% of patients w/DM
-usually occurs in ppl over 40 -80-90% of patients are overweight |
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What is insulin resistance?
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-body tissues do not respond to insulin
-results in hyperglycemia |
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What is impaired glucose tolerance? (IGT)
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-occurs when the alteration in b cell function is mild
-blood glucose levels are higher than normal but not high enough for a diagnosis |
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In type 2 DM....
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-pancreas continues to produce some endogenous insulin
-insulin produced is either insufficient or poorly utilized by the tissues in the body |
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what is insulin resistant syndrome? (syndrome x)
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-cluster of abnormalties that act synergistically to increase the risk of cardiovascular disease
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Onset of type 2 DM
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-gradual onset
-person may go many yrs with undetected hyperglycemia -marked hyperglycemia (500-1000mg/dl) |
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Gestational diabetes
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-developes during pregnancy
-detected at 24-28 weeks -increased risk for cesarean delivery, perinatal death, neonatal complications |
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Secondary diabetes
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-results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels
-cushing syndrome -hyperthyroidism -parenteral nutrition |
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Clinical manifestations of type 1 DM
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polyuria, polydipsia, polyphagia, weight loss, weakness & fatigue, ketoacidosis
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Clinical manifestations of type 2 DM
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Non specific symptoms
fatigue, recurrent infections, prolonged wound healing, visual changes |
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Diagnosic studies
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-fasting plasma glucose level >126mg/dl
-random plasma glucose measurment of >200mg/dl -two hour OGTT level >200mg/dl using a glucose load of 75g -impaired glucose tolerance, IGT: fasting blood glucose level of >110mg/dl but less than 126mg/dl -hemoglobin A1C test |
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Who requires exogenous Insulin?
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-all type 1 DM
-prescribed for type 2 DM patients who cannot control blood glucose by other means, such as by diet & exercise &/or oral meds |
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Types of insulin
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-human insulin:
-most widely used -cost effective -decrease likelihood of allergic reactions Insulins differ in regard to onset, peak & duration & different types of insulin may be used for combination therapy |
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Goals of diabetes management
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-reduce symptoms
-promote well-being -prevent acute complications -delay onset & progression of long-term complications -patient teaching -nutritional therapy -drug therapy -exercise -self-monitoring of blood glucose |
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Types of Insulin:meds
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-rapid acting:Lispro
-short acting-regular -intermediate acting:NPH or Lente -long acting:Lantus or Ultralente |
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Types of administration of insulin
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IV or SQ injection for self administration
*insulin can not be taken orally! |
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Problems with insulin therapy
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-hypoglycemia
-allergic reactions -lipodystrophy -somogyi effect |
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Mixing Insulin
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-check date, color & type
-roll NPH vial in hands-do not shake -wipe off both vial tops w/alcohol -draw air into syringe that equals TOTAL dose of both insulins to be given CLEAR TO CLOUDY -inject amt of air = to dose of NPH into NPH vial -inject amt of air = to dose of regular into regular vial -invert regular insulin & w/draw correct dose carefully inject needle into NPH & w/draw correct dose w/o injecting air or regular insulin into vial |
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Oral agents for treatment of DM
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-sulfonylureas
-meglitinides -biguanides -a-glucosidase inhibitors -thiazolidinediones **These are not insulin!! *These work to improve the mechanisms in which insulin & glucose are produced & used by the body |
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Oral agents that affect blood glucose levels
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-b-adrenergic blockers
-thiazide -loop diuretics |
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Nutitional therapy for those w/DM
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ADA's guidlines indicate an overall heathy eating plan where a person w/DM can eat the same foods as ppl w/o DM. Overall goal of ADA is to assist ppl w/DM to make changes that lead to improved metabolic control.
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Alcohol & DM
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-high in calories
-promotes hypertriglceridemia -can cause severe hypoglycemia |
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Food composition & diet teaching for those w/DM
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-individual meal plan developed w/dietitian, nutritionally balanced, does not prohibit the consumption of any one type of food.
Dietician initially provides instruction for food consumption & meal planning should include the patient's family and sig others |
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Nutritional therapy for type 1 DM
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-meal plan based on individual's usual food intake & is balanced w/insulin & exercise patterns
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Nutritional therapy for those w/type 2 DM
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-emphasis placed on achieving glucose, lipid, & blood pressure goals
-calorie reduction |
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Exercising for the DM patient
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-exercise is essential part of DM management
-increases insulin sensitivity -lowers blood glucose levels -decreases insulin resistance -best done after meals -blood glucose levels should be monitored before, during, & aafter exercise -several sm carb snacks can be taken every 30 min during exercise to prevent hypoglycemia -plans should be individualized |
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Pancrease transplant for those w/DM
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-used for pt's w/type 1 DM who have end-stage renal disease & who have had or plan to have a kidney transplant.
-eliminates need for exogenous insulin -can also eliminate hypo & hyper glycemia |
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New developments for insulin delivery systems
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-inhaled insulin:Exubera **pulled by FDA
The following have not been approved by the FDA: -skin patch -oral spray -pills |
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Nursing assessment for DM
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-vial infections
-medications -recent surgery -positive health hx -obesity -weight loss -thirst -hungar -poor healing -Kussmaul RS |
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Nursing diagnoses for DM
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-ineffective theraputic regimen management
-fatigue -risk for infection -powerlessness |
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Nurse management planning for DM
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Overall goals:
-active patient participation -no episodes of acute hyperglycemic emergencies or hypoglycemia -maintain normal blood glucose levels -prevent chronic complications -lifestyle adjustment w/minimal stress |
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Acute complications of DM
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-diabetic ketoacidosis DKA
-hyperosmolar hyperglycemic nonketonic syndrome -hypoglycemia -angiopathy: -macrovascular -microvascular -nephropathy -retinopathy -neuropathy -skin problems -infection |
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Nursing implemintations for those w/DM
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Health promotion:
-identify those at risk -routine screening for overweight adults over 45 Ambulatory & home care: -enable pt or caregiver to reach an optimal level of independance -insulin therapy & oral agents -personal hygiene -medical ID & travel -pt & family teaching Acute interventions: -stress of illness &/or surgery: -increased BG=increased chance of hyperglycemia -continue regular meal -increases intake of noncaloric fluids -continue taking oral agents &/or insulin -frequent monitoring of BG |
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Methods of insulin administration
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-insulin pump
-insulin pen injectors -intranasal insulin -insulin jet injectors |
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Side effects of insulin
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-hypoglycemic reaction (insulin shock)
-ketoacidosis |
