Diabetes

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Author:
Prittyrick
ID:
312019
Filename:
Diabetes
Updated:
2015-11-24 21:16:01
Tags:
DM
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Description:
too much sugar
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  1. DM
    • disorder of CHO, protein, and fat metabolism due to an imbalance between insulin need and insulin availability
    • - absent or insufficient insulin
    • - impaired receptors
  2. Diabetes
    • gestational diabetes- incre for DM II, CVD
    • Type 1 DM- 5% no insulin
    • pre diabetes- previous hx of hyperglycemic, beta cells are functioning but not as well, FBS is 100-125. not incre enough consistently , lie style modification can help
    • DM 2- 95% decre in insulin, or insulin resistant
  3. diabetes and CVD
    • cardiovascular disease is the leading cause of death for people with DM
    • in adults with DM:
    • - 68% die of heart disease or stroke
    • - the risk for stroke is 2 to 4 times higher
    • - 67% have high blood pressure
    • - smoking doubles the risk for heart disease
  4. diabetes complications
    • diabetes is the leading cause of:
    • - kidney failure: dm is listed as the primary cause of kidney failure 44% of new cases in 2011
    • - new cases of adult blindness: 4.2 million people w/dm aged 40 and older had dibetic retinopathy in 2005-2008
    • - nontraumatic lower amputations: 60% of those occurs with pts with DM
  5. More DM complication
    • the risk of peridontal disease is two to three times higher in adults with dm- loss teeth
    • - 1/3 of peeps with dm have severe peridontal disease
    • 60-70% with dm have mild to severe system damage
    • - almost 30% of people with dm aged 40 yrs or older have impaired sensation in their feet
    • people with dm are twice as likelt to have depression
    • when your sugars go and high and lows it impairs your wbc and increases your risk for infection
  6. common types of dm
    • type 1 dm in adults 5%
    • type 2 dm in adults 95%
    • - directly related to obesity, truncal obesity
  7. US Dm prevalence
    all ages 2010
    • 29.1 million people have dm
    • diagnosed 21 million people
    • undiagnosed 8.1 million people
  8. Dm incidence
    a total of 1.7 million new cases of dm were diagnosed in 2014 in United states among people aged 20 yr and older
  9. African Americans and DM
    • 4.9 million; 1.817% of all blacks aged 20 and older have diagnosed and undiagnosed dm
    • compared to whites blacks risk is 77% higher
  10. Hispanic/latinos and DM
    • 12.8% of all latinos aged 20 and over have diagnosed dm
    • rates vary amongst group
    • - cubans and central and south americans
    • - mexican americans 13.9%
    • - puerto ricans 14.8%
  11. US DM Prevalence
    people younger than 20 yrs 2012
    • 0.26% of young people have dm
    • type 1 dm is more common than type 2 in younger people expect indian youth
    • type 2 is extremely rare in children under 10
    • type 2 dm rates are higher in youth aged 10-19 yrs with higher among minority populations compared to non hispanics whites
  12. Pre DM in US
    78 million adults 20 yrs and older have pre dm- raised risk for developed type 2 and CVD
  13. estimated cost of dm in US
    • total: $245 million
    • direct medical cost $176 billion
    • indirect cost: $69 billion
    • medical cost twice as high as a non DM
  14. every 24 hours
    • 5225 new cases of dm are diagnosed
    • 180 non traumatic lower limb amputations are performed
    • 133 people begin tx for end stages renal disease or dm is contributing cause of death
    • 634 people
  15. Normal A&P
    • CHO consumption
    • increased serum glucose
    • beta cells release insulin
    • glucose is transported into cells, liver, muscle, adipose tissue
    • decreased serum glucose
  16. Normal A&P
    • Hormones opposing insulin- increase glucose
    • - glucagon- alpha cells in liver- when BS drops
    • - epinephrine- adrenal medulla stimulate SNS- increase BS beta 2 cells
    • - growth hormone- anterior pitutary gland- incr BS
    • cortisol- adrenal cortex
    • goal is BALANCE
    • 70-100 BS
  17. Insulin
    • 6 major functions:
    • transports glucose into cells for energy
    • stimulates storage in liver and muscles
    • enhances fat deposit adipose tissue
    • increases amino acid (protein) transport into cells
    • inhibits gluconeogenesis (stops fats and protein from making glucose)
    • signals liver to stop release of glucose
  18. Type 1 DM
    • less common than type 2 dm
    • destruction of the pancreatic beta cells
    • formerly called juvenile dm or insulin dependent diabetes
    • can occur at an age
    • acute onset
  19. type 1
    pathophysiology
    • vast majority of cases are thought to be due autoimmune destruction of beta cells
    • 80-90% destruction before manifestations
    • - may take months to years
    • genetic, virus, toxins as factors in development
  20. type 1 dm patho continous
    • lack of insulin causes: incre blood sugar
    • - inability of liver to store ingested glucose
    • - glycogenolysis and gluconeogenesis have no opposition
    • - glucose level will be higher
  21. Glycogenolysis and gluconeogenesis
    • stimulate breakdown of adipose tissue, mobilizing fatty acid, and resulting in ketone body production (acidic)
    • - ketones are: byproducts of fats, acidotic: cause metabolic acidosis
    • cant get glucose in cells so it breaks down
    • result also polyphagia- incre hungry
  22. Glucosuria
    • Glucosuria
    • renal threshold for glucose: 180 mg/dl
    • glucosuria triggers osmostic diuresis resulting in polyuria and polydipsia
    • FVD, dehydration, thirsty
    • Remember body always wants to create balance
    • u cant remove the sugar so u end up removing water
  23. Results high BS type 1 dm
    • Result is hyperglycemia, metabolic acidosis and dehydration
    • rapid rise in blood sugar
    • At risk for DKA, hyperglycemic acidy ketone
  24. DKA
    • type 1 dm
    • hyperglycemia, ketosis, and acidosis bc u don't have the insulin
    • this is the end result
  25. Type 2 Dm
    • 90-95% of cases
    • impaired insulin secretion
    • insulin resistance- cells not sensitive to insullin
    • - decreased tissue sensitivity to insulin
  26. type 2 dm
    risk factors
    • Genetic
    • - Fhx 2-4x increased risk
    • - race/ethnicity
    • age
    • HTN
    • inc chol
    • hx of gestational dm
    • environmental
    • - lifestyle- inactivity
    • - obesity- esp. central (abdominal fat) diabesity
  27. Type 2 dm patho
    • insulin resistance stimulates increased insuline release- metabolic syndrome
    • beta cells eventually get overworked inefficient
    • - dont stop completely
  28. Metabolic syndrome
    type 2 DM
    • this is reverisible
    • hyperglycemia
    • abdominal obesity- bc insulin pressure
    • hyperlipidemia
    • - elevated trig, and LDL
    • hypertension
    • some glycolysis (breakdown of glucagon) and glyconeogenesis (Making cho from non cho) by liver- incr BS
    • ketone body production not likely as there are some functioning insulin receptors - bc there is enough insulin to get into cells

