Diabetes Flashcards
What is Diabetes Mellitus
A chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both
Affects 25.8 million people
Seventh leading cause of death
Contributing factors?
It is also a major factor contributing to heart disease and stroke.
Adults with diabetes have heart disease death rates two to four times higher than adults without diabetes.
The risk for stroke is also two to four times higher among people with diabetes.
In addition, it is estimated that 67% of adults with diabetes have hypertension.
Leading cause of?
Leading cause of Adult blindness End-stage kidney disease Nontraumatic lower limb amputations Major contributing factor Heart disease Stroke Hypertension
Etiology and Pathophysiology
Combination of causative factors Genetic Strong association between DM 2, and to a lesser extent of DM 1 Autoimmune Environmental Cold climate (DM 1) Viruses (DM1) Solid food early versus breast fed (DM1) Obesity (DM2) Absent/insufficient insulin and/or poor utilization of insulin
Etiology and Pathophysiology
Normal insulin metabolism
Produced by B-cells in islets of Langerhans
Released continuously into bloodstream in small increments with larger amounts released after food
Stabilizes glucose level in range of 70 to 120 mg/dL
Insulin is a hormone produced by the β-cells in the
islets of Langerhans of the pancreas.
Under normal conditions, insulin is continuously released into the bloodstream in small pulsatile increments, with increased release when food is ingested.
Insulin lowers blood glucose and facilitates a stable, normal glucose range of approximately 70 to 120 mg/dL (3.9 to 6.66 mmol/L).
The average amount of insulin secreted daily by an adult is approximately 40 to 50 U
Altered mechanism in Type 1 and Type 2 diabetes
Basically the cells are not receptive to the insulin as pts who do not have diabetes therefore the glucose stays outside of the cell instead of being transferred into the cell to give us energy
Other causes of alterations
having excessive adipose tissue
What does insulin do?
Insulin
Promotes glucose transport in skeletal muscle and adipose tissue
Storage of glucose as glycogen
Inhibits gluconeogenesis (mostly occurs in liver)
Enhances fat deposition
Increases protein synthesis
Which other organs or tissues require an adequate glucose supply for normal function?
Other tissues (e.g., brain, liver, blood cells)
do not directly depend on insulin for glucose transport but require an adequate glucose supply for normal function.
Although liver cells are not considered insulin-dependent tissue, insulin receptor sites on the liver facilitate the hepatic uptake of glucose and its conversion to glycogen.
Type 1 Diabetes Mellitus
Formerly known as juvenile-onset or insulin-dependent diabetes Accounts for 5% of all cases of diabetes Onset in people younger than 40 years Incidence increasing More frequently in younger children
Type 1 Diabetes MellitusEtiology and Pathophysiology
Autoimmune destruction of β-cells = total lack of insulin
Genetic predisposition and viral exposure
HLA-DR3 and HLA-DR4 (remember this is type 1 only)
When a person has certain human leukocyte antigens and is exposed to a virus, the B-cells of the pancreas can be destroyed by the autoimmune procress.
Autoantibodies are present for months to years before symptoms occur
Manifestations develop when pancreas can no longer produce insulin—then rapid onset with ketoacidosis
Idiopathic diabetes
No evidence of autoimmunity, found mostly in Africa and Asia
Latent autoimmune diabetes in adults (LADA)
Longer onset, often mistaken for DM2
Clinical ManifestationsType 1 Diabetes Mellitus
Know the 3 P’s!!
Polyuria, peeing a lot!! (losing fluids, important electrolytes)
Polydipsia (very thirsty)
Polyphasia
Hunger bc glucose is not getting into the cells so our body thinks it’s always hungry
Other manifestations
Weight loss may occur because the body cannot get glucose and turns to other energy sources, such as fat and protein.
Weakness and fatigue may result because body cells lack needed energy from glucose.
Infections, UTI, skin, vaginal (candidia), familial tendency
10 - 15 years when they get it usually
Type 2 Diabetes Mellitus
Lack of exercise
Unhealthy eating
Family history
Overweight
Type 2 diabetes mellitus was formerly known as adult-onset diabetes (AODM) or non–insulin-dependent diabetes (NIDDM).
Type 2 diabetes mellitus is, by far, the most prevalent type of diabetes, accounting for over approximately 90% to 95% of cases of diabetes.
Overweight, obesity, advancing age, and a family history of type 2 diabetes are risk factors for developing the disease.
Although the disease is seen less frequently in children, the incidence in children is increasing as a result of the increase in prevalence of childhood obesity.
Who is most affected?
Prevalence of type 2 diabetes is greater in some ethnic populations. African Americans, Asian Americans, Hispanics, Native Hawaiians or other Pacific Islanders, and Native Americans have a higher rate of type 2 diabetes than do white people.
