Type 2 Diabetes

Question 1

DEFINITION

type 2

Answer 1

A progressive disorder in which the person has a combination of insulin resistance and decreased secretion of insulin by pancreatic beta cells.

Question 2

PATHOPHYSIOLOGY/Etiology

type 2

Answer 2

Insulin resistance develops from obesity and physical inactivity in a genetically susceptible person. Often accompanied by hyperlipidemia, hypertension, and increased clot formation. Specific cause unknown.

Question 3

INCIDENCE

Type 2

Answer 3

Offspring of pts w type 2 have a 15% chance for developing the disease. Obese pts & physically inactive pts. Diagnosed most often in the middle to older aged adult. More prevalent in men.

Question 4

RISK FACTORS

type 2

Answer 4

Abdominal obesity (waist circumference of 40 in or more for men, 35 or more for women)
Hyperglycemia (BG >100)
Hypertension (BP >130/85)
Hyperlipidemia (triglyceride level of 150 or more)
Family history
Race (African American, Hispanic, Native America)

Question 5

SIGNS & SYMPTOMS

type 2

Answer 5

Frequently none
S/S often develop more slowly than type 1
Thirst
Blurred vision
Vascular/neural complications

Question 6

COMPLICATIONS & RELATED CARE

type 2

Answer 6

• Acute: DKA, HHS, Hypoglycemia
• Chronic: Macrovascular (cardiovascular disease; cerebrovascular disease) & Microvascular (eye & vision complications; diabetic neuropathy; diabetic nephropathy; male erectile dysfunction)

Question 7

MEDICAL/SURGICAL TREATMENT

type 2

Answer 7

• Nutrition (high fiber, low fat)
• Planned exercise program
• Diabetes medication/insulin (ex. Sulfonylurea Agents & Biguanides)
• Blood sugar monitoring
• *surgical**
• Whole-Pancreas Transplantation (can improve the quality of life by eliminating the need for injections, BG monitoring, & dietary restrictions. But it requires life long therapy to prevent graft infections)
• Islet Cell Transplantation (eliminates the need for insulin & protects against the complications of diabetes)

Question 8

PHARMACOLOGY & RELATED NURSING CARE

type 2

Answer 8

**Insulin is indicated when BG cannot be controlled w use of 2 or 3 anti-diabetic agents. 
Anti-diabetic Drugs:
-Insulin Secretagogues
-Sulfonylurea agents
-Meglitinide Analogs
-Insulin Sensitizers
-Alpha Glucosidease Inhibitors...

Question 9

NURSING MANAGEMENT

type 2

Answer 9

****Plan ahead for pain control after surgery (pain can increase BG & insulin needs)

Question 10

PATIENT TEACHING

type 2

Answer 10

Nutrition: pt needs to understand how to adjust food intake, planned exercise, & social occasions when usual time of eating is delayed.

Question 11

NUTRITION

type 2

Answer 11

• Carbohydrates : 45 to 65 % of calories, w a minimum intake of 130 g of carbohydrates. Include fruits, vegetables, whole grains, legumes, & low fat milk.
• Dietary fat & cholesterol: Limit saturated fatty intake to 7%. Minimize trans fat intake. Limit dietary cholesterol to 200 mg/day. include 2 + servings of fish.
• Trans fatty acids: limit commercially fried foods & bakery goods.
• Protein: intake of 15 to 20% of total calories.
• Fiber: at least 14g/1000 calories. Legumes, fiber-rich cereals, fruits, veggies, whole grain products. Should also increase fluid intake.
• Sweeteners: Sucrose can be included as long as it is adequately covered w insulin or other glucose lowering agents.
• Alcohol: 2 beverages for men, 1 for women can be ingest w meal plan. Alcohol raises plasma triglycerides, thus abstaining is important for pts w hyperlipidemia.

Question 12

AGING/GROWTH & DEVELOPMENT

type 2

Answer 12

.

Question 13

COMMUNICATION

type 2

Answer 13

.

Question 14

when might a Type II diabetic usually treated with oral hypoglycemic agents require occasional insulin?

Answer 14

During periods of physical stress such as surgery, infection, or trauma.