Diabetes Mellitus Flashcards
Diabetes Mellitus (DM)
- multisystem disease related to: defect in insulin production or action, or both
- always results in hyperglycemia no matter the cause.
- 7th leading cause of death in the US
What is the leading cause of chronic diseases?
diabetes mellitus
Types of Diabetes Mellitus
- Type 2 Diabetes Mellitus
2. Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
- Most common
- 90-95% of patients have Type 2
- Affects adults and children
Pathogenesis: Type 2 Diabetes Mellitus
Caused by relative INSULIN DEFICIENCY (reduced insulin secretion by pancreas) and insulin produced is either insufficient or poorly utilized by the tissues (INSULIN RESISTANCE) due to defective insulin receptors –> hyperglycemia
Insulin Resistance
- tissues do not respond to insulin (reduced number and sensitivity of insulin receptors)
- resistance to the actions of insulin in muscle, fat and liver
Impaired fasting glucose
mild alteration in Beta cell function
Impaired glucose tolerance
- progression impaired from fasting glucose approx. 10-25% will convert to DM Type 2 within 10 years
- many are obese
Metabolic Syndrome
also known as insulin resistance syndrome, Metabolic X.
Metabolic Syndrome: Collection of comorbidities that are associated with type 2 diabetes
- Coronary artery disease
- Central obesity
- Dyslipidemia
- HTN
- Microalbuminuria (spilling of protein into urine), and increase risk for thrombotic events.
Goal BP for Type 2 Diabetes
130/80
Prediabetes Screenings
categories of increased risk for diabetes including:
- hemoglobin A1C of 5.7% - 6.4%
- Fasting plasma glucose (FPG) levels higher than or equal to 100 mg/dL but less than 126 mg/dL.
- impaired glucose tolerance test (oral glucose exchange)
Diabetes screening is recommended every
3 years for all patients 45 years of age or older.
Type 2 Diabetes Diagnostics
- Fasting plasma glucose level > or = 126 mg/dL
- Random Plasma glucose > or = 200 mg/dL plus symptoms
- HgbA1C > or = 6.5%
- Two-hour plasma glucose > or = 200 mg/dL during oral glucose tolerance test
Clinical Manifestations of Type 2 Diabetes
- asymptomatic at early onset
- weight loss
- 3 P’s: Polydipsia, Polyuria, Polyphagia
- May have other symptoms
Possible Physical Findings in Patients with Type 2 Diabetes Mellitus
- Obesity, particularly central
- Hypertension
- Eye-hemorrhages, exudates, neovascularization
- Skin-acanthosis nigricans (particularly in dark skinned ethnic and racial groups); candida infections
- Neurologic: decreased or absent light touch, temp sensation and proprioception; loss of deep tendon reflexes in ankles
- fleet-dry, muscle atrophy, claw toes, ulcers
What are causes of Hyperosmolar nonketotic syndrome (HNKS) ?
- illness, infection, severe pain
- uncontrolled blood glucose, high carb diet, medications (i.e steroids)
- can result in metabolic acidosis -> coma, if untreated.
Hyperosmolar nonketotic syndrome (HNKS) signs/symptoms
LIFE THREATENING
- polyuria, polydipsia
- dehydration, anorexia
- lethargy, confusion, tachypnea, electrolyte disturbances, N/V
Hyperosmolar nonketotic syndrome (HNKS)
- severe dehydration and electrolyte imbalance
- less ketones when compared to DKA
- blood glucose >600 mg/dL
Hyperosmolar nonketotic syndrome (HNKS) treatment
- Normal Saline IV (administer 1st for fluid loss)
- Regular Insulin (for hyperglycemia)
- Potassium (to treat potassium/electrolyte loss)
- Acid-base balance
- Treat underlying cause (i.e infection, pain, illness.)
Type 1 Diabetes Mellitus
- mostly in children and young adults but can occur at any age
- < 10% of individuals with DM have Type 1
Pathogenesis: Type 1 Diabetes Mellitus
- Destruction of pancreatic beta cells (caused by autoantibodies, genetic predisposition & RT human leukocyte antigens (HLAs) or exposure to a virus)
- lack of insulin production
Clinical Manifestations of Type 1 Diabetes Mellitus
- 3 P’s: Polydipsia, Polyuria, Polyphagia
- Other symptoms: fatigue, generalized weakness, visual changes, frequent infections, rapid weight loss
Diabetic Ketoacidosis (DKA)
- when no insulin is present to allow glucose to be used for energy production, the body resorts to breaking down fatty acids for fuel which produces ketones as a by-product.