    diet and excerise
  29. End results Dm 2
    • hyperglycemia
    • hyperlipidemia
    • less likely ketosis
  30. Manifestations
    • type 1- abrupt
    • type 2- insidious- non specific
    • depend on level of hyperglycemia
    • 3 P's
    • Polyuria- dehydration
    • polydipisia-
    • polyphagia
  31. manifestation
    wt
    • type 1- wt loss
    • type 2 may have wt gain
  32. manifestations
    • weakness, fatigue- low bs
    • vision changes- changes due to retina
    • numbness/tingling extremities neuropathy
    • dry skin- dehydration
    • wounds heal slowly- perfusion, wbc dont work as well
    • recurrent infections- skin infection, celluitis, uti
    • DKA
  33. Diagnostic finding
    • blood glucose-
    • - a1c > or = 6.5% (glucose is elevated it starts to bind to the hgb molecule, the more glucose the that is bind to hgb which makes the a1c high)
    • - fasting plasma glucose- > or = 126mg/dl
    • - 2 hr postprandial glucose > or = 200mg/dl following oral load of glucose
    • random plasma glucose 0 > or = 200mg/dl in a person with classic symptoms
  34. diagnostic findings
    • incre trig, LDL
    • incre serum creatinine
    • urinalysis
    • - glucose, protein and ketones
  35. Pre DM
    • fasting plasma glucose- 100-125mg/dl
    • lifestyle interventions
    • - low fat, reduced-calorie diet ** portion control
    • increa physical activity
    • weight loss
    • treat HTN, hyperlipidemia
    • f/u is essential
  36. medical management
    • diabetes control and complications trial
    • - intensive blood glucose control in type 1 dm significantly reduced complication by 75%
    • - frequent glucose monitoring
    • - 3-4 injections of insulin daily or insulin pump
    • - weekly contact with diabetic educators
    • - dentist
    • - social workers
    • - excerise specialist
  37. diabetes management
    • nutrition therapy
    • exercise
    • monitoring
    • pharmacologic therapy
    • education
  38. medical management 2
    • to reduce symptoms, complications and promote overal good health
    • diabetes self-management education
    • - educational, clinical, behavioral, emotional needs quality of life
    • - pt centered approach
    • - highest possible level of self care and quality o
  39. medical management 3
    • team care-
    • - pcp, nurse practitioner, PA, endocrinologist, psychologist
    • dm educator certified
    • - dietician
    • - nurses
    • - pharmacists
  40. medical management 4
    • self care behaviors as identified by the American Association of Dm educators
    • healthy eating
    • being active
    • monitoring
    • taking medication
    • problem solving
    • reducing risks
    • healthly coping

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