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Which type of diabetes is formerly known as "juvenile onset" or "insulin dependent". Occurs in people under 30 years of age. Peak onset between ages 11 and 13.
What's the main patho of type 1 diabetes?
Progressive destruction of pancreatic B cells by bodys own T cells. 80-90% B cells are destroyed until symptoms start.
What are causes of Type 1?
- Genetics-human leukocyte antigen (HLA)
- Exposure to a virus
What are symptoms of Type 1 diabetes?
- Hx of recent, sudden, weight loss
What is one definite differential from type 1 to type 2?
Type 1 will require insulin for the rest of their life
What is the definition of prediabetes?
Not high enough for diabetes diagnosis and increased risk for type 2 in 10 years
What diagnostic level for impaired fasting will diagnose prediabetes?
- Fasting glucose levels= 100 mg/dl-126 mg/dl
- 2-hour plasma glucose=140-199 mg/dl
- HGB1AC= 5.7-6.4%
If a patient is diagnosed as pre-diabetic what should the nurse teach about?
- Check blood sugars regularly
- Monitor for signs of 3 P's
If a patient id diagnosed with Type 1 diabetes what should the nurse teach them about their disease process?
- Occurs when the pancreas no longer produces insulin
- Will need exogenous insulin to sustain life
- May have long term damage to heart and blood vessels already occurring
Which diabetes is most prevalent. usually occurs in people over 35 years of age. occurs in younger kids that are obese. 80-90% of these diabetics are obese.
What are some risk factors for developing Type 2 diabetes?
- Increase age
- African, Asian, Hispanic, and Native Americans
- Obesity with abdominal/visceral fat
- large ratio of waist:hip
- Metabolic Syndrome
How would you define Type 2 diabetes?
- Pancreas continues to produce some endogenous insulin
- insulin produced is either insufficient or poorly utilized by issues
What are the major problems with the body with Type 2 diabetics?
- 1. insulin resistance
- 2. pancreas decreases ability to produce insulin
- 3. inappropriate glucose production from liver
- 4. alteration in production of hormones and adipokines
What is the problem with the insulin being resistant?
Insulin receptors on adipose tissues either unresponsive or decreased in numbers and therefore don't respond to insulin
What is the problem with the pancreas inability to produce enough insulin?
- B cells are tired from trying to work extra hard to compensate for the lack of insulin produced
- causes loss of B cells
Which major problem is not a primary factor in the development of type 2 diabetes?
Inappropriate glucose production from liver
What is the cause of inappropriate glucose production from liver?
The liver starts to make too much glucose and not enough insulin in the body to absorb
What is the cause of alteration in production of hormones and adipokines?
Adiponectin and leptin and cytokines play a role in glucose and fat metabolism
What problems are categorized as metabolic syndrome or syndrome X?
- Elevated insulin levels
- Increased triglycerides
- Increased LDL's
- Decreased HDL's
What are risk factors of Metabolic Syndrome?
- central obesity
- sedentary lifestyle
Which diabetes develops during pregnancy, detected at 24-28 weeks of gestation?
If a patient has developed gestational diabetes when should the nurse tell the patient her glucose levels will return to normal.
6 weeks postpartum
If a patient has gestational diabetes what should the nurse tell the patient that she is at risk for?
- cesarean delivery
- perinatal death
- neonatal complications
- developing type 2 diabetes in 5-10 years
What would you expect a doctor to treat a patient with gestation diabetes?
- Change nutrition first
- May have insulin
Which type of diabetes is caused by another medical condition?
Which type of medical conditions that can cause secondary diabetes?
- cushing syndrome
- parenteral nutrition
- cystic fibrosis
Which type of drugs can cause abnormal blood glucose levels?
- Corticosteroids (Prednisone)
- Phenytoin (Dilantin)
- Atypical antipsychotics (clozapine)
When should you tell a patient that their secondary diabetes will be treated?
When the underlying condition or drug is treated
What are the signs/symptoms of type 2 diabetes?
