DM ppt Flashcards
DM risk factors
genetics obesity race/ethnicity age HTN high HDL gestational diabetes, baby >9 lbs
DM 1
FKA brittle diabetes, juvenile diabetes
beta cells in panrease are destroyed
decreased insulin production and unchecked glucose production
5% of DM
DM 2
95% of DM
most common in obese >30 y/o
insulin resistance
impaired insulin secretion
gestational diabetes
hyperglycemia develops with pregnancy 2/2 secretion of placental hormones
r/o HTN during pregnancy
highest risk: obesity, Hx of gestational diabetes, glycosuria, genetics
latent autoimmune diabetes of adults (LADA)
progression of autoimmune beta cell destruction is slower than in DM1/DM2
not insulin dependent initially
3 Ps
polyuria
polydipsia
polyphagia
DM diagnostic findings
casual glucose reading > 200mg/dL
flasting glucose >126 mg/dL
greater than 200mg/dL in oral glucose tolerance
A1C > 6.5%
DM medical mgmt
A1C < 7% nutritional therapy exercise monitoring medication educatoin
nutritional therapy
control of total caloric intake to maintain or attain reasonable body weight
control blood glucose levels
meal planning
maintain pleasure of eating
meal planning
carbs: 50-60%
fat: 30%
cholesterol: <300mg
non animal sources of protein
rapid acting insulin
shorter duration
eat within 5-15 min
short acting insulin
clear solution
given 15 min prior to meal
can be given IV
intermediate acting insulin
NPH or Lente
white and cloudy soltuion
should eat food around onset/peak
long acting “peakless” insulin
absorbed over 24 hrs
given once daily at the same time
conventional insulin therapy
pt should not vary meal patterns 1-4 injections qd appropriate for: terminally ill frail older adult with self-care limitations pts unwilling to do self mgmt
complications of insulin therapy at injection site
redness, swelling, tenderness, induration, 2-4 cm wheal at site
may appear 1-2 hr after injection
another type of insulin may be needed
complications of insulin therapy (systemic)
rare
immediate skin reaction that spreads in hives
associated with edema, anaphylaxis
give desensitization kit
complications of insulin therapy: insulin lipodystrophy
localized reaction at injection site
lipoatrophy: dimpling, loss of subcutaneous fat (mostly resolved with use of human insulin)
lipohypertrophy: development of fibrofatty masses at injection sites caused by repeated use of site; absorption may be delayed
complications of insulin therapy: resistance
immune antibodies develop and bind the insulin
all insulins cause antibody production
treated by administering a more concentrated insulin
complications of insulin therapy: morning hyperglycemia
insulin waning
dawn phenomenon
Somogyi effect
insulin waning
progressive rise in glucose from bedtime to moring
increase evening dose or administer before evening meal
dawn phenomenon
normal until 3 am. then level begins to rise
change time of evening insulin from dinner time to bedtime
Somogyi effect
normal at bedtime, decrease 2-3 am caused by production of counter regulatory hormones
decrease evening dose or increase evening snack
insulin pens
prefilled cartridges loaded into pen-like holder
attach disposable needle
convenient for eating out, traveling
jet injectors
deliver insulin under skin through a fine stream
expensive, require training
insulin absorbed faster
insulin pumps
small and worn externally
needle/cath in subcutaneous tissue gets changed every 3 days
infused at basal rate; calculates carbs at meal
good for people with hectic lifestyles
insulin pump issues
tubing may get dislodged
battery is depleted
supply of insulin runs out
oral antidiabetic agents
used for DM2 patients
major side effect: hypoglycemia
