Week 4 Diabetes Management Flashcards
Bile duct and pancreatic duct combine to form the
Common Bile Duct
Opening into the duodenum is the
Ampula of Vater
Sphincter is called the Sphincter of Odi
Gallstone within the gallbladder
Cholelithiasis
Gallstone within the duct
Choledolithiasis
Alpha Cells
20 % secrete glucagon
Hormone formed in the pancreas that promotes the breakdown of glycogen in the liver
Beta Cells
75% secrete insulin
Hormone produced in the pancreas by the islets of Langerhans that regulate the amount of glucose in the blood.
Moves glucose to cells, stores as glycogen in the liver and skeletal muscle
Islet of Langerhans Cells
Composed of Alpha and Beta Cells
Delta Cells
5% secrete somatostatin
Somatostatin- from the hypothalamus inhibits pituitary gland secretion of growth hormone and thyroid stimulating hormone
Somatostatin is produced in the
Pancreas
Inhibits the secretion of other pancreatic hormones such as insulin and glucagon
D1 Cells
VIP- Vasoactive Instestinal Polypeptide
Neuropeptide functions as neuromodulator and neurotransmitter . Potent vasodilator.
PP Cells
Pancreatic Polypeptide
Inhibitor of glucagon release at low glucose level . Feeling of fullness of hormone.
Exocrine Function
Acini Cells- Secrete Amylase, Lipase, trypsin as digestive enzymes
Exocrine
Acini Cells
Secrete Pancreatic Juices
Endocrine
Islets of Langerhans
- Secrete insulin and glucagon
Pancreas has two main functions
Exocrine Function- Helps in digestion
Endocrine Function- regulates blood sugar
DM
Disease characterized by hyperglycemia, caused by defects in insulin secretion, insulin action, or both
DI caused by problems with what hormone
Vasopressin
4 types of DI
Central
Nephrogenic
Dipsogenic
Gestational
Absence of insulin production ( beta cells are destroyed from autoimmune response)
Type 1
Insulin Dependent or Juvenile
Type 2 DM
Deficiency of insulin production, decreased insulin action, and increased insulin resistance
non- insulin diabetes or adult onset diabetes
Any degree of glucose intolerance with onset of pregnancy
Gestational Diabetes
LADA
Latent AutoImmune Diabetes of Adults
Destruction of beta cells of langerhans- progresses more slowly
Pre Diabetes, IGT, or IFT
Impaired fasting glucose
Impaired glucose tolerance
Hx of Hyperglycemia
Risk Factors of Diabetes
Family Hx
Obesity
Race/ Ethnicity
Age
HTN
HDL
Hx of gestational diabetes or delivery baby over 9 pounds
Functions of Insulin
Transports and metabolizes glucose for energy
Stimulates storage of glucose in liver and muscle as glycogen
Signals the liver to stop the release of glucose
Enhances storage of fat
Accelerates the transport of AA
Inhibits the breakdown of stored glucose, protein, and fat
Medications that can potentiate Diabetes
Anti- Seizure
Psychiatric
HIV meds
Glucocorticoids
Sulfas
Thiazide
Estrogens
Loops
Type 1 Diabetes
Insulin producing beta cells in pancreas are destroyed by autoimmune process
Requires insulin because little or no insulin produced
Onset is acute and usually before age 30
Peak incidence at puberty
Classic presentation of Diabetes
3 P’s
Polyphagia
Polydipsia
Polyuria
Type 2 Diabetes
Decreased sensitivity to insulins and impaired beta cell function result in decreased insulin production
Slow progressive glucose intolerance
Treated with diet and exercise
Oral Antidiabetics
Type 2 Diabetes
Stronger Diabetic disposition
Caused by either decreased insulin secretion
DKA can occur with hyperosmolality
HHNS may occur
Risk Factors of Type 1 Diabetes
Genetics
Immunologic factors
Environmental factors
Risk Factors of Type 2 Diabetes
Obesity
Age
Impaired fasting glucose
HTN
HDLs
History of gestational diabetes
Clinical Manifestations
Three Ps
Fatigue, weakness, vision changes, tingling and numbness in hands or feet’s, dry skin, skin lesions, slow to heal, recurrent infections
Type 1 may have sudden weight loss
Diagnostic Findings
Fasting Blood Glucose 126 or more
Random glucose exceeding 200mg/ dl
Two hour post load glucose equal to or greater than 200 during an oral glucose tolerance test
Hgb A1C > 6.5%
Gerontologic Considerations
Age related elevation of blood glucose
Glucose tolerance test is more specific than urine testing for the elderly
Treatment Goal of Blood Glucose Levels
Intensive Control
Insulin Pump
Monitoring Glucose
Weekly Contracts
Decreases complications progression
Dietary Management Goals
Maintain the pleasure of eating, include personal and cultural preferences
Promote exercise and activity
Achieve and maintain BMI under 25
Decrease serum lipids
Prevent wide fluctuations of blood glucose
Role of the Nurse with Diabetes
Knowledge of diet
Communicate with dietician
Reinforce Pt understanding
Support Dietary and lifestyle changes
Meal Planning
Consider food preferences, lifestyle, cultures
Review diet history and need for weight loss
Caloric requirements
Carbohydrates
Fat
Protein
Fiber
Glycemic Index
Combining starchy foods with protein and fat slows absorption and glycemic response
Raw or whole food tend to have lower responses than cooked, chopped, pureed foods
Eat whole fruits than juices because of fiber
Adding food with sugars may produce lower response if eaten with foods that re more slowly absorbed
Other Dietary Concerns include
Alcohol
Nutritive and nonnutritive sweeteners
Reading Labels
Exercise does what?
Lowers blood sugar
Aids in weight loss
Lowers CV risk
Exercise Precautions
Exercise elevates blood sugar levels, insulin must be adjusted
refrain from exercise when glucose is above 250 or ketones in the urine
Insulin normally decreases with exercise
Pt on exogeneous insulin should eat carbohydrate snack before moderate exercise to prevent hypoglycemia
Monitor Blood glucose
Inhaled Insulin
Afrezza
Rapid Acting
Pt instructed eat no more 5-15 min after injection
ex LAG
Lispro
Aspart
Glulisine
Short acting
Given 15 min before a meal either alone or in combination with longer acting
Regular Insulin- Only insulin that can be given IV
Insulins with R
Intermediate Acting
NPH
White and Cloudy. Should eat food around some time around onset and peak.
Insulins with N
Educating Pt in Insulin Self management
Use and action insulin
Symptoms of hypoglycemia and hyperglycemia - Required Actions
Blood Glucose Monitoring
Self Injection of Insulin
Insulin Pump Use
Small machine that gives small and steady doses of insulin throughout the day
Insulin Pump.
Can give pumps during meal times
If attaches to skin- self adhesive Pump
Used for pt with Type 2 diabetics
Oral antidiabetic medications
Combinations of oral drugs may be used
Major side effect: hypoglycemia
Nursing Interventions: monitor blood glucose for hypogly
Pt education
