Diabetes lecture With Mary Ellen Walker
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- Define Diabetes Mellitus
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Siphon or flow/sweet
A complex chronic disorder characterized by disruption of normal carb, fat and protein metabolism and the development over time of MICROVASCULAR and MACROVASCULAR complications and neuropathies. - What type of cell secrete insulin, glucagon
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Beta Cells/pancrease
Alpha Cells -
Type I Diabetes
Insulin dependant diabetes mellitus -
NO INSULIN/ need to perserve life.
onset: any but usually <30
Body weight: generally thin
Prevelance: 5-10%
Etiology:autoimmune - What is the leading cause of death in DM I
- Renal Failure
- Complications
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DKA
Hypoglycemia - Treatment for DM I
- Diet, Exercise and insulin
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Type II DM
Non-insulin dependant DM -
Age of onset: Usually >30
Body weight: 80% overweight
Prevelance: 90-95%
Etiology: heredity, may also be auto immune, OBESITY - Leading cause of death with Type II DM
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Acute coronary syndrome
stroke - Complication Type II
- neuropathy, retinopathy, prone to renal failure/disease
- Treatment Type II
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DIET! loss of 10-20% of body weight gives more glucose control
exercise and meds(PO) - Vyetta-SC
- New medication that stimulates beta cells to produce insulin
- Risk factors for DM
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Family hx
obesity BMI>27
race/ethnicity
age>45
impaired fasting glucose or imparied glucose tolerance
HTN
HDL <35
Triglycerides>250 -
Diagnostic
Urinalysis -
microalbumin in uria-NOT normal.
Pt with DM who don't know have freq. UTI's B/C DM affects leukocytes and Phagocitosis -
Fasting blood glucose
Casual blood glucose -
Impaired glucose intolerance is 100-125
Diabetes >126
Casual <200 - Post prandial
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BS below 140 is normal
impaired b/w 140-199
DM >200
done 2 hours after meals to see how body is handling glucose, -
3P's
clincial manifestations of all DM -
Polyuria-increased urination
polydipsia-increased thirst
polyphagia-increased appitite -
Glycosylated hemoglobin
Heme A1C - Not diagnostic for DM but tests control of glucose. Glucose attaches to Hgb what they are looking for is <6
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Assessment:Objective
Nutrition -
Thirsty?
hungry?
Signs of DM -
Assessment:Objective
Elimination -
young children may see bed-wetting after previously being potty trained
Older-nocturia
Type II not diagnosed will see bowel incontinence
If have neuropathy may have urine/feces incontinence
Decreased function and drug clearance -
Assessment:Objective
Neurosensory -
numbness/tingling
confusion
change in vision, decreased smell, taste changes
Type II-classic sign change in consciousness, confused/disoriented -
Assessment:Objective
Mobility -
Fatigue and weakness
Inability to moce
Type I increase muscle cramps due to latic acid -
Assessment:Objective
Circulation -
when not in DKA: angina,(w/neuropathy silent angina) HTN, PVD (more arterial)
In DKA: HTN tachycardia -
Diet
Qualitative - Non-concentrated sweet diet (type II) want complex carbs not simple sugars
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Diet
Quantitative - CHO counting. Does not differentiatie b/w different types of carbs
- Diets should be based on...
- weight, sex and amount of exercise
- Why would you not take PO medications for DM if pregnant or thinking of becoming pregnant?
- PO meds cross the placenta. Switch to Insulin as soon as you plan or become pregnant.
- Why are type II diabetics on Insulin sliding scale in the hospital?
- Due to increased stress which can increase blood glucose,
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Hypoglycemia
Etiology -
BS <60
Delayed or omitted meal, insulin OD, excessive exercise without food or insulin adj.
CAN HAPPEN TO NON DIABETICS! -
Hypoglycemia
Onset - Rapid mins to hours
- If unsure if S/S are from hypo or hyper glycemia treat it as .....