- uncontrolled diabetes, LIFE THREATENING
Causes of Diabetic Ketoacidosis
- illness, infection, severe pain
- extreme anxiety, stress
- vigorous exercise, omission of meds/insulin
Signs and Symptoms of Diabetic Ketoacidosis
- extreme hyperglycemia (BLOOD GLUCOSE OF 300 OR MORE) and PRESENCE OF KETONES in serum
- METABOLIC ACIDOSIS, dehydration and electrolyte imbalances
- nausea, vomiting, confusion, lethargy
- polydipsia, polyuria, polyphagia, tachypnea
Treatment for Diabetic Ketoacidosis
- Normal Saline IV (0.9-0.45%: for fluid loss)
- Regular Insulin (for hyperglycemia)
- Potassium (for potassium/electrolyte loss)
- Acid-base balance
- Treat underlying issue
Without treatment for Diabetic Ketoacidosis, it could lead to
coma and death
DKA is most common in
patients with type 1 but can be seen in patients with type 2.
Gestational Diabetes
- Hyperglycemia that develops during pregnancy.
- Pancreas can be overwhelmed due to glucose needed for the woman AND the fetus.
Gestational Diabetes occurs in what percentage of pregnancies and is detected after how long?
- 2-10% of pregnancies.
- is detected at 24-28 weeks of gestation
Gestational Diabetes effects
- increases pregnancy complications, mortality and fetal abnormalities if left untreated
- usually subsides after delivery, but 30% of pts may develop type 2 diabetes within 10-15 years
Gestational Diabetes Treatments
- Diet and Medications (meds if necessary)
- Insulin (to prevent birth defects)
- Glyburide or Metformin (concern for long-term adverse effects from these meds)
Secondary Diabetes
..
Diagnostics for Secondary Diabetes?…
- Fasting plasma/serum glucose level > 126 mg/dl
- Random plasma/serum glucose >200 mg/dl measurement plus symptoms
- IFG 100-125 mg/dL
HgbA1C
hemoglobin A1C or glycosylated hemoglobin A1C.
**most comprehensive evaluation of glucose control
A1C goal
less than 7
Hypoglycemia
abnormally low blood glucose level
<50 mg/dL
Clinical Manifestations of Hypoglycemia
….
Treatment of Hypoglycemia
- orange juice
- buccal tablets
- semisolid gel
- 50% dextrose in water (D50W)
- glucagon
Chronic Complications of Diabetes Mellitus
- PVS, coronary artery disease, cerebrovascular accident (stroke)
- Retinopathy, nephropathy, dermopathy (microvascular/capillary damage)
- Neuropathy
- Infection
Goals of DM Management
- reduce symptoms
- promote well-being
- prevent acute complications
- delay onset and progression of long-term complications
Treatment Plan for DM
- patient teaching
- lifestyle changes (diet, regular exercise)
- drug therapy
- self-monitoring of blood glucose
- regular follow up with HCP
Preventative Measures of Diabetes Mellitus
- reducing alcohol intake
- regular exercise
Complete Pathogenesis of Type 1 Diabetes
- Transition between preclinical and onset of type 1 is triggered by acute illness, major emotional stress or an unidentified viral infection.
- These triggers involve the release of cortisol and epinephrine which cause more glucose to be released, which triggers the final autoimmune reaction that destroys the insulin-producing beta cells.
Macrovascular complications from DM
secondary to large vessel damage caused by deposition of atherosclerotic plaque
-CAD, cardiomyopathy, HTN, cerebrovascular disease, peripheral vascular disease.
Microvascular complications from DM
complications secondary to damage to capillary vessels (impairs peripheral circulation and damages eyes and kidneys)
-retinopathy, nephropathy, neuropathy
Glucose homeostasis is regulated by
insulin (beta cells) and glucagon (alpha cells)
Glucose
primary source of energy for cells in the body
Optimal blood glucose levels
70-100 mg/dL
Hemoglobin A1C tests normal
<5.5%
RBC life span around 2-3 months
Insulin
-uptake of glucose in skeletal, cardiac and adipose tissue.
causes liver to store glucose as glycogen
Without insulin
blood glucose levels rise
Polyphagia
excessive eating due to being hungry all the time
Polyuria
increased urine output
polydipsia
increased water intake due to being thirsty
Importance of screening
…
Risk factors for DM
…
Significance of DM
….
Nonpharmacological management of DM
….
Nursing Process and Patient Centered Care: Patient Teaching
pg 514-521
Most common S&S of diabetes mellitus
- elevated blood glucose levels
- polyuria
- polydipsia
- polyphagia
- glycosuria
- weight loss
- blurred vision
- fatigue