Transcript Diabetes Mellitus - mustafaaltinisik.org.uk

Diabetes Mellitus
Dr. Belle Erickson
With thanks to
Karen McKenna, MSN, RN
1
PANCREAS - An Endocrine Gland

Islets of Langerhans
– Beta Cells
» INSULIN
– Alpha Cells
» GLUCAGON
2
INSULIN

Lowers blood sugar by:
– Transporting glucose into cell
• Receptor sites
– Converting glucose to glycogen for
storage in muscle and liver
tissue(glycogenesis)
– Converting excess glucose into fat cells,
forming lipids from fatty acids
(lipogenesis) and promoting storage in
adipose tissue
3
GLUCAGON

Known as Hyperglycemic agent

Promotes activities that raise blood
sugar- - • Converting of stored glycogen to glucose
(Glycogenolysis)
• Formation of glucose from protein and fat
sources (Gluconeogenesis)
4
Hormones affecting CHO
metabolism

ACTH (Adrenocorticotropic hormone)
and Glucocorticoids
– enhances gluconeogenesis

Epinephrine
– enhances glycogenolysis
5
Vocabulary








Glucose
Glucagon
Glycogen
Glycogenesis
Gluconeogenesis
Glycogenolysis
Lipogenesis
Glycolysis
6
Carbohydrate Metabolism




Active transport of glucose into cells &
metabolism of glucose with release of
energy
Storage of glucose
Conversion of glycogen back to glucose
Conversion of proteins to glucose
7
CHO (not enough)

Decreased blood sugar & depleted
glycogen stores

Unable to use available glucose
8
Body needs energy source

Catabolism of fats and proteins
• Where?

Ketones
9
Diabetes Mellitus

Chronic disorder characterized by
hyperglycemia
– Imbalance between Insulin supply &
demand

Abnormal metabolism of fat,
carbohydrate, & protein
10
Types of DM





*Type 1 (IDDM) 10 - 15 % of all Diabetics
*Type 2 85 - 90-% of all cases
Secondary
Gestational
(High Risk) Impaired Glucose Tolerance
11
Type l
(Type I)
IDDM = Insulin Dependent Diabetes Mellitus
Juvenile Diabetes
Body produces NO INSULIN
Must take at least one injection of
Know This Stuff insulin per day to control blood
sugar
Usually occurs before 30 years old
Body weight thin or ideal
Onset abrupt
Know This Stuff
TYPE 2
Type II
Adult/Maturity Onset
NIDDM = Non Insulin Dependent Diabetes Mellitus

Body does not produce enough insulin
and/or

Body cannot use the insulin it has made
Know This Stuff
TYPE 2
Type II
Adult/Maturity Onset
NIDDM = Non Insulin Dependent Diabetes Mellitus




May control blood sugar with diet and
exercise alone (but may take oral meds.
or insulin)
Clients usually > 35/40 years old
Clients usually overweight/obese
1/2 go undiagnosed for years & by then
complications can be underway
RISK FACTORS

Heredity
– Race







Increased Age
Obesity
Stress
Viruses
Diet
Auto-immune
Environment
_____Type______
1
2
African,Hispanic,
1 caucasions 2 Asian, Native Americans
2
2
?
2
1
2
1
2
1
16
DM - Pathophysiology


Lack of Insulin
 Glucose
• Where?
• ECF

Fat & Protein breakdown

Ketosis & Negative Nitrogen balance

Hyperglycemia - - - WHY?
17
Pathophysiology (cont’d)

Intracellular fluid deficit

Glycosuria

ECF deficit

Signs of DM
18
Four Cardinal Symptoms

Polyuria

Polydypsia

Polyphagia

Weight Loss
19
WARNING SIGNS -TYPE 1
usually occur suddenly




3 “poly’s” & weight loss
irritability
weakness and fatigue
nausea and vomiting
20
WARNING SIGNS -TYPE 2
usually occur less suddenly & may be very mild






any of the Type 1 signs
recurring or hard-to-heal skin, gum or
bladder infections
drowsiness
blurred vision
tingling or numbness in hands or feet
itching
21
Assessment - Lab Studies
FBS
Postprandial glucose
Glycosylated Hgb (Hb A1c)
normal value is 3-8%
(Oral Glucose Tolerance Test =OGTT)
(Fractionals)
23
Control

