Diabetes

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Author:
Danette
ID:
148280
Filename:
Diabetes
Updated:
2012-04-17 22:01:30
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Exam Two
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Diabetes
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  1. Normal control of glucose by pancreas
    • Beta Cells
    • *Secretes insulin - key to cell
    • *Stores glucose in liver in form of glycogen
    • *Prevents fat breakdown
    • *Protein synthesis
    • *Transports

    • Alpha Cells
    • *Release glucagon - causes breakdown of glycogen in liver
    • *Epinephrine causes glucagon to be released
    • *Decreased blood glucose causes stimulation of epi, epi causes glucagon to be turned into glucose

    • Delta Cells
    • *Controls somatostatin
    • *Regulatory role - cares for alpha & beta cells
  2. Actions of Insulin
    • Provides for glucose storage
    • Prevents fat breakdown
    • Increases protein synthesis
  3. Brain cells & glucose
    The CNS cannot store glucose so it requires a continuous supply of glucose for fuel

    Maintain BS no <74 mg/dl for diabetic
  4. Types of DM
    Type I - IDDM - juvenile diabetes - insulin dependent
    • *Destruction of beta cells
    • *Autoimmunie response triggered by viral infection
    • *Genetic predisposition

    S/S - decreased weight, weakness, 3 Ps polyuria, polydipsia, polyphagia

    Management - diet, exercise, insulin

    Microvascular problems: eyes, kidneys, nervous system
  5. Hyperglycemia
    Hyperosmolarity of extracellular fluids

    • H2O
    • NA+ (hyponatremia)
    • Magnesium (hypomagnesemia)
    • Calcium (hypocalcemia)
    • K+ (hypokalemia) - potassium - affects heart - most important
    • Chloride
    • PHosphate (hypophospatemia)

    Ketosis - lack of insulin - fat breakdown - free fatty acids - convert into ketone bodies (happens in type I only)
  6. Types of DM
    Type II - NIDDM - non insulin dependent - inadequate insulin or insensitivity
    • *Diet
    • *Usually after age 40
    • *Usually not dependent on insulin

    S/S - fatigue, drowsy after meal, irritability, nocturia, itching of skin, poor wound healing, blurry vision, cramps in muscles

    Management - diet, exercise, oral agents

    Macrovascular problems
  7. Other types of Diabetes
    • Gestational - during pregnancy - type III
    • Impaired Glucose Tolerance (IGT) - borderline - calorie restriction weight reduction
    • Secondary Diabetes (IV)
    • Diabetes Insipidus - Decreased ADH
  8. Diagnostic Evals
    • 2 hour post prandial - adjust to & dispose of glucose load
    • Glucose tolerance test - ability to store glucose by removing it from blood
    • Urine tests
    • Self-measure (accucheck)
    • Hemoglobin A1c - 3 months-hemoglobin
  9. Insulin Therapy
    • Beef or pork (slaughter house) - peptide composition = antibodies
    • Biosynthetic human insulin (lower levels of antibodies) - ex: humulin - N, R, L
    • Semisynthetic insulin (amino acid replaced) - ex: novolin - N, R, L

    NPH - neutral protamine hagedorn
  10. Classify insulin
    • Rapid Acting
    • *5-15 min
    • *Novolog
    • *Humalog

    • Short-Acting
    • 30 min
    • Novolin R
    • Humalin R - only IV

    • Intermediate acting
    • *Used for day long control
    • *NPH & Levemir (Detemir)

    • Long Acting
    • *Protamin zinc & Ultralente
    • *Replaced with Lantus = 24 hours
  11. Complications with Insulin Therapy
    • Lipoatrophy - loss of fat tissue in areas of repeated injection - immune reaction to impurities in beef or pork insulin
    • Lipohypertrophy - increased swelling of fat at site of repeated insulin injections
  12. Oral Antidiabetic Agent
    • Sulfonylureas - short, intermediate, long acting
    • Stimulates pancreas - needs functionining pancreas
    • Success - diet restrict, check bs
    • Diabinese - hypoglycemia
  13. Caloric distribution
    • 45-65% - complex carbs
    • 25-30% - fat
    • 10-20% - protein

    • Fiber - improve blood glucose - decreases exogenous insulin
    • Exercise - decreased blood glucose & fatty acids

    Snack - 15 gm cho (fruit) before exercise, same time, same amount each day
  14. Hypoglycemia
    • Check abnormal decreased BS, usually 50-60 mg/dl
    • Check BS <20 = brain damage

    • Causes - lack of glucose in cells not lack of insulin
    • Ex: too much insulin, too little food, excessive physical activity

    S/S - cool, clammy skin, diaphoretic, tachycardia (epi from SNS) , coma

    TX - simple, fast acting sugar, OJ, lifesavers, glucose tablets

    • Can occur:
    • 1-3 hours after reg
    • 4-18 hours after NPH or levemir
    • 18-30 hours after protamine zinc or lantus
  15. Somogyi effect
    • Sudden falls in bs are followed by rebound hyperglycemia
    • Release of counter regulatory hormones
    • Excessive adm of insulin or insulin sensitivity
    • Increased risks: stress, pregnancy
  16. Ketoacidosis (DKA)
    Hyperglycemia - absence or inadequate amount of insulin

    S/S - polyuria, polyphagia, polydipsia

    Kussmaul breathing, sweet breath, dehydration, F&E imbalance

    • Management
    • *Restore normal carbs, protein, & fat metabolism
    • *Reverse hypovolemia
    • *Correct electrolyte imbalance
    • *IV insulin
  17. Long-Standing Diabetes
    • Thickening of the capillary basement membrane in the affected organ
    • Glycoprotein layer incorporates sugars into its structure
    • Swelling of basement membrane
  18. Atherosclerosis
    • Same changes in large arteries that occur in aging process only earlier
    • Cardiovascular disease - most common complication of DM
    • Strokes, MI, Gangrene
    • Defects in blood clotting process
  19. Retinopathy
    • Caused by changes in small blood vessels in the retina of the eye
    • Bulges in walls of the capillaries branch out & grow into other areas of the eye
    • Hemorrhage & scar formation
    • Neovascularization - hemorrhage - loss of adequate
    • blood flow - glaucoma, retinal detachment - blindness
    • After 20 years of DM - nearly all with type I & 78% with type II
  20. Neuropathies
    • Usually lower extremities
    • Pain = dull or aching
    • Paresthesias = tingling, coldness, numbness
    • Not notice injury to the feet
    • Exernal heat never below knees
  21. Kimmelstiel-Wilson Syndrome
    • Renal DZ of DM
    • R/T thickening of capillary basement membrane in the glomerulus
    • H20 absorbed causing nerve cells to expand
    • Decreased nerve conduction speed & irreversible nerve damage
  22. Education
    • Patho of DM
    • Dietary management
    • Administration of insulin
    • Exercise
    • Urine or blood testing
    • S/S hypo-hyperglycemia
    • Foot Care
  23. Foot Care
    • Do not soak feet
    • Dry between toes
    • Good shoes
    • Soft, absorbent socks

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