112 terms

Diabetes Mellitus

Location of pancreas
accu check test sugar
outside of the cell
risk factors for DM
obesity, genetics, chronic pancreas disorders, meds (steroids)
Alpha cells produce
glucagon turns into
beta cells produce
delta cells secrete
inhibits glucagon and insulin
glucagon is used for
energy production
insulin is the
key to the cell to let glucose inside the cell
metabolic disorder of the pancreas that affects fat, CCHO, and protein metabolism
Prevalence of DM
adults are more prone than children, 7th leading cause of death in the USA, African Americans-high prevalence
when cells don't have glucose they go into starvation mode and attack
muscle, organs, and even bone
quick source of energy
longer lasting energy
waste product of protein metabolism in the body
Function of insulin
key to open the cell to let glucose in
Production of insulin takes place
in the pancreas by the beta cells
Type 1 DM (IDDM or juvenile)
pancreas does not secrete insulin, usually caused by destruction of beta cells, requires insulin injections, onset is rapid, theory is that it is a AUTO IMMUNE DISORDER, hereditary link, prone to get ketoacidosis
Type 2 DM (NIDDM or adult onset)
some insulin production, can change to IDDM, largest cause HEREDITY, obesity, NO CURE
the only cure for DM is
a pancreas transplant
Gestational diabetes
occurs during pregnancy, usually resolves itself AFTER THE BABY IS BORN, more susceptible to having DM later in life, may require insulin during pregnancy
risk factors for Gestational diabetes
>25 years of age, obesity, previous GD, family hx of DM
GTT (glucose tolerance test)
requires to drink a sugary drink and then the blood and urine is tested every hour
impaired glucose intolerance
blood sugar is above normal without meeting other DM requirements
BS 140-200 after 2 hours =
glucose intolerance
IFG (impaired fasting glucose)
after fasting for 8 HOURS a result of 10-126=impaired fasting glucose
Syndrome X
metabolic disorder; insulin resistance, glucose intolerance, low HDL, high LDL, HTN, abdominal obesity, going to lead to DM
TX for syndrome X
lifestyle changes
Other causes of DM
chronic pancreatitis, prolonged use of steroids, diuretics, thyroid medication
MODY (maturity onset diabetes of the young)
inherited insulin impairment that occurs before age 25
S/S of DM
polydyspia, polyuria, polyphagia, glycosuria, nocturia, fatigue, blurred vision, abdominal pain, headaches
Random Blood sugar
no preplanning; results >200=DM
Fasting Blood Glucose
obtain after 8 hours fasting; results 70-110= normal
Postprandial Glucose
obtain 2-4 hours after a meal; results >140=DM
Oral GTT
drink high sugary drink and test urine and blood 3 hours after; results glucose levels return normal in 2-3 hours and urine negative for glucose= normal
Hgb A1C
lab draw test for last 90-120 days; >8%=DM or poorly controlled DM
Tx for DM
oral medication, insulin, CCHO diet
Prevention of DM
wt loss, diet, exercise, regular check up with MD
Goal of tx for DM
keep BS in normal range, HGB A1C- 7%-8%, accu check- less than 120
Nutrition therapy goal
maintain BS levels and lipid levels near normal to prevent longterm complication
Components of Diet include a consistent amount of
carbs, proteins, and fats
CCHO diet goal is
less restriction of foods and less rigid; very individualized
Nutritional therapy food plans
limit high fat foods, encourage fruits, veggies, and grains
Exercise facts
important to lower cholesterol, BS usually goes down with exercise
Insulin needs related to exercise
exercise decreases BS and may decrease insulin needs, at risk for HYPOGLYCEMIA, check BS frequently with change in exercise, DON NOT EXERCISE DURING INSULIN PEAK TIMES
Cautions with exercise
pt taught to carry quick simple sugar source when exercising, AVOID EXERCISE WHEN BS IS GREATER THAN 250 because liver releases glucagon and increases change of diabetic ketoacidosis
blood vessel damage in the eyes; avoid straining exercise
may injure themselves and not know it; heal slowly or not at all
facts about sick days for DM
if vomiting; get to stop and encourage 8oz of liquid every 30 minutes, may need to adjust insulin, illness makes bs elevate, EDUCATE to use caution with OTC meds (loaded with sugar), check BS more often
when pt is NPO for procedure
ask MD if unsure if they want insulin administered; check BS frequently
always given to IDDM; given to NIDDM when ill
sources of insulin
most common is synthetic, also have pork and beef insulin
cultural considerations for insulin
be mindful when giving pork/beef insulin
Onset of insulin
when insulin begins to work
Peak of insulin
when insulin is working its HARDEST
Duration of insulin
length of time insulin works
normal pancreas secretes
1 unit of insulin per hour; secretes more with food intake
precautions for LANTUS/LEVMIR
can not be mixed with other insulin, given only 1 time in 24 hours and does NOT have a peak
Rapid Acting insulin; HumaLOG, NovaLOG
onset 15-30min, peak 30-90min, duration <5 hours
special considerations; give 15-30min before meal, CLEAR INSULIN
Short acting insulin; Regular; HumuLIN R, NovaLIN R
onset 30-60min, peak 2-5hours, duration 5-8hours
special consideration; ONLY insulin that can be given IV, snack during peak, CLEAR INSULIN
Intermediate Acting; NPH, Humulin N, Novolin N
onset 1 1/2-2hr, peak 4-12 hours, duration 24 hours
special consideration; given in am and supper, CLOUDY insulin, snack at 10am and 2pm (protein)
Long Acting; Lantus/Levmir
onset 2-4hr, NO PEAK, duration 24hours
special considerations; NEVER mix with other insulins
Insulin mixtures
humulin 50/50, humulin or novolin 70/30, humalog 75/25
scar tissue does not
absorb meds
insulin site facts