Normal FBS

B.S.  180mg 2hrs. after a meal

Glycosylated Hgb 10% or less

Normal weight and general good health
24
Diabetes Management

Diet management

Physical Activity

Medications
25
Recommended Nutrient Intake
PROTEIN
10 -20% of total energy intake
FAT
< 30% (Depends on lipid
& glucose levels)
CARBOHYDRATE
40-60% of total intake (Based on
glucose & lipid levels and client’s habits)
NCS
***FIBER***
20-35 grams
Fiber slows/moderates blood absorption of
carb/glucose
6 MAJOR EXCHANGE LISTS
MILK
VEGETABLE
FRUIT
BRE AD
Non-Fat, Low Fat
All Non-Starchy Vegetables
All Fruits & Fruit Juices
Bread, Cereal, Pasta,
Starchy Vegetables
& Prepared Foods
MEAT
Lean Meat, Medium &
High Fat & Other
Protein Rich Food
FATS
Polyunsaturated, Saturated
and Non Saturated
Medications
Type 1
– Insulin
• Administered SQ or IV
NOT ORALLY
NOT IN TUBE FEEDINGS
Type 2
– Oral Hypoglycemic Agents
– Insulin
28
Insulin

Types of insulin

Duration of action
• Short - Intermediate - Long

Action
• Onset - Peak - Duration
29
Insulin - (cont’d)

Concentration
– Expressed in Units
• U100

Insulin Order
• NPH Humulin (U100) 32U SQ daily before
dinner
30
Types of Humulin Insulin and Comparative
Actions
Action
Short-acting
Intermediate-acting
Long-acting
Preparation
Appearance
Onset
Action, hr*
Peak
Duration
Humalog (insulin
lispro injection)
Clear
Immediate
0.5-1.5
2-4
Regular
Clear
0.5-1
2-3
3-6
NPH
Cloudy
2-4
4-10
10-16
Lente
Cloudy
3-4
4-12
12-18
Premixed
(70% NPH,
30% regular)
Cloudy
0.5-1
2 peaks:
3-4 and 8-12
16-24
Ultralente
Cloudy
6-10
None
18-20
31
Sliding Scale Insulin
Measure BG at -7am -11am - 4pm - 9pm
Give Humulin Regular Insulin
BG Value
150-200
201-250
251-300
301-350
351-400
over 400
under 50
Dosage
0 units
2 units
4 units
6 units
8 units
call MD
give 6oz OJ
repeat BS
32
Insulin

Dosage
– Individual requirements
– Individual response
33
Insulin Administration

Check Order

Gather equipment

Insulin - Precipitate
34
Administration - cont’d

Combining Insulins
– 30U of NPH & 6U of Regular

Drawing up

Injecting
– NO aspiration - 900 angle not 450
35
Special Things About Regular Insulin




Only one to give IV
Only one to give in Emergencies
Only one to give for coverage
Given via Insulin Pump (or Humalog)
Teaching








Pathophysiology
Diet
Exercise
Diabetes Mellitus ID
Sexuality
Community Resources
Stress Management
Health Care
38
Teaching

Home management
– Insulin
•
•
•
•
•
administration
storage
travel
exercise
sick days
39
Insulin pumps

Mimic release of pancreas
– electro - mechanical with computer chip

Basal rate (++)

Sub-Q

Complications
40
Oral Hypoglycemic Agents





Sulfonylureas
Insulin ?
Functioning Beta Cells
OOC on diet and exercise
Action
– release insulin from beta cells
– enhance sensitivity of receptor sites

*Metformin - (Glucophage) guanidine
derivative not a sulfonylureas
41
Physical Activity

Exercise
– Lowers BS levels
–  uptake of free fatty acids
– lower cholesterol & triglycerides
– promote cardiac stabillity
– reduce stress &  sense of well-being
42