Diabetes Mellitus (DM)
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Created by:
jrasmussenvt on January 27, 2012
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73 terms
Terms | Definitions |
|---|---|
 Lifestyle changes to prevent type 2 | - Excersize - Diet - Weight management |
| Normal Blood glucose level | - 70 to 110 |
| Mixing insulin | - draw up rapid acting first (clear to cloudy) |
| Classic manifeestation | - Polyuria - Polydipsia - Polyphagia |
| Hypoglycemia signs and symptoms | - Not mentally sharp - light headed, dizzy - shaky, irratable possibly vision problems and slurred speach |
| Insulin cannot be given orally | - insulin is protein which gets broken down in GI |
| Best body area | - abdomen |
| Acute | - DKA - Impaired healing |
| Long term | - Vascular (micro and macro) -- eyes, kidneys, senssation (neuropathies) - Depression - gasterophersis |
| Diagnosis Tests | - A1c - Fasting blood glucose - Oral glucose tolerance test - urine analysis (ketones) |
| Nurisng diagnosis | - Alterations in senssations - impaired skin integrety - knowledge deficit |
| Stress | increases blood sssugar |
| Pancrease structure | - head c chaped curve against duodenum, see pics - islet of langerhanse cells in ducts |
| Endocrinologist | - Specialist in diabetes and other endocrine disorders |
| Islets of langerhans | - Alpha - produce glucagon (increase blood glucose) - Beta - secrete insulin (help transport glucose into cells - Delta - produces somastatin (inhibits production rates of others) |
| Insuling | - secreted by beta - moves to liver - released to general circulation - Increases when blood glucose is high - Decrease when bld glucose levels decrease |
| Insulin rates | - normal 70 to110 - See power point |
| cultural incidence | - 2X in african americans - 5X in Native americans - HIgher in hispanic americans |
| Type one | - used to be called juvinile diabetes - cchanged in 1979 |
| New terms | - Type 1(5-10%) - Type 2 (90-95%) - Other (1-2%) - gestational (2-5% of pregnancies) |
| Absolute Deficiency | - require lifelong insulin replacement, beta cells are destroyed (90% destroyed) - cOuld be caused by genetics, environmental (viruses and toxins) idopathic or immne mediated |
| type one | - thin - abrupt onset - onset before ate 20 - prone to ketoacidosis - honeymoon period |
| Type two | - Relative deficiency - Peripheral insulin resistance (body does not respone to insulin |
| Risk factors | heredity - ppt |
| Type two charaaacteristics | - generally obesee gradual onset - usually onset after 40 |
| Other specific types | - genetic defects - disease of pancrease, cyctic fibrosis or injury - infectinos - drug or chemicallyinduced diabetes - endocrinopathies |
| Gestational | - any degree of abnormal glucose during preg - affects 2-3% - usually at the midpoint of preg - increases risk of complications - Hyperglycemia and hypoglycemia - ccan threaten normal fetal growth |
| Gestational cont. | - Treated with diet and insulin - may return to normal but increaseds future risk - history of large babies etc.. |
| Prediabetes | - known as impaired glucose intolerance (IGT) - blood sugars are higher but not diabetic levles - most will develop within 10 years - Long term damage occuring - ppt |
| Cardinal signs | - ppt |
| Diagnostic labs | - FBS- fasting serum blood glucose - two hour post prandial (fasting) - GtT - glucose tolerance test - SMBG - self monitoring bloood glucose (finger stick) - A1C or HbA1c (glycosylated hemoglobin) -- blood test measures glucose conrtol ofer the past 120 days -- goal of A1C levels is less than 7.0% (means that 7% of hemoglobin has glucose attached to it) recommed below 6.5% |
| Urine glucose and ketone leevels | -Renal threshold 180/100 ml - ketone monitoring (ketostix) - Results (neg, trace, small, mod, large - INterpretation : fats are energy source, inadequate insuling - if untreated could pregress to DKA |
| Ketones | - Using fat as fuel, resultsin ketones in blood, blood becomes acidic |
| Manageing triad | - Diet - limit caloric intake, focuses on CHO content - Exercise - Medications |
| Weight loss | - cannot be underestimated - slows release of glucose increases insulin receeptors |
| Exercise | - Lowers glucose - stimulates muscles to take up glucose - reduces complications - helps lower weight - lowers serum cholesteraol - never exercise when sugar are at or ne300 |
| FIT | ppt |
| Pharmacolgy | - Oral hypoglycemic agents -- supplement diet and exercise intype 2 (IS NOT INSULIN) - Insulin -- Type 1 -- Type 2 -- in periods of illness, stress or long term control |
| OA's | -- Stimulate secretion of insulin - increase tissue sensitivity to insulin - ppt |