Type 2 Diabetes MellitusEtiology and Pathophysiology
Pancreas continues to produce some endogenous insulin
Insulin insufficient or poorly utilized
Multiple etiologic factors
***Obesity is greatest risk factor
Genetic component increases insulin resistance and obesity
Type 2 Diabetes Mellitus: Metabolic Syndrome a Risk
What are the 5 characteristics?
elevated glucose levels, abdominal obesity, elevated blood pressure, high levels of triglycerides, and decreased levels of high-density lipoproteins (HDLs).
An individual with 3 of 5 components is
considered to have metabolic syndrome.
Clinical ManifestationsType 2 Diabetes Mellitus
3 Ps and weight loss are possible
Usually more nonspecific symptoms Fatigue Recurrent infection Recurrent vaginal yeast or candidal infection Prolonged wound healing Visual changes
Will prediabetic patients go on to develop DM?
Unfortunately Yes
Gold standard lab test
Diagnostics
and prediabetic % levels
A1C if >6.5% pt has DM
% of glucose that is attached to Hgb molecule
in PRE they ate going to have >5.7-6.4
Fasting plasma glucose level of 126 mg/dL (7.0 mmol/L or greater.
A 2-hr plasma glucose level of 200mg/dL or greater
Gestational Diabetes
Develops during pregnancy
Increases risk of need for cesarean delivery and of perinatal complications
Screen high-risk patients first visit; others at 24 to 28 weeks of gestation
Usually glucose levels normal 6 weeks post partum
Fact: about 50% of women with gestational diabetes go on to develop type 2 DM
Diagnostic Studies
Hemoglobin A1C test
Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months
Used to diagnose, monitor response to therapy, and screen patients with prediabetes
Goal: less than 6.5% to 7%
Fructosamine
Reflects glucose levels past 1-3 weeks
Autoantibodies
Patient’s might present with the following:
Urine: positive for glucose and negative for protein
Wet preparation of smear from rash: consistent with Candida albicans
ECG: evidence of early ventricular hypertrophy
What three treatment modalities will you expect to teach your patient?
Diet, exercise, medications
Collaborative Care
Patient teaching……
Patient teaching Nutritional therapy Drug therapy Exercise Self-monitoring of blood glucose
Foot care (amputations are primarily caused by pts with infections due to neuropathy, encourage to always wear sturdy shoes, no open toes) Inspect feet!
Do not put a lot of lotions or wet ointments on feet because that can be a breeding ground for bacteria.
KEY: Diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes
All patients with type 1 require insulin
For some people with type 2 diabetes, a regimen of proper nutrition, regular physical activity, and maintenance of desirable body weight is sufficient to
attain an optimal level of blood glucose control. However, for the majority, drug therapy is necessary.
Commercially Available Insulin. (know the peak times)
Rapid acting Peak: 30 minutes
Short acting (taken before meals) - Peak 2-5 hrs.
Intermediate acting- Peak 4-12 hour
Long acting - no pronounced peak (athletes or activities that require a lot of caloric expenditure)
The insulin regimen that most closely mimics endogenous insulin production is the
Basal-bolus regimen
Most closely mimics endogenous insulin production
Rapid- or short-acting (bolus) insulin before meals
Intermediate- or long-acting (basal) background insulin once or twice a day
Less intense regimens can also be used (commonly mixed with short or rapid)
Can the kidneys be injured by any type of DM? if so, what condition will you see?
The kidneys can be damaged.
Clinical manifestation for chronic DM is proteinuria (too much protein in urine.)
Also, the left ventricle of the heart can become enlarged ( lack of perfusion in coronary arteries due to CHF, other cardio)
Why is it important to know the peak time of when these insulins begin working?
Because as a nurse we want to know when the patient is most likely to be HYPOGLYCEMIC! low blood sugar <70
Monitor patient within 10-
After administering rapid acting insulin when should you check up on your patient?
Monitor patient within 10-30 minutes up to 3 hours for S/S of hypoglycemia.
Why do you want to act quickly when you find your patient in a hypoglycemic state?
Remember that our brain needs oxygen and glucose and this needs to be addressed right away.
Only 5 minutes to react.
Does long acting insulin have a pronounced peak?
If no, then what does this mean?
No
It means that it is not going to throw the patient into a hypoglycemic state at all.
Signs and Symptoms of hypoglycemia
Confusion Diaphoresis Extreme hunger Irritability Seizure!! if very deprived of glucose
What are the 3
RAPID acting insulin preparations?
lispro (humaLOG)
aspart (NovoLOG)
glulisine (Apidra)
Onset 10-30 minutes
Peak: 30 min -3 hr
Duration: 3-5 hr
Typically taken before meals
Short acting
REGULAR
HINT: ends in “lin”
Humulin R, and Novolin R
Onset 30 minutes
Peak: 32-5 hr
Duration: 5-8 hr
Independent acting
NPH (Humulin R, and Novolin R)
Onset 1.5-4 hour
Peak: 4-12 hr
Duration: 12-18hr
Is Metformin part of the Basal-bolus regimen?
Yes. Patients who typically are on a basal bolus regimen take metformin