back of arm, adipose tissue of abdomen, legs, lower back (love handles), shoulder blades; always given SUBQ
insulin pump
closest thing to a pancreas, delivers subQ insulin at a basal rate and allows for bolus administration
benefit for insulin pumps
allows flexibility and a quality of life
Insulin pump
requires close monitoring from an Endocrinologist; pt should know about their condition before running pump
Mixing insulins
Sliding scales for insulin
dose is based on BS results; not all scales are the same and they are doctor prescribed
Somogyi effect
BS continues to increase in spite of increased insulin doses; caused by increased release of glucagon and cortisol (gland problem)
tx for somogyi effect
decrease the amount of insulin
Dawn phenomenon
occurs related to the release of cortisol early in the morning resulting in high fasting BS results in the am
tx for dawn phenomenon
check BS between 2am-4am, high dose of insulin at HS or supper, NPH or Lantus insulin are preferred choices
Oral hypoglycemic agents are given
30 minutes before meal
First generation sulfonylureas;diabinaese, orinase
stimulate insulin release from pancreas; side effects= nausea, anorexia, risk of hypoglycemia; nsg considerations; given BID before breakfast and supper, avoid during pregnancy
Second generation sulfonylureas; amaryl, glucotrol, diabeta, micronase (given to pt's who have higher BS)
stimulates insulin release from pancreas; side effects= N/V, anorexia, risk for hypoglycemia; nsg conisderations= given QD before bfst, do not stop abruptly, avoid during pregnancy
Alpha Glucosidase inhibitors; Precose (used with sulfonylureas)
delays the absorption of CCHO's; side effects=diarrhea, flatulence, hypoglycemia; nsg considerations= given TID before meals, avoid during pregnancy
Biguanide Compounds; Glucophage(meformin)
improves the use of insulin by the body; side effects=N/V/D, hypoglycemia; nsg considerations=avoid alcohol, avoid during pregnancy, MRI precautions (can not take 48 beofre or after and MRI)
Insulin Enhancing Agents; Avandia, Actos
increase the effectiveness of circulating insulin; side effects=liver damage; nsg considerations=liver function test, given QD in the am, avoid during pregnancy
Meglitinides; Prandin, Starlix
stimulates insulin release; side effects= increases risk for infection; nsg considerations= protection for infection, teach s/s of infection and early tx, avoid during prenancy
nasally inhaled insulin; measured in MILLIGRAMS, given 10 min before meals (RAPID ACTING) usually given QID
Self monitoring of Blood Glucose
teach pt importance and how to take bs, take bs before bfst (fasting) and then TID or QID, HGB A1C done every 3-4 months
Goal for Type 2 DM
keep BS 70-110;
elderly and children bs between 100-150
Urine glucose and ketone monitoring
check at times of stress or illness, if positive it indicates the bs is really elevated
Ketones in urine
develops when there is no glucose in the cell, body breaks down fat and the waste product is KETONES; check at times of stress and illness
Pancreatic transplant
the only cure for diabetes; Immunosuppressants for life which increases risk for infection
occurs when calories exceed insulin available; BS above 200
causes for hyperglycemia
eating too many carbs, not enough insulin, stress and illness
insulin exceeds caloric intake; BS less than 60
causes for hypoglycemia
too much insulin, skipping a meal, exercising during peak times of insulin
S/S of hypoglycemia
h/a, lethargy, diaphoresis
DKA= diabetic ketoacidosis
happens in TYPE 1 DM; caused from BS being very HIGH, glucagon released from liver which increases BS even more, EMERGENT SITUATION which will require pt to be in the ICU on an insulin drip. Frequent Accu checks, ABG's to check acidotic status
juicy fruit breath and urine, flushed dry
HHNK= Hyperosmolar
happens in TYPE 2 DM; results in high BS; still secreting insulin but not enough so no ketones. the increased BS causes the polyuria, glucosuria, dehydration
Nsg for HHNK
monitor BS, insuin, IV fluids for dehydration
prevent long term complications by
maintaining good control of BS
Macrovascular; circulatory system
increased risk for heart disease; MI, CVA, PVD
PVD (peripheral vascular disease)
leads to amputation; S/S= cold extremities, dusky color skin, weak pulse
prevention of heart disease
maintaining good control of BS, exercise, balanced diet, lipid lowering meds
Microvascular; eyes, kidneys
diabetic retinopathy; causes blindness
prevent by seeing a ophthalmologist twice a year and keeping BS and B/P under control
Renal failure- blood vessels in kidney get ruined results in decrease blood supply in kidney; Prevent by BS control, I&O, renal labs to monitor function
unable to feel or sensation of burning/tingling; increased risk for injuries (physical and thermal)
Prevention of foot complications
good BS control, inspect feet (THE WHOLE FOOT) for cracks, dry skin, ingrown toenails, see a podiatrist for any problems and to cut toenails, always wear shoes, no stockings or high heel shoes, wear cotton socks, teach pt the risk of doing foot care on themselves
HIGH AND DRY; s/s extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea
LOW AND WET; s/s shaking, fast heartbeat, sweating, anxious, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable
long term affects of DM
heart disease, neuropathy, retinopathy, increased risk for infection, amputation, renal failure
factors that affect the amount of insulin a person takes
diet, stress and illness, exercise, weight, medication, pregnancy
normal bs
major cause for type 1 DM
autoimmune disorder
when are oral diabetic agents administered
30 min beofre meals
where is insulin given and why
subQ- longer absorption rate