- recurrent infections
- recurrent vaginal yeast/monilia infections
- Prolonged wound healing
- visual changes
- may have symptoms of type 1
What are the 3 ways to diagnose diabetes?
- 1. fasting plasma glucose=126 and above
- 2. random plasma glucose=>200 + sypmtoms
- 3. 2 hour oral glucose + 75 glucose load=>200
What does the Hemoglobin A1C test indicates?
- determines glucose levels over time
- monitor success after 90-120 days
What is the normal level of HgbA1c?
What are the goals of diabetes management?
- decrease symptoms
- promote well-being
- prevent acute complications
- delay onset and progression of long term complications
What is the most important thing a nurse needs to teach a patient about their diabetes?
monitor their blood glucose
What are 3 important things to teach about treating their diabetes?
- 1. nutritional therapy
- 2. exercise
- 3. monitor blood glucose
What is a best way for a patient to help with nutritional therapy?
- Being in a support group
- hearing that you need to change diet from a HCP
what is the importance of exercising for a patient with diabetes?
- essential in diabetes management
- increase insulin receptor sites
- lowers blood glucose levels
- contributes to weight loss
- lowers appetite
What things characterize acute complication of diabetic ketoacidosis?
Which type of diabetes will most likely have DKA?
What factors can cause DKA?
- inadequate insulin dosage
- undiagnosed type 1
- poor self management
How dose DKA form?
- body breaks down fat stores
- ketones are by-products of fat metabolism
- ketones alter ph balance cause metabolic acidosis
- ketone are excreted in urine
What are signs/symptoms of DKA?
- Early signs: Lethargy/weakness
- Late signs: Dehydration
- abdominal pain
- Kussmaul respirations
- sweet fruity ordor
If a patient is presented in the ER with kussmaul respirations, tachycardia, abdominal pain, blood glucose >300 what should the nurse expect is going on and how should the nurse treat it?
- treat promptly serious condition
What laboratory findings will diagnose DKA?
- Ketones in the urine
- blood glucose >300
- arterial blood pH <7.3
- bicarbonate level <15
what is the priority of the nurse when treating DKA?
Manage airway-administer oxygen
What are the steps in treating DKA?
- 1. manage airway-administer oxygen
- 2. administer .45-.9 NS
- 3. once blood glucose 250 administer 5% dextrose
- 4. potassium replacment
Which acute complication is life threatening, less common, and occurs in patients over 60 years of age?
Hyperosmolar hyperglycemic syndrome (HHS)
Which type of diabetes will most likely have HHS?
What are the causes of HHS?
- inadequate fluid intake
- increasing mental depression
What laboratory findings will diagnose HHS?
- blood glucose >400
- increase in serum osmolality
- NO ketones
How is HHS treated?
- 1. Administer larger fluids than DKA
- rest is the same as DKA
What is defined as hypoglycemia?
low blood glucose <70 mg/dl
What may cause hypoglycemia?
- too much insulin in proportion to glucose in the blood
- mismatch in timing of food and insulin intake
What are signs/symptoms of hypoglycemia?
- visual disturbances
If hypoglycemia is not treated what can it lead to?
- loss of consciousness
If a person doesn't not experience warning signs/symptoms of hypoglycemia but they do have decreased blood glucose levels what can you tell the patient they have?
How do you treat a patient with hypoglycemic?
- <70 mg/dl treat with 15 to 20 grams of simple carbohydrate, 4-6 oz of orange juice, regular soft drink
- recheck blood glucose in 15 mins
If you have given your patient carbohydrate and recheck their blood sugar levels after 15 minutes and their levels are <70 what should the nurse do?
- treat with 15 to 20 grams of simple carbohydrate,
- 4-6 oz of orange juice,
- regular soft drink
- recheck blood glucose in 45 mins
After you have given your patient carbohydrates twice and their blood glucose levels are still <70 what should the nurse d?
- administer 1 mg of glucagon IM or subq
- then eat carbohydrates
If your patient starts experiencing seizures or loss of consciousness after having a blood glucose of less than 70 what is the nurses priority to administer?
