-all tissues & organs need glucose, but not all tissues need insulin for glucose uptake: Brain, liver, intestine, & renal tubules don't require insulin to transfer glucose into cells because they use a different transporter for glucose uptake. Skeletal muscle, cardiac muscle, & adipose tissue do require insulin to move glucose into cells.
-Normal blood glucose is maintained by insulin & glucagon
-increased glucose levels, amino acids, & fatty acids stimulate pancreatic beta cells to produce insulin.
-as cardiac & skeletal muscle cells & adipose tissue take up glucose, plasma levels of nutrients decrease, suppressing the stimulus to produce insulin.
-If blood glucose falls, glucagon is released to raise hepatic glucose output, raising glucose levels. Glucose counterregulatory hormones also help raise glucose levels
1.Saturated fat: Animal meats (butter fats, lard, bacon), cocoa butter, coconut oil, palm oil, & hydrogenated oils
2. Polyunsaturated fat: Oils of corn, safflower, sunflower, soybean, sesame seed, & cottonseed
3. Trans fatty acids: Partially hydrogenated vegetable oils, shortenings and in animal fats (trans fats lower HDL cholesterol & increase LDL cholesterol --->leading to CHD)
4. Monosaturated fat: Peanut oil, olive oil, & canola oil.
Dietary fiber may help prevent constipation, GI disorders (colon cancer), & provides feeling full. must increase gradually
-intake 14g/1000 Kcal per day is recommended
-increase in fiber with no increase in fluids can cause nausea, diarrhea, constipation, or flatulence
1.Large amounts of soluble fiber may be beneficial to serum lipids. Is found in dried beans, oats, barley, vegetables & fruits (peas, corn, zucchini, cauliflower, broccoli, prunes, pears, apples, bananas, oranges)
2.Insoluble fiber facilitates intestinal motility & gives feeling of fullness. Is found in wheat, corn, vegetables & fruits ( carrots, brussels sprouts, eggplant, green beans, pears, apples, strawberries)
-surgically revising the GI tract & replacing or transplanting the pancreas, pancreatic cells or beta cells,
-islet cell transplantation has had moderate success
-surgery is a stressor that alters self-management and glycemic control in DM. stress causes levels of catecholamines, cortisol, glucagon, & GH to increase & causes insulin resistance. Hyperglycemia occurs & protein stores are decreased, diet & activity patterns change, then have a higher risk for post operative infection, delayed wound healing, F&E imbalances, hyper- hypo- glycemia & DKA
Dehydration (from hyperglycemia)
-thirst, warm, dry skin with poor turgor, soft eyeballs, dry mucous
membranes, weakness, malaise, rapid, weak pulse,
Metabolic acidosis (from ketosis)
-Nausea & vomiting, Ketone breath odor, lethargy, coma
Other manifestations,Abdominal pain (cause unknown)
-kussmaul's respirations (increased rate and depth of respirations, with a longer expiration; a compensatory response to prevent a further decrease in pH
-therapeutic agents that cause hyperglycemia; glucocorticoids, diuretics, beta blockers, immunosuppressants, chlorpromazine, Diazoxide
-therapeutic procedures; Peritoneal dialysis, Hemodialysis, Hyperosmolar alimentation, surgery
-acute illness: infection, gangrene, urinary infection, burns, GI bleed, MI, pancreatitis, stroke
-chronic illness; renal disease, cardiac disease, hypertension, previous stroke, alcoholism
caused by responses of the ANS
-hunger,Nausea, anxiety, pale, cool skin, sweating, shakiness, irritabilit, rapid pulse, hypotension
*caused by impaired cerebral function (no glucose in brain cell)
-strange or unusual feelings, HA, difficulty in thinking, inability to concentrate, change in emotional behavior, slurred speech, blurred vision, decreased LOC, seizures, coma
-onset is sudden with glucose <45-60mg/dL
-may cause death
- are isolated peripheral neuropathies that affect a single nerve
-Palsy of the third cranial (oculomotor) nerve, headache, eye
pain, inability to move the eye up, down, or medially
-Radiculopathy (a neuropathy), with pain over a dermatome &
loss of cutaneous sensation, most often located in the chest
-Diabetic femoral neuropathy, with motor & sensory deficits
(pain, weakness, areflexia) in the anterior thigh & medial calf
-Entrapment of compression of the medial nerve at the wrist-->
results in carpal tunnel syndrome with pain & weakness of the
hand, ulnar nerve at the elbow, with weakness & loss of
sensation over the palmar surface of the 4th & 5th finger
-the peroneal nerve at the head of the fibula with foot drop
amputations & problems with feet are a result of; angiopathy, neuropathy, & infection.
-increased risk are; those who have had DM for more than 10 years, are male, have poor glucose control, have cardiovascular, retinal, or renal complications.
-vascular changes in the lower extremities result in arteriosclerosis.
-DM arteriosclerosis occurs early & equally in males & females, is bilateral, & progresses more rapidly--> blockages form in the large, medium & small arteries of the lower legs and feet. --
-Multiple occlusions with decreased blood flow result in the manifestations of peripheral vascular disease.
*musculoskeletal assessment= foot & joint ROM, bone abnormalities (bunions, hamertoes, overlapping digits), gait patterns, use of assistive devices for walking and abnormal wear patterns on shoes.
*neurologic assessment= sensations of touch and position, pain, and temperature
*Vascular examination= includes assessment of lower extremity pulses, cap refill, color & temperature of skin, lesions & edema
*Hydration status= dryness or excessive perspiration
*Lesions, fissures between toes, corns, calluses, plantar warts, ingrown or overgrown toenails, redness over pressure points, blisters, cellulitis or gangrene
*wash feet daily, test water temperature & use thin coat of lubricating lotion (not between toes)
*Do not smoke. Nicotine causes vasoconstriction , further decreasing the blood supply to the feet
*Teach that hyperglycemia promotes the growth of microorganisms so must control BG levels
- do not use throw rugs
*monitor for and teach patient and family to recognize and seek care for the manifestations of DKA in the patient with type 1DM:
-Hyperglycemia, thirst, headache, nausea, vomiting, increased urine output, ketonuria, dehydration & decreased LOC
*Monitor for and teach patient and family to recognize & seek care for the manifestations of HHS in patient with type2DM:
-extreme hyperglycemia, increased urine output, thirst, dehydration, hypotension, seizures, & decreasing LOC. HHS is a life threatening condition.
*Monitor for and teach patient and family to recognize & treat the manifestations of hypoglycemia:
-low blood glucose, anxiety, headache, uncoordinated movements, sweating, rapid pulse, drowsiness, decrease LOC, & visual changes.
-carry some form of rapid-acting sugar source at all times
-hypoglycemia is caused by too much insulin, too little food, or too much exercise.
-wear a MedicAlert bracelet or necklace