Diabetes Mellitus Flashcards
How many people in the world are living with Diabetes?
- 425 million adults are living with diabetes
Factors contributing to the increase in the number of people with type II Diabetes
- Aging population
- Sedentary lifestyle
- Aboriginal ethnicity
- Asian/South Asian/African (immigration)
- Increasing obesity rates
- Longer life expectancy
What is Diabetes Mellitus (DM)?
- DM is a metabolic disorder characterized by the presentation of hyperglycaemia due to defective insulin secretion, defective insulin action, or both
Types of Diabetes - Classifications
- Prediabetes
- Type 1 Diabetes
3/ Type 2 Diabetes
Prediabetes
- impaired glucose tolerance (IGT) - the body is no longer responding to the insulin the body is producing so the blood sugar remains high
Lab values for Prediabetes
- 2-hour glucose level
- Fasting glucose (IFG - impaired fasting glucose)
2-hour glucose levels between 7.8 and 11.1
IFG (impaired fasting glucose) 6.1-6.9 mmol/L
Type 1 Diabetes
pancreatic beta cell destruction
Type 2 DM
pancreas produces insufficient insulin and the body is not responding sufficiently to the insulin
Normal Blood Glucose Range
4-6mmol/L
What is Gestational Diabetes
Diabetes in pregnant women. Screen women at risk. Usually no longer present after the delivery.
Metabolic Syndrome - a collection of risk factors that increase an individuals chance of developing cardiovascular disease and diabetes mellitus (5)
- Abdominal obesity
- Hypertension
- Dyslipidemia
- Insulin resistance
- Dysglycemia
Modifiable Risk Factors of Type 2 Diabetes Mellitus (4)
- Obesity
- Physical inactivity
- Hypertension
- Abdominal cholesterol levels and dyslipidemia
Non-modifiable Risk factors for Type 2 DM (4)
- Age
- History of gestational diabetes
- Family history
- Race/ethnic background
Function of Beta cells of the pancreas
- regulate the hormone insulin
Function of Alpha cells of the pancreas
Regulate the hormone glucagon
Function of insulin
increases cellular uptake of glucose
Function of Glucagon
increases release of glucose by the liver
Effect of increased glucose on insulin and glucagon
Increase insulin and decreased glucagon
Effect of decreased glucose on insulin and glucagon
Decreased insulin and increased glucagon
Pathophysiology of Type 1 DM
- Lack of insulin secretion
- destruction of beta-cells resulting in decreased or absent insulin secretion
- Manifestations seen when 80-90% of normal beta-cell function is destroyed
Pathophysiology of Type 2 DM
- Insulin resistance
- Body tissues do not respond to action of insulin
- Decreased responsiveness of beta cells to hyperglycaemia
- Decrease in ability to produce insulin
- Inappropriate glucose production by liver
- Diagnosis of Type 1 DM is…
- Typical onset at ….
- Cachexic appearance…
- Insulin …
- Often difficult to control …
- Often diagnosis is precipitated by …
- Abrupt
- younger age (<30) (Juvenile Diabetes)
- gaunt
- Insulin dependent for survival
- Blood sugar
- Stress or illness
- Typical onset at …
- Onset is …
- Combination of …
- Oral hyperglycaemic agents or insulin …
- Relatively stable …
- older age
- slow and gradual
- genetic and environmental factors
- may be necessary
- Blood sugar
Lab Values: Symptoms of diabetes + 1. random plasma glucose value 2. plasma glucose value in 2-hr sample 3. A1c 4. Fasting plasma glucose (FPG)
- Random plasma glucose value > 11.1 mmol/L (normal values: 4-6mmol/L)
- Plasma glucose value in a 2-hr sample > 11.1 mmol/L
- A1c > 6.5%
- FPG >7.0 mmol/L
A1c Test
Determines the presence of glucose on hemoglobin cells
Impaired Fasting Glucose
Test: Fasting Plasma Glucose
Results: 6.1-6.9
Impaired Glucose Tolerance
Test: 2-hr Plasma Glucose in 75-g Oral Glucose tolerance test
Results: 7.8-11.0
Prediabetes
Test: Glycated Hemoglobin (A1c)
Results: 6.0-6.4
Clinical Manifestations of Type 1 DM
Polyuria polydipsia polyphagia weight loss Ketonuria weakness and fatigue visual changes
Polyuria
Too much urine
Polydipsia
Excessive thirst and drinking a lot
Polyphagia
Excessive hunger and eating a lot
Ketonuria
spilling ketones into the urine from the burning of fat and protein
- Fruity breath. N & V, Abdominal pain
- Very ill person.
Clinical Manifestations of Type 2
- Gradual onset
- may have classic manifestations
- chronic blurred vision
- recurrent infections (skin, vaginal yeast), slow-healing wounds
- Neuropathic pain
- Weight gain.