20 -50 ml of 50% dextrose IV push
Which long term complication of DM causes disease of large and medium sized blood vessels?
What is the risk of having macrovascular disease?
increased atherosclerotic plaque formation
What are risk factors of developing macrovascular disease?
- altered lipid metabolism
- high fat diet
- sedentary lifestyle
Which long term complication of DM causes thickening of vessel membranes in capillaries and arterioles?
What is the difference in patients with microvascular vs. macrovascular disease?
- microvascular is seen only in patients with diabetes
- macrovascular is seen in all patients
Which body parts are affected mostly by microvascular disease?
What is diabetic retinopathy?
microvascular damage to retina due to chronic hyperglycemia
What are the two type of diabetic retinopathy?
What is nonproliferative disease of diabetic retinopathy?
- most common form
- partial occlusion of small blood vessels in retina causes microaneurysms
- capillary fluid leaks out cause retinal edema and hard exduates or hemorrhage occurs
What is proliferative disease of diabetic retinopathy?
- most sever form
- involves the retina and vitreous
- where retinal capillaries are occluded and new blood vessels are formed
- the new vessels formed are very fragile and hemorrhage easily
- may cause retinal detachment
When a patient is diagnoses with diabetes what other examinations are they most likely going to have?
- yearly eye exams
- monitor kidney functions
- monitor feet
How can retinopathy be treated?
- photocoagulation- laser to destroy ischemic areas of retina and new blood vessels
- cryotherapy- freeze off excess blood vessels
- vitrectomy- aspiration of blood, membrane, fibers from inside eye through small incision
When do we use cryotherpay treatment for retinopathy?
to treat peripheral areas of retina
When do we use vitrectomy treatment for retinopathy?
- viteral hemorrhage does not clear in 6 months
- threatened or actual retinal detachment
What is diabetic nephropathy?
damage to small blood vessels that supply the glomeruli of the kidney
What is the leading cause of end stage renal disease and adult blindness?
- End stage renal disease-nephropathy
- adult blindness- retinopathy
What is diabetic neuropathy?
nerve damage due to metabolic derangments of diabetes
What is the difference of what part of the body is affected with sensory neuropathy vs. autonomic neuropathy?
- sensory- affected the hands and/or feet
- autonomic-affect nearly all body parts
What are s/sx of sensory neuropathy?
- loss of sensation
- abnormal sensation
- tingling pain
- pain worse at night
- atrophy of small muscles of hand/feet
What is the best way to treat long term complications of diabetes?
tight glucose control
How can we treat sensory neuropathy?
- topical creams to numb the area
- tricyclic antidepressants
- selective serotonin and norepinephrine reuptake inhibitors
- antiseizure medications
What are complications of having autonomic neuropathy?
- gastroparesis (delayed gastric emptying)
- cardiovascular abnormalities
- sexual function
- neurogenic bladder
What are the main cause of having foot complications?
combination of microvascular and macrovascular disease
What are risk factors for having foot and lower extremity complications?
- sensory/autonomic neuropathy
- peripheral artery disease
- clotting abnormalities
- impaired immune function
What symptoms classify acanthosis nigricans?
dark, coarse, thickened skin in patches
Which diabetic is most likely to have Necrobiosis lipoidica diabeticorum?
Which diabetic is most likely to have Granuloma annulare?
If patient describes their skin as having red-yellow lesions in circular shape and skin is shiny and able to see tiny blood vessels what type of skin complication are they likely having?
Necrobiosis lipoidica diabeticorum
If a patient describes their as having partial rings of papules what type of integumentary complication are they having?
What should a nurse teach a patient with diabetes about infections?
- Diabetics are more susceptible to infections
- its caused by a defect in mobilization of inflammatory cells
- impairment of phagocytosis by neutrophils and monocytes
- loss of sensation may delay detection of infection
- treatment must be prompt and vigorous
What should a nurse teach a patient with diabetes and 75 years of age?
- presence of delayed psychomotor function could interfere with treating hypoglycemia
- monitor for hypoglycemia due to hypoglycemia unawareness is very common