Diabetes Flashcards
what occurs in the body when you dont have diabetes?
- The food that is consumed, moves into the blood stream as glucose
- Insulin from the pancreas is released in response to the increase of glucose in the bloodstream. Insulin is the key for unlocking cell receptors and allowing glucose to move into the cells
Insulin
- A hormone that is secreated by the beta cells in the islet of langerhans
- secreted by the beta cells of the pancreas
- stimulus for insulin is high blood glucose levels
pre-diabetes
impaired glucose intolerance
* occurs when glucose levels are higher than normal, but not high enough for a diagnosis of diabetes
* high risk for developing type 2 diabetes & CV diease
Gestational diabetes
- occurs during pregnancy
- high risk women include= obese, advanced age,family history of diabetes
- increased risk for c-section, prenatal death, and fetal injury
- screening at 24-28 weeks using OGTT
- blood sugar returns to normal within 6 weeks postpartum
type 1 diabetes
- autoimmune disease
- insulin dependent
- genetic deposition
- more common in yong indiv
- 5-10% of all diabetes
- no or little insulin production
what occurs with type 1 diabetes
- the pancreas stops making insulin
- glucose builds up in the blood
- cells have no glucose for energy
- body breaks down fat and protein
- ketons are made
how do you manage type 1 diabetes
Replace insulin
1. background insulin
2. bolus insulin
type 2 diabetes
- most prevalent
- gradual onset
2 main problems
1. insulin resistance=body has decreases sensitivity to insulin
2. inpaired beta cells functioning, which results in decreased insulin production
Contriubuting problem
* muscles- making up glucose for energy effeciency; imparied insulin secretion
* Fat- altered production of hormones and cytokines by adipose tissue
Risk factors for diabetes
- family history of diabetes
- obesity
- BMI >27
- race/ethnicity
- HTN
- triglycerides > 200 mg/dl
- previous impaired glucose tolerance
clinical manifestations for diabetes
- polyuria
- polydipsia
- polyphagia
- weakness/fatigue
- dry mouth
- numbness in hands/feet
- high blood sugars
- dry itchy skin
- cellulites
- blurred vision
- high blood pressure
- weight loss or gain
Diagnostic studies
- A1C of 6.5% OR higher
- fasting plasma glucose level of > 126 mg/dl with no calorie intake for 8hr
- two hr OGTT level >200 mg/dl using a 75g glucose load
Tools for self measurment for diabetes
- medication
- good nutrition
- incresed physical activity
- monitoriting blood glucose
Drug therapy for diabetes
- drugs+nutrition+exercise= GOOD
- medication may need to increase as disease progresses
- injectables: insulin and noninsulin
- oral medications
insulin
3 major characteristics of insulin
1. onset
2. peak
3. duration of action
* can only be given subQ
* comes in a vial or pen device
* can be delivered by insulin pump
componets of insulin regimen
Basal insulin- background coverage
bolus insulin- mealtime coverage
correction- bolus insulin used to correct occasional high BG excursions
intensive insulin therapy is the use of both basal and bolus insulin consisting of multiple daily injections
long acting (basal) insulin
- keeps blood glucose levels consistant when not eating
- covers hepatic glucose production
- migrates dawn production
- characterized by hyperglycemia that is present on awakening in the morning due to the release of counter-regulatory hormones in the predawn hours
types of basal insulin
long acting- Lantus & Levemir
* no peak
* 1-2 injections per day
* low incidence of hypoglycemia
intermediate- NPH
* breakfast and dinner or bedtime
* peaks between 4-10 hours
* high variability, high incidence of hypoglycemia
mealtime (boulus) insulin
- lowers blood glucose after meals
- used in insulin pumps for continual basal and bolus dosing
- timing of injection is important to help control post meal blood glucose
rapid acting insulin
- starts working within 5-15 min & works with food and is gone within 3-5 hours
- inejct right before eating
short acting insulin
- starts working within 30-60 min and can last up to 6 hours
- inject 30 min prior to eating
nutrition management
- BMI of 25-29 is considered overweight
- BMI over 30 is considered obese
nutritional therapy
- meal planning and weight management are foundations of diabetes self-management
- nutritional therapy has the greatest impact on the persons diabetes if provided at the onset of the diagnosis
- need to control total caloric intake to attain or maintain a reasonable body weight & have good glycemic control
nursing management for diabetes
Health promotion
* education and screening
Acute care
- stress increases blood glucose
- insulin may be ordered for nondiabetics
chronic care
* certified diabetes educator
