Diabetes Flashcards
Define type one diabetes
An immune-mediated disease, caused by autoimmune destruction of pancreatic beta-cells, the site of insulin production
Define type 2 diabetes
Insulin levels are insufficient for the needs of the body and/or insulin is poorly used by the tissues
Define gestational diabetes
Diabetes diagnosed in pregnancy- insulin production is insufficient as insulin requirements are four times higher in pregnancy.
What are the goals of diabetes management?
Reduce symptoms, promote wellbeing, prevent acute complications, delay the onset/progression
Education
What are common oral drug therapies for type 2 DM?
Biguanides (metformin)- decrease hepatic glucose output, increase tissue response to insulin
Sulfonylureas (glipizide)- increase insulin production
Meglitinides (nateglinide)- rapid and short-lived release of insulin from the pancreas
Thiazolidinediones (pioglitazone)- increase glucose uptake in the muscle; decrease endogenous glucose production.
What is the nurses role in relation to health promotion and diabetes?
Goals are to: engage pt in self-care behaviours to actively manage their diabetes; experience no or few episodes of acute hypo/hyperglycaemia; maintain blood glucose levels at normal/near-normal levels; prevent or minimise complications of diabetes, adjust lifestyle- health promo
What are some acute and chronic complications of diabetes?
Neuropathy, nephropathy, retinopathy, HTN, DKA, infections etc
Define diabetic ketoacidosis
DKA is caused by a profound deficiency of insulin and is characterised by hyperglycaemia, ketosis, acidosis and dehydration. It is most likely to occur in people with type one but may be seen in T2DM in conditions of severe illness or stress where the pancreas doesn’t make enough insulin.
What are precipitating factors for DKA?
Illness, infection, inadequate insulin dosage, undiagnosed type 1 diabetes, poor self-management and neglect.
What is the pathophysiology behind DKA?
When the circulation supply of insulin is insufficient, glucose can’t be be properly used for energy. The body compensates by breaking down fat stores as a secondary source of fuel. Ketones are acidic by-products of fat metabolism that can cause serious problems when they become excessive in the blood. Ketosis alters the pH balance, causing metabolic acidosis to develop. Ketonuria is a process that occurs when ketone bodies are excreted in the urine. Electrolytes are also excreted in an attempt to maintain electric neutrality.
Insulin deficiency impairs protein synthesis and causes excessive protein degradation. This results in nitrogen losses from the tissues. Insulin deficiency also stimulates the production of glucose from AA in the liver and leads further to hyperglycaemia. Because of the deficiency of insulin, the additional glucose cannot be used and the blood glucose levels rise further, adding to osmotic diuresis.
If not treated, the patient will develop severe depletion of sodium, potassium, chloride, magnesium and phosphate. Vomiting caused by acidosis results in more fluid and electrolyte loss- eventually hypovolaemia, followed by shock occurs. Renal failure from this, causes retention of ketones and glucose and every thing just gets worse-comatose and death results.
What are the signs and symptoms of DKA?
Dehydration- poor skin turgor, dry mucous membranes, tachycardia and orthostatic hypotension. Lethargy and weakness Abdominal pain, anorexia, nausea, vomiting Kussmaul respirations (rapid and deep breathing associated with dyspnea)- attempt to reverse acidosis Sweet, fruity odour- acetone
What does the multidisciplinary care of a patient with DKA involve?
Blood studies- BGL, FBC, pH, ketones, electrolytes, serum urea, arterial blood gases
IV therapy- fluids and rapid-acting insulin Electrolyte replacement Assessment mental status FBC ECG monitoring
Briefly define hyperosmolar hyperglycaemic syndrome
Life-threatening syndrome that occurs in a patient with diabetes who is able to produce enough insulin to prevent DKA but not enough to prevent severe hyperglycaemia, osmotic diuresis and extracellular fluid depletion
What are common causes of HHS?
UTIs Pneumonia Sepsis Any acute illness Newly diagnosed T2DM
What is the main difference between HHS and DKA?
HHS usually enough circulating insulin so DKA doesn’t occur.