- HYPOGLYCEMIA
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Hypoglycemia
S/s mild hypoglycemia -
low blood glucose levels
SNS-sweating,tremors, tachy, palpitations, nervousness and hunger! - Why does hypoglycemia affect brain functioning?
- The brain can not use ATP for energy so if no glucose the brain is deprived from the fuel it needs to function.this causes neuro changes
- S/s Moderate hypoglycemia
- impaired CNS function: inability to concentrate,headache,lightheadedness,confusion, memory lapses,numbness of lips and tounge, slurred speech, impaired coordination, emotionsl changes, irrational or combative behavior.double vision, drowsiness. Plus the SNS systems.
- S/S severe hypoglycemia
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Will need assistance from another person....
disoriented behavior, seizures, difficulty arousing from sleep, loss of consciousness and COMA - Hypoglycemia interventions
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Need simple sugars ASAP
JUICE,Glucose tablets,
Icing gel
Epinephrine -
Hyperglycemia
Etiology - Undiagnosed DM, neglected treatment, infection, cardiovascular disorders, physical stress, emotional stress
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Hyperglycemia
Onset - Slow- hours to days
- What are some Adrenergic Changes
- Hunger, weakness, diaphoresis, tachycardia, pallor, anxiety, tremors, nervousness, REBOUND hyperglycemia.
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Long Term Complications
Macrovascular -
Blood vessel walls thicken, sclerose and become occluded. 3 main types of Macrovascular ar CAD, Cerebralvascular disease, PVD
MI, CVA, diminished peripheral pulses, intermittent claudication. PVD cause for increased levels of gangrene and Amputation -
Long Term Complications
Microvascular -
unique to diabetes
(The basement membrane thickens) Affects the retina and the kidneys - Define Retinopathy
- Deterioration of the small blood vessels that nourish the retina.
- Clinical manifestations of retinopathy
- Blood vessels in the retina develop microaneurysms that leak fluid, causing swelling and forming deposits.
- Nephropathy-define
- Long term complication of DM, where the kidney cells are damaged. Charecterized by microalbuminuria and progressing to end stage renal disease
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Long Term Complications
Neuropathys -
effects all types of nerves
decreases gastric emptying, incont of urine/feces. sexual dysfunction. peripheral-esp. the feet - Define Vitrectomy
- The surgical removal of the vitreous of the eye. The removed vitreous is replaced with liquid or gas.
- Sick day rules
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Check BS regularly/q6 hr
Check ketones/Call md is spilling
Continue to take Insulin/stress and infection
Encourage drinking juice - What do Ketones produce?
- Acidosis
- Why does glucose cause glycosuria and osmotic diuresis?
- Because Glucose has a high osmolarity and will pull fluid from the cells! Reason why DKA pt are dehydrated and thirsty!
- When should a diabetic test for Ketones in their Urine?
- When their BS is >250
- Where is glucose stored?
- Liver
- What is DKA. Etiology
- Diabetic Ketoacidosis. caused by absence or markedly inadequate amount of insulin resulting in disorders of metabolism
- What are the three main clinical features of DKA?
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Hyperglycemia
Dehydration and electrolyte loss
Acidosis - Why is dehydration and electrolyte loss caused by DKA?
- Without insulin the glucose can not get into the cell and the liver produces more glucose. The kidney then excrete the glucose in an attempt to rid the body of the excess. So out goes water and Na and K
- What are the three main causes of DKA?
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decreased or miss dose of insulin
illness or infection
undiagnosed or mistreated DM - S/S of DKA
- Hyperglycemia, polyuria,dehydration,blurred vision,headache, weakness, increased thirst, orthostatic hypotension, GI symptoms, kussmaul resp.
- LAB values for DKA
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BS 300 to 800
Low serum bicarb
low PCO2
increased ketone bodies
NA and K low, normal or high depending on water loss.(monitor closely will eventually need to be replaced. Esp K
elevated BUN and creatinie
elevated H&H - What electrolyte is a major concern with regards to DKA
- K due to arrhytmias