| Oral hypogglycemics | - sulfonylureas - nonsulfonylureas -- Biguanides (metphorimin/glucophage)**** --Alpha-glucosidase Inhibitors (newest class) Acarbose -- Thiazolidinediones (end with glitazone) -- Meglitinides (end with glinide) -- Dipeptidyl Peptidase-4 (DDP-4) Inhibitors (end in gliptin) no weight gai |
| Sulfonylureas | - could be allergic first and second generations in ppt |
| Pharmacology management | - Glyburide/metformin (glucovance) others ppt |
| Nursing considerations with OA | - administer with food except glipizide - monitor for hypoglycemia - diet - avoid alcohol - can interfere with oral contraception |
| Glucophage | - contraindicated with contrast dye, potential of renal failure and lactic acid complications - hold 48 hrs prior to study and 48 hours afet - contraindicated in renal disease |
| Exanatide injecction (Byetta) | - Synthetic version of human hormone - prefilled pen- stored in frig - not aaaa substitute for insulin! - give 60 min before meal, not after - patients loose wieght - most common side effect is nausia that decreases over time -Amalyn is similare |
| Sliding scale | - physician produces chart to determine dosage based one |
| Time for insulin | When OA ans Injectinos fail - not a cure - Only REGULAR can be given IV!!!! - ab, arm thigh, buttock |
| Insulin classifiaction | - Rapid Acting (LISPRO) 5 to 10min - SHort (REGuLAr) 30 to 60 min - Intermediate (NPH) 2-4 hrs - Long acting (Ultralente) - Very long acting (Lantus) starts and has no peak - Combination therapy (Novolog(70/30) - on safe practice list, 2RNs need to sign |
| Insulin | - derived from E. Coli(semi-synthetic) 99% allergy free - Metabolized in liver and muscle - pppt |
| Insulin storage | - No heating or freezing no prolonged exposure to sunlight vials cna be stored at room temp up to 4 weeks - prefilled syringes stable up ot 1 week in frig -- 50 unit 1/2 cc or 100 unit 1cc - if traveling in hot climate keep in thermos |
| INSULING DRUG INTERACTIONS | _ Increase blood sugar -- thiazide diuretics ---Glucocoritcoids (steroids diabetes) -- thyroid preparations -- estrogens - decrease insulin need -- ppt |
| insulin regimens | - Basl/Bolus regimen Best -- mimics endogenous insulin -- rapid and short acting (bolus) -- llong acting (basal) |
| Lispro | -Very rapid acting - ppt |
| Lantus | -Long acting - clear solution (exception to rule) - SubQ - lasts 24 hrs peakless |
| Insulin Pens | - multiple dose - contains 300 units of U100 insulin - use a new needlw - ppt |
| Insulin Pumps | - Implantable - Portable - frequent monitering - sepssis infection issues - educated and motivated patients |
| New developments | - Inhalation - Exubera - rapid onset, short duration powder.. -- may reduce number of injections necessary, pulled from market 2007, close to FDA approval again. |
| Insulin Drips | - ONly Regular insulin - tighter control- absorption is consistatn |
| Problem with insulnn | Lipodystrophy -ppt |
| Hyperglycemia | - Diabetic ketoacidosis (DKA) type 1 - Hyperosomal ppt |
| ppt | ppt |
| Treatment of hyperglycemia | - addition insulin may benecessary - IV fluids - ppt |
| DKA (TYPE1) | - Bld Glucose over 300 - dehydrated - thirst dry mucus membraens weak warm dry skin malaise hypotension rapid weak pulse nasua vomiting soft eyeballs metabolic acidosis ketone breath kussmmmauls respirations (increase in rate and depth) - medical emergency |
| DKA treatment | - IV regular - Fluid IV - Monitor and replace electrolites - assesemnet of glucose levels - I and O |
| HHS Type 2 | - Blood sugar over 600 - slow onset altered levels of consciousness - serious life threateneing medical emergency - different fROM DKA in that no ketones |
| HHS symptoms | - dehydrations skin flushed, warm , dry normal breath increase pulse, decrease BP resp. normal NV, abd. Pain Decrease LOC- Seizures |
| HHS treatment | - same as DKA - IV insullln - hydration - replace electolyutes - ppt. |
| 2 others | Somogyi - rebound (2-3AM) treated with less insulin Dawn - present on awakening, possibly related to growth hormonesl |
| Hypoglycemia | Neuro symptoms appear - ppt - can be serious problem |
| Hypoglycemia | - conscious - give simple carb - unconscious patient --IV dextrose --ppt |
| Chronic complications | - Macrocirculation - Microcirculation - neuropathy - DPN (diabetic peripheral neuropathy, prickling - burning - numbness in feet in lower legs -Nephropathy - ----- cardovascular impact - erectile dysfunction - occu ppt |
| Foot care | ppt |
| Preventing foot trauma Patient educattion | ppt important |
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