* assess pt’s goals, understanding and ability
* education about disease process and self-management
nursing assessment for diabetes
- pt history
- signs related to diagnosis of DM
- hyperglycemia
- hypoglycemia
- blood sugar monitoring
- status of symptoms
- adherence to treatment regimen
- lifestyle, culture, psychosocial and economic factors
- physical exam
nursing diagnosis for diabetes
- deficient knowledge about diabetes, self care skills and information
- self care deficit, physical impairment or social factors
- hyperglycemia
- hypoglycemia
- risk for infection
- risk for impaired skin integrity
- risk for injury
- impaired peripheral neurovascular function
nursing goals and outcomes for diabetes
- engage in self care behaviors to manage diabetes
- few or no hyperglycemia or hypoglycemia emergencies
- maintain normal or near-normal blood glucose levels
- prevent, minimize or delay complications
nursing interventions for acute care diabetes
- diabetes should check their glucose levels every 4 hours during times of sickness
- if glucose is over 240 check urine for ketone every 3-4 hours
- those who are critically ill may have a higher target goal
nursing interventions: ambulatory care
- pt and caregiver education
- assess the meaning of having diabetes
- determine mutual goals that are based on treatment plan
- identify and include support system in pt counseling
- flexibility is important
nursing management evaluation
- state key elements of the treatment plan
- describe self care measures that may prevent or slow progression of chronic complications
- maintain a balance of nutrition, activity, and insulin availability that results in stable safe and healthy blood glucose levels
- have no injury from decreased sensation in the feet
- implement measures to increase peripheral circulation
diabetic ketoacidosis
- caused by an absence or inadequate amount of insulin
- caused by disorders in the metabolism of fats, CHO, and proteins
signs and symptoms
1. nausea and vomitting
2. rapid breathing
3. extreme tiredness and drowsiness
4. muscle weakness, fatigue, and malaise
5. hyperglycemia
6. dehydration and electrolyte loss
7. acidosis
- insulin deficiency leads to a breakdown of fats into free fatty acids and glycerol
- free fatty acids are converted into ketone bodies by the liver
- fruity breath, tachycardia and hypotension
diabetic ketoacidosis (DKA)
causes, treatment, and potential complications
caused by:
* decreased or missed dose of insulin
* illness or infection
* undiagnosed or untreated diabetes
Treatment
* IV fluids and electrolytes replacement
* administer insulin
* establish cause of DKA
Potential complications
* fluid overload
* hypokalemia
* cerebal edema
hyperglycemia hyperosmolar nonketotic syndrome
- blood glucose= 800-1000
- ketosis usually minimal or absent
- defect is usually lack of effective insulin (insulin resistance)
- persistent hyperglycemia causes osmotic diuresis= loss of water and electrolytes
hyperglycemia hyperosmolar nonketotic syndrome
causes, signs//symptoms and treatment
causes
* acute illness
* medication that exacerbate hyperglycemia
* dialysis treatment
signs//symtoms
* hypotension
* dehydration
* tachycardia
* variable neurological signs
* mortality rate 10-40%
treatment
* fluid replacement
* correct electrolytes
hypoglycemia
- Abnormally low blood glucose lvls
causes
* too little or oral hypoglycemic agent
* too little food or excessive excercise
* delayed or skipped meals
S/S
* sweating
* tremors
* tachycardia
* palpitations
* nervousness
* hunger
* inablity to concentrate
* numbness of the tounge and lips
* slurred speech
* visual changes
Management
* teach pts to always carry simple sugars with them
* consistent pattern of eating and administering insulin
long term complication of DM
- poor vascular circulation
- cardiovascular disease
- kidney failure
- retinopathy
- neuropathy
- stroke
macro-vascular complications
- disease of large and medium sized vessles
- atherosclerosis-from altered lipid metabolism
- cerebral vascular
- peripheral vascular disease
microvascular disease
- capillary basement membrane thickening
- affects the retina and kidneys
diabetic retinopathy
- can lead to vision loss and blindness if not treated
- most common cause of blindess in persons ages 20-74
- results from chronic hyperglycemia
nephropathy
- diabetes can alter the normal function of the kidneys
- leading cause of end-stage renal disease
*
diabetic neuropathy
- impaired sensation or pain in the feet or hands
- slowed digestion of food in the stomach
- carpal stomach
- more than 60% of non-traumatic lower limb amputations occur in those with diabetes
- can be a leading cause of sexual dysfunction for patients with diabetes
