EAC Diabetes and Drug Therapy Flashcards
define:
Diabetes Mellitus
A disorder where there is inadequate insulin for carbohydrate metabolism.
Glucose absorbed form the GI tract cannot be metabolised or stored and so reaches higher than normal levels in the bloodstream.
2 types of Diabetes Mellitus
Insulin dependant diabetes mellitus: type 1 IDDM
-insulin not being produced at all
Non-insulin dependant diabetes mellitus: Type 2 NIDDM
-Insulin is released but the receptor sites have mutated and insulin is unable to enter the cells to allow sufficient glucose absorption
How the body normally regulates blood sugar
The pancreas has the ability to determine the level of sugar in the blood and releases different hormones to regulate this.
Glucagon released by alpha cells of pancreas causes the liver releases glucose into the blood.
Insulin released by beta cells of pancreas causing fat cells to take in glucose from the blood.
complications of Diabetes
Cardiovascular disease Neuropathy (dysfunction of peripheral nerves) Nephropathy (kidney disease) Renal failure Infection Hypoglycaemia coma Hyperglycaemia coma
complications of diabetes:
Cardiovascular disease
Atheroma and calcification of the tunica media of large arteries, leading to peripheral vascular disease, MI, cardiovascular disease
Thickening of the epithelial basement membrane of arterioles, capillaries and vessels leading to:
Peripheral vascular disease
Retinopathy
Nephrotic syndrome and renal failure
Peripheral neuropathy (damage to nerves causing diminished sensation in lower limbs and bladder problems)
complications of diabetes:
Infection
Diabetics are very susceptible to infection, especially from bacteria and fungi
complications of diabetes:
Renal Failure
Due to vascular changes and infection, it is a common cause of death in diabetics
complications of diabetes:
Hypoglycaemia
can occur in type 2 and type one diabetics.
This occurs in insulin dependant diabetics where insulin administered is in excess of that needed to balance food intake and expenditure of energy. It will lead to coma and if prolonged, irreversible damage can occur
complications of diabetes:
Hyperglycaemia
it is accompanied by disturbances of the acid base balance of the body, and is most common in insulin dependent diabetics. Its onset is gradual and often follows an infection and gradual loss of diabetic control.
aetiology (causes) of:
Hypoglycaemia
Overdose of insulin Food intake inadequate Overdose of oral agents GI disturbances eg, vomiting, diarrhoea Unexpected exercise Excess consumption of alcohol Hepatic or renal dysfunction Other illnesses inc. infection Alcohol intake pregnancy and breastfeeding the elderly
aetiology (causes) of:
Hyperglycaemia
Poor diabetic control; failure of the patient to administer the required dose of drugs
Inadequate adjustment of the prescribed dose to meet the patients needs
The presenting feature of diabetes, especially in the young
Undiagnosed diabetes
Illness
Infection
Myocardial infarction
Medication including steroids
signs and symptoms of:
Hyperglycaemia
Polyuria Polydipsia (thirsty) Polyphagia (hungry) Ketone breath Kussmaul's respiration (deep/laboured) Lethargy and confusion Dehydration and signs of shock Hyperventilation Rapid weight loss Unconsciousness Low blood pressure Abdo pain, nausea, vomiting Dry skin Rapid weak pulse abnormally high BM
management of:
Hyperglycaemia
DRABCDE correct AB problems time critical measure BM Record ECG O2 if required placing in the recovery position if unconscious Pre-alert time critical transfer
Paramedic/CHUB or GP advise must be sought before leaving patients at home.
Non-conveyed Non-diabetic patients: HYPER
Routinely assess BM of all patients >40 years
BM 8-12.9 = letter sent to GP within 3 weeks for follow up blood test
BM >13 = Contact EBS to make GP referral for follow up within 24-48 hours
BM >25 = convey to hospital if declined contact EBS for GP referral
one test doesn’t diagnose
record/handover: weight loss, >thirst, weakness
risk factors: excess weight, sedentary lifestyle, bad diet, smoking
signs and symptoms of:
Hypoglycaemia
Autonomic: sweating, palpitations, shaking, hunger
Neurological: confusion, drowsiness, odd behaviour, speech difficulty, un-coordination, aggression, fitting, unconsciousness
General malaise: headache, nausea
