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Diabetes Mellitus

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metabolic disease characterized by increased levels of glucose in blood , resulting FROM defects in insulin secretion, action, or both

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Major sources of glucose

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food in GI tract or liver from food substances

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Insulin

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found in pancreas, when person eats a meal, insulin secretion increases and moves glucose from blood into MUSCLE, LIVER, & FAT CELLS for ENERGY

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Type 1 age

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can be any age, but less than 30

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Type 1 is usually - at diagnosis

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THIN, WITH RECENT WEIGHT LOSS

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TYPE 1 is characterized by

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the DESTRUCTION of pancreatic beta cells- which produce insulin, resulting in decrease in insulin production

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GLUCOSE derived from food____

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cannot be stored in liver, but instead remains in bloodstream and contributes to postprandial hyperglycemia

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Type 1 CAUSE

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genetic predisposition/tendency, or autoimmunity

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TYPE 1 Complications

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hyperglycemia, DKA

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TYPE 1 has ____ to ____

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litte to no Endogenous insulin

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TYPE 1 needs

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Exogenous insulin, life time treatment

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TYPE II age

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can be any age but usually over 30 years

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TYPE II is usually ___ at diagnosis

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OBESE

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TYPE II is characterized by

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insulin resistance and impaired secretion of insulin

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TYPE II CAUSES

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obesity , hereditary, & environmental factors

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TYPE II has enough ___ to ___

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insulin to prevent breakdown of fat - no ketones present- NO DKA

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TYPE II control

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weight loss if obsese, diet & exercise

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TYPE II if diet and exercise unsuccessful

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Oral diabetic agent given

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TYPE II may need

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Insulin - on short or long term basis to control hyperglycemia

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Hyperglycemia manifestations

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polyuria, polydipsia, polyphagia, fatigue, weakness, sudden vision changes, tingling/numbness in hands/feet, dry skin, skin lesions/wounds- slow to heal, recurrent infections

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TYPE 1 hyperglycemia additional manifestations onset

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weight loss, N/V, abdominal pain -bc body is breaking down fat and proteins

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FASTING BLOOD GLUCOSE SIGNIFYING DIABETES

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GREATER THAN 126 MG/dL

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RANDOM PLASMA GLUCOSE

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GREATER THAN 200

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2-HOUR POST-LOAD

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GREATER THAN 200

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HgA1c

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Long term diabetic control- gives 120 day picture of diabetic status Excessive glucose attaches to portion og Hgb Results reported in % Normal 6%-120 each additional % add 40 pts

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Urinalysis

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check for ketones and glucose

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Meal plan focuses on

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% of calories from carbs, proteins, and fats

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Carb %

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50-60%

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Fats %

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20-30%

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Protein %

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10-20%

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Fiber

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increase intake, can help improve blood sugar, decreased need for exogenous insulin, and lowers cholesterol and lipids in blood

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Alcohol can

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cause hypoglycemia, drink with food -moderation

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Exercise

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helps lower blood sugar and cardiovascular risk factors

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Short acting insulin AKA

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Regular insulin

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Names of short acting- regular insulin

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Humulin R, Novolin R

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Short acting insulin is the only insulin that is

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ok for iv use

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Short acting insulin indications

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20-30 min before a meal, may be taken alone or with longer lasting insulin -NPH

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short acting onset

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30-60 min

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short acting peak

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2-4 hours

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short acting duration

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4-8 hours

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Hypoglycemia is when

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blood glucose falls less than 50-60

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Blood sugar of ____ should be rechecked and intervened

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70 or less

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severe hypoglycemia

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less than 40

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timed meals, snacking can help

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prevent hypoglycemia

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Mild Hypoglycemia S/S

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sympathetic NS- Adrenergic symptoms- surge of epinephrine and norepinephrine - SWEATING, TREMORS, TACHYCARDIA, PALPITATIONS, NERVOUSNESS, & HUNGER

