Nursing Management: Diabetes Mellitus Flashcards
Diabetes Mellitus
DM is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both.
The chronic hyperglycemia of diabetes is associated
with relatively specific long-term microvascular complications affecting the eyes, kidneys and nerves, as well as an increased risk for cardiovascular disease (CVD).
Prediabetes
Impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)
FPG = 6.1 – 6.9 mmol/L
Types of diabetes
Gestational diabetes
Secondary diabetes.
- Chronic Pancreatitis
- Cystic Fibrosis
- Hemochromatosis
Metabolic Syndrome
A collection of risk factors that increase an individual’s chance of developing cardiovascular disease and diabetes mellitus
- Abdominal obesity
- Hypertension
- Dyslipidemia
- Insulin resistance
- Dysglycemia
Primary prevention for Type 2 Diabetes
Modifiable Risk Factors
Obesity
Physical inactivity
Unhealthy diet
Smoking
Hypertension
High cholesterol
Non-modifiable Risk Factors
Age
Family history
Ethnicity
History of gestational diabetes
Pathophysiology of diabetes: Pancreas
- Beta cells regulate insulin
Insulin increases cellular uptake of glucose - Alpha cells regulate glucagon
Glucagon increases release of glucose by the liver
↑ glucose → ↑ insulin & ↓ glucagon
↓ glucose → ↓ insulin & ↑ glucagon
Other hormones that increase blood glucose:
Epinephrine
Growth hormones
Cortisol
Pathophysiology of Type 1 Diabetes
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
Possible causes:
- Immune system disorder (genetic predisposition)
- Virus
Pathophysiology of Type 2 Diabetes
- Insulin resistance
- Body tissues do not respond to action of insulin
- Decreased responsiveness of beta cells to hyperglycemia ->
desensitization - Decrease in ability to produce insulin
- Inappropriate glucose production by liver
-Not a primary factor in development of DM2 - Alteration in production of hormones & cytokines by adipose tissue
- Adipocytokines play role in glucose & fat metabolism
Type 1 Diabetes:
Typical onset at young age (< 30 years)
Cachexic appearance due to muscle and fat breakdown
Abrupt diagnosis
Often diagnosis is precipitated by an infection or stress
Insulin required for survival
Often difficult to control blood sugar levels
Type 2 Diabetes:
Typical onset at older age, though becoming increasingly common among young people
Slow, gradual onset
Combination of genetic and lifestyle factors
Oral hypoglycemic agents or insulin may be necessary
Relatively stable blood sugar levels
Diagnosis of diabetes
Symptoms of diabetes plus a random plasma glucose value ≥ 11.1 mmol/L
A fasting plasma glucose (FPG) ≥ 7.0 mmol/L
A plasma glucose value in the 2-h sample (2hPG) of a 75g oral glucose tolerance test (OGTT) ≥ 11.1 mmol/L
A1C >6.5% (in adults)
Glucosylated Hemoglobin: HbA1c
Shows amount of glucose that has been attached to Hgb molecules, which are attached to RBC for life of cell (approx. 120 days)
Indicates overall glucose control for previous 90-120 days
All clients with diabetes should have this tested q3-6 mos.
People who can maintain near-normal A1c levels have greatly reduced risk for development of complications
Ideal is ≤ 7% for those with diabetes (normal range ≤ 6%)
Impaired fasting glucose (IFG)
Fasting Plasma Glucose (mmol/L): 6.1 - 6.9
Impaired glucose tolerance (IGT)
2-hr Plasma Glucose in a 75-g Oral Glucose Tolerance Test (mmol/L)
7.8 – 11.0
Prediabetes
Glycated
Hemoglobin
(A1C) (%)
6.0 - 6.4
Clinical Manifestations Type 1
The 3 P’s: Polyuria, Polydipsia, and Polyphagia.
Weight loss
Ketonuria & ketoacidosis:
- Fruity breath
- Nausea & Vomiting, Abdominal pain
- Very ill person
Weakness & fatigue
Visual changes
Type 2
Symptoms Associated with Prolonged Hyperglycemia:
Chronic blurred vision
Recurrent infections (skin, vaginal yeast), slow-healing wounds
Neuropathic pain
Characteristics:
Gradual onset
May have “classic” manifestations
No typical weight loss; often weight gain (especially middle fat, although limbs may be thin)
Often fatigue is the only symptom
Goals for Management of Diabetes
Maintain blood glucose levels within the target range
Monitor and manage cardiovascular risk factors
Control the diabetes so it does not control you!
Promote overall health through a balanced diet and regular physical activity
ABCDESSS of Diabetes Care
A - A1Ctargets
B – BP Targets
C – Cholesterol Targets
D - Drugs for CV and/ or Cardiorenal protection
E – Exercise goals and healthy eating
S – Screening for complications
S – Smoking cessation
S – Self-management
Pharmacological Management
Insulins:
- Rapid
- Short acting
- Intermediate acting (cloudy)
- Extended long acting
- Premixed (cloudy)
Rapid-acting insulin analogues (clear):
Insulin aspart (NovoRapid®)
Insulin glulisine (Apidra™)
Insulin lispro (Humalog®)
Onset: 10 - 15 mins
peak: 1 - 1.5 hr
Duration: 3 - 5 hr
Short-acting insulins (clear):
Insulin regular (Humulin®-R)
Insulin regular (Novolin®geToronto)
Onset: 30 mins
Duration: 2 - 3 hr
Duration: 6.5 hr