- Fatigue (may be only symptom)
Medications associated with Type 2 DM
- Statins –> cholesterol lowering
- ACE inhibitors –> lower BP
- Aspirin
Goals for management of diabetes (4)
- Reduce symptoms
- prevent and manage acute complications
- delay onset and progression of long-term complications
- Attaining desirable weight
Glycogen
Stored glucose in the liver and muscle
Glucose
Source of energy in the body
Glucagon
strongly opposed the action of insulin. Stimulates conversion of glycogen to glucose
Gluconeogenesis
making glucose from non-carbohydrate sources
Gycogenolysis
Glycogen breakdown to make glucose
Endogenous insulin
insulin the body/pancreas makes
Exogenous insulin
Externally made insulin
Hypoglycaemia
Too much insulin in proportion to available glucose in blood.
Causes of Hypogycemia (4)
- mismatch in the timing of food intake and the intake of insulin or an oral hyperglycemic agent.
- Excessive insulin, or oral hyperglycemic agents
- Ingestion of insufficient carbohydrates
- Excessive exercise
Adrenergic Signs and Symptoms of Hypoglycemia
Epinephrine release (fight or flight)
body is in stress state which causes:
- diaphoresis, tremors, hunger, nervousness, anxiety, pallor & palpitations
Neuroglycopenic Symptoms of Hypoglycemia
Brain is not getting enough glucose.
- irritability, visual disturbances, difficulty speaking, confusion & coma
What happens if hypoglycemia is left untreated?
loss of consciousness, coma, seizure
What to do in the case of hypoglycemia
- check blood sugar: threat is BS < 4mmol/L
- administer 15-20g simple carbohydrate
- check BS in 15 minutes & give more CHO prn
Once BS > 4 mmol/L give longer-acting starch & protein (cereal and milk) (peanut butter sandwich)
Diabetic Ketoacidosis (DKA)
- Profound deficiency of insulin. hyperglycemia & dehydration.
- Fats are metabolized in absence of insulin –> ketosis & acidosis
what type of DM is most likely to get DKA?
Type 1
- happens when a person doesnt know they have type 1 diabetes
In DKA the cells are starved for glucose. so the body…
breaks down fats to try and create energy for the body.
Betahydroxybuterate
the ketone that is tested for in the blood to diagnose DKA. The one that is check to see if the patient is ketotic. As well as blood gas which will show the pH and the amount of acidosis.
Precipitating Factors of DKA (6)
- Illness
- Infection
- Inadequate insulin dosage
- Insulin omission
- Undiagnosed type 1 diabetes
- Poor self-management
Signs and Symptoms of DKA
- polyuria, polydipsia, polyphagia
- Dehydration
- lethargy and weakness (early symptoms)
- poor skin turgor, dry mucous membrane, tachycardia, orthostatic hypotension, sunken eyes.
- N & V
- Abdominal pain
- Kussmauls respirations
- Fruity odour to breath
- Blood glucose > 14 mmol/L, pH < 7.35. HCO3 < 15 mmol/L
- ketones in blood & urine
Treatment of DKA
- Ensuring airway
- IV access
- First step - hydrate them because their blood is hypertonic. Boluses of fluid - 1-2L. Until urine output is 30-60mL/hr.
- Insulin infusion (slowly) 3-4 ml/hr
- Electrolyte pannel Q4h
- When glucose is around 14, D5W (5% dextrose in water) will start to be infused to prevent hypoglycemia
Hyperosmolar Hyperglycemic nonketotic syndrome (HHS)
- occurs in clients able to produce enough insulin to prevent DKA but not enough to prevent sever hyperglycemia, osmotic diuresis & ECF depletion
- Ketoacidosis does not occur
- Less common than DKA
- Develops slowly over time until it gets to a dangerous place
Who is HHS most common in?
Older adults with type 2 DM because of impaired thirst sensation, functional inability to replace fluids
Signs and Symptoms of HHS
- Somnolence, coma, seizure, hemiparesis, aphasia
- BG > 35 mmol/L
- Marked increase in serum osmolality
- Tachycardic
- Low BP
- Severe dehydration
Treatment
- more fluid replacement
- IV admin of insulin
- Replacing electrolytes
- monitoring repsonse to treatment
- high mortality
- Patients do not correct as well as in DKA
Chronic Complications of DM
Macrovascular complications
Microvascular complications
Neuropathy
Macrovascular complications
- coronary artery disease, stroke, hypertension, atherosclerosis, peripheral vascular disease
- 2-3x greater risk of heart disease
- important to optimize their BS (control HTN, hyperglycemia and dyslipidemia)
Microvascular complications
specific to diabetes patients. Secondary to thickening capillary beds and arteries.
- retinopathy - issues with eyesight
- nephropathy - chronic kidney disease
Neuropathy
Nerve damage (peripheral vasculature)
- sensory neuropathy - digestion, temp control, BP, heart
- autonomic neuropathy, when the nerves that control involuntary bodily functions are damaged. Loss of autonomic innervation ot heart.
Infections and DM
- people with DM are at higher risk fo infections (infections of skin, osteomyelitis, vaginitis, peridontal infection)
- hyperglycemic state leads to increased infection because of poor blood supply.
- increase in glucose levels stimulate growth of microorganisms
- Good wound care is essential nursing intervention