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Moderate Hypoglycemia S/S

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CNS- depriving brain cells of needed fuel for function - INABILITY TO CONCENTRATE, HA, LIGHTHEADEDNESS, CONFUSION, MEMORY LAPSES, NUMBNESS OF LIPS/TONGUE, SLURRED SPEECH, IMPAIRED COGNITION, EMOTIONAL CHANGES, IRRATIONAL/COMBATIVE BEHAVIOR, DOUBLE VISION, DROWSINESS

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Severe Hypoglycemia S/S

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CNS- DISORIENTATED, SEIZURES, DIFFICUTLY AROUSING FROM SLEEP, OR LOSS OF CONSCIOUSNESS

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Patients with -autonomic neuropathy have a

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decrease in adrenergic symptoms to hypoglycemia

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management of hypoglycemia- conscious patient

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4-6 oz of juice/soda, 6-10 hard candies, 2-3 tsp of sugar/honey

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management of hypoglycemia - unconscious patient who cannot swallow

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give glucagon injection -1 MG subQ or IM, check in 15 min, keep giving till consciousness regained and BS ok

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Glucagon Side effects

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can induce nausea and vomiting- turn patient on side to prevent aspiration

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Management of hypoglycemia- pt in ER situation/hospital setting - can't swallow, unconscious

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IV- D50 or IV push D15

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Diabetic Ketoacidosis

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caused by absence or inadequate about of insulin, results in disorders in metabolism of carb, protein, fats- breakdown of fat into free fatty acids and glycerol, free fatty acids converted to ketones which are acids and their accumulation leads to METABOLIC ACIDOSIS

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Sick day rules for DKA prevention

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take insulin/oral agents as usual test bs/urine for ketones every 3-4 hrs report elevated glucose levels/ ketones to MD if on insulin, may need supplemental doses of regular insulin every 3-4 hours if can't follow usual meal plan, - gelatin, cream soup, custard, graham crackers 6-8x day if V/D- cola, juice, gatorade, broth - to prevent dehydration report N/V/D to MD bc of extreme fluid loss unable to retain oral fluids- hospitalization

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DKA clinical manifestations

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polyuria, polydipsia, marked fatigue, may experience blurred vision, weakness, HA

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DKA s/s in pts w/ intravascular volume depletion

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orthostatic hypotension, or hypotension in general w/ weak- rapid pulse

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DKA -GI s/s

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anorexia, N/V, and abdominal pain

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DKA major sign

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FRUITY BREATH

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DKA - In attempt to reverse the acidosis-

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KUSSMAL respirations

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Diagnostics of DKA

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BS 300-800, low bicarb, pH, CO2-kussmal, ketones in blood & urine, increased levels of creatinine, BUN & hematocrit- if dehydrated

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Treating DKA priority

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correcting dehydration, electrolyte loss, and acidosis before correcting hyperglycemia with insulin

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DKA major electrolyte concern

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K+ monitor frequently b/c rehydration leads to increased plasma value and decreases in K+

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DKA and K+

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monitor closely -arrythmias - ECG and lab every 2-4 hours

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monitor __ during DKA management

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ECG, BP, HR, ABG's, Breath sounds, & mental status , Neuro status hourly bc cerebral edema can occur-fatal, hourly blood glucose testing

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FVD related to

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polyuria and dehydration

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Fluid and Electrolyte Imbalances related to

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fluid loss/shifts

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Knowledge deficit related to

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diabetes-selfceare skills or info

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Anxiety related to

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loss of control, fear of inability to manage diabetes. misinformation r/t diabetes, fear of diabetes complications

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Potential Complications -DKA

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fluid overload, pulmonary edema, HF, hypokalemia, hyperglycemia and ketoacidosis, hypoglycemia, cerebral edema

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Maintaining F&E balance

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I&O, IV fluids & electrolytes, oral fluids, labs, vitals, breath sounds, LOC, edema, ECG

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Hypokalemia - in DKA

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potential complication of DKA treatment- rehydration and insulin treatment can cause this.

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Cerebral Edema in DKA

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rapid correction of hyperglycemia, resulting in shifting fluids, gradually reduce blood glucose level to precent cerebral edema, monitor blood glucose levels, electrolytes, I&O, neuro signs.

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