Diabetes 1 Flashcards
Diabetes mellitus
A chronic disease related abnormal insulin production( disprder of the pancreas)
Impaired insulin utilisation
Characterized hy hyperglycemia
Normal glucose level
4-7.8 mmol/l (diabetes aus)
3.9- 6.1 mmol/l ( brown)
Regulation of blood glucose level
Pancreas
Liver
Pancreas
A digestive and endocrine gland
Endocrine function: Secretes glucose, insulin , somatostatin
Liver
Glucose metaolism Glycogen storage Glycogenesis Glycogenolysis Regualtion of blood glusoce concentration
Normal insulin metabolism
Only hormone that directly lowers bgl Produced by b cells in islet of langerhan Promotes glucose transport across cell memebranes Stimulates glycogenesis, glycogenolysis Increase protoen synthesis
Glycogenesis
Storage of glucose as glycogen
Hormones that opsoe the effects of insulin
Glucagon , epinephrine, growth hormone, cortisol
Stimulate glucose production by liver
Decrease movement of glucose
Type 1 diabetes
No insulin being produced
Type 2 diabetes
Person is resistant to the insulin being produced
Diabetes aetiology
Person eats/drinks-
Blood glucose rises
Vete cells in pancreas detect rise in blood glucose
Pancreas releases insulin into the blood
( 1 : no insulin 2: resistant to insulin)
Tissue cells take up glucose
Blood glucose falls
Diabetes 1 risk factor
Not inherited, but genetic predisposition combined with immunologic and possibly environmental factor
Type 2 diabetes risk factor
Family history Race Pbese Poor nutrition Smoking High bp
Clinical manifestation of high bgl
3 ps
Polyuria: urine
Polydipsia: excessive thrist
Polyphagia : excessive hunger
Other symptoms of high bgl
Weight loss Weakness Blurred vision Headache Numbness of feet Wounds slow to heal Recurrent infection
Classifications of diabetes
Type 1 Type 2 Gestational Pre diabetes Secondary diabetes
Type 1 diabetes
Insulin producing b cells in pancreas destroyed by autoimmune process
No insulin production
Wffects of lack of glucose in insulin production
Catabolism Adipogenesis Glycogenesis Result - poor utilisation of glucose lead to feeling of hunger, tiredness, increased breakdown of alternate engery sources
Catabolism
Impeded due to the lack of transport of glucose into the cytoplasm
Adipogenesis
Glucose conversion into fattty acid is limited due to the lack of insulin
Glycogenesis
Glucose is stored in liver and muscle as glycogen. This is activated by insulin l, therefore limited
Treatment of type 1 diabetes
Insulin injections
Type 2 diabetes
Pancreas continues to produce insulin by insufficient or poorly utilised by body
Pathophysiology of type 2 diabetes
Insulin resistance
Decreased insulin production
Increased glucose production
Altered production of hormones and cytokines bu adipose tissue
Type 2 diabetes symptoms
Slow progressive glucose intolerance
Hyperglycaemia
Asymptomatic for years byt type 1 diabetes may be experienced
Treatment of type 2 diabetes
Treated initially with diet and exercise
Oral hypoglycemic agents may be used
Insulin may ultimately
Prediabetes
High risk for type diabetes 2
Have impaired glucose tolerance
Asymptomatic but long-term damage already occuring
Undergo screening
Manage risk factors
Monitor for symptoms of diabetes
Maintain healthy weight, exercise, healthy diet
Gestational diabetes
Glucose intolerance develops during pregnancy
Management
Similar to type 2 diabetes
Dietary modification
Oral agents avoided
Post pregnancy
Bgl levels return to norma after delivery (6weeks)
Increased risk of developing type 2 diabetes early in life
Secondary diabetes
Can result form damage or injury, interferance , destruction of b cells in the pancreas
medications, medical conditions
Can be resolved if condition is treated or medication is didscontinued
Management of diabetes mellitus primary goal
Keep blood sugar level simlar as normal as possible
Normalize activity of insulin and glucose
Other goal management of diabetes
Reduce symptoms
Promote wellbeing
Prevent acute complication
Delay long term complications
Major components of care
Patient teaching Self monitoring of bgl Nutritional therapy Exercise Pharmacologic therapy
Multidisciplinary care
Multidisciplinary team train is diabetes care is managaing the patient
Diagnosing and monitoring diabetes
Fasting blood glucose >=7.0mmol/L
Random plasma glucose >=11.1 mml/L
2 hour OGTT>= 11.1 mmol/L
HbA1c>=6.5%
Self monitoring of BGL
With insulin- 2-4 times a day , before meals and at bedtime
No insulin: 2 hours before and after the largest meal(2-3 times per week)
Type 1 diabetes target range
4-8 mmol/l before meals
>10 mmol/L two hours after starting meal
Type 2 diabetes bgl target range
6-8 mmol/L before meals
6-10 mmol/L 2 hours after meals
Risk of hypoglycaemia bgl range
Less than 4mmol/L if insulin or certian type of tables are used
Blood glucose monitoring nursing considerations
Nurse competency
Quality control tests of blood glucose meter
- once dailt or new strips or new machine or new batteries
- high and low range testing
- documentation in logbook
Lancet use
- sharps precautions, ppe
