PN 114-1

How many people in the US have diabetes

34.2 million

Type 1 diabetes

body does not produce insulin

Type 2 diabetes

Body produces insulin but can't use it well

Gestational diabetes

A temporary condition in pregnancy

Risk of death with diabetes

50% higher than those without diabetes

Serious health complications that can happen with diabetes

\--blindness

\--kidney failure

\--heart failure

\--Stroke

\--Loss of toes, feet, or legs

diabetes mellitus

chronic disorder characterized by abnormal metabolism or carbs, proteins and fats

Metabolism

breakdown of carbs, protein, and fat

What does metabolism do

turn sugar into glucose

If people don't have insulin to move glucose into cells

it stays in blood stream and creates high glucose levels

Why do cells need glucose

to use it as energy

Only cure for type 1 diabetes

Pancreas transplant

What systems often experience complications from diabetes

Circulatory and nervous systems

What do diabetes complications have in common

affect small blood vessels

Pancreas

Gland located between the stomach and small intestine, with the tail next to the spleen

Endocrine pancreas function

produces hormones of insulin and glucagon which are secreted into the blood stream to regulate the blood sugar levels

Exocrine pancreas function

Produces pancreatic juice to digest food

Anatomy and physiology of insulin function

\-Blood glucose is regulated by insulin, a hormone produced by the beta cells in the islets of Langerhans in the pancreas

\-Small amount of insulin is secreted continuously into the blood stream

\-Ingestion of carbs, triggers the secretion of larger volume of insulin (insulin pumps mimic this body process)

Different cell types

Alpha, beta, delta

Alpha cells

secretes glucagon which is stored form of glucose

Beta cells

produces and secretes insulin

Endogenous insulin

produced by one's own body

exogenous insulin

come from an external source, the insulin you give your patients

Action of insulin

stimulate the transport of glucose into cells (need insulin to bring glucose into cells to use as energy)

How is insulin administered?

subcutaneously

How can regular insulin be administered

IV and subcutaneously

Length of needle used for insulin administration

1/2 inch

What angle is insulin administered

90 degree

What to never to with an insulin vial

shake it

Sites to administer insulin

arms, thighs, abdomen

Last resort insulin administration site

Butt

Where is insulin absorbed the fastest

abdomen

Things to note about abdominal insulin administration

differed amounts of fat under it dependent on where you give the insulin which can effect absorption as well

Insulin pump

works similar to pancreas. Gets continuous dose and can give bolus after eating

How is the dosage of insulin determined?

sliding scale

What type of insulin is humulin R

short regular

Onset of short regular insulin

30 minutes

Peak of short regular insulin

2-5 hours

Reaction of short regular insulin

1-3 hours

Duration of short regular insulin

5-8 hours

What type of insulin is NPH, and Humulin N

intermittent

Onset of intermittent insulin

1-2 hours

Peak of intermittent insulin

6-12 hours

Reaction of intermittent insulin

Late afternoon

Duration of intermittent insulin

18-26 hours

What type of insulin is lantus levemir

Basal

Onset of basal insulin

1-2 hours

Peak of basal insulin

no peak

Reaction of basal insulin

High (01-02)

Duration of basal insulin

up to 24 hours

What type of insulin is 70/30

premixed

Onset of premixed insulin

30 minutes

peak of premixed insulin

2-12 hours

reaction premixed insulin

variable

Duration of premixed insulin

18-24 hours

What type of insulin is Humalog and Novolog

very short

Onset of very short insulin

5-15 minutes

Peak of very short insulin

30 minutes

Reaction of very short insulin

variable- but don't give more than 15 minutes before food

Duration of very short insulin

3-5 hours

Who is type 1 diabetes most associated with

children to very young adults

Risk factors for type 1 diabetes

genetic or environmental factors

What is type 1 diabetes treated with

insulin

Is type 1 diabetes preventable

No

What percentage of diabetes cases is Type 1

5%

What group is associated with type 2 diabetes

adults

Risk factors for type 2 diabetes

Obesity, older age, family of personal history of the disease

What is type 2 diabetes treated with

diet, exercise and sometimes oral drugs or insulin

Is type 2 diabetes preventable?

yes

What percentage of diabetes cases is type 2

90-95%

What is an indicator for undiagnosed gestational diabetes

Large babies

Who is associated with gestational diabetes

pregnant women

Risk factors for gestational diabetes

obesity, or family history of diabetes

How is gestational diabetes treated

diet and exercise or insulin

Is gestational diabetes preventable

recent studies suggest there may be ways to prevent some cases

What percentage of diabetes cases are gestational

9% of pregnant women

What age group is more prone to diabetes

People over 40

What races are more predisposed to diabetes

blacks, Hispanics, and native Americans

How large does an infant have to be to suspect gestational diabetes

9 lbs or more

Autoimmune disease and type 1 diabetes

Type 1 research is questioning if we get a virus that attacks the beta cell and causes them to stop producing insulin

Predisposing factors for diabetes

\-Age

\-Race

\-Family history

\-Obesity

\-History of gestational diabetes

\-Autoimmune disease

Diagnostic tests for diabetes

\-FBS (fasting blood sugar)

\-Oral glucose tolerance test (OGTT)

\-Self monitoring blood glucose (SMBG)

\-Glycosylated hemoglobin test (HbA1C)

\-Urine samples

\-Casual blood glucose (bedside)

How long do people fast for for an FBS

8 hours

Most common diagnostic test

FBS

Normal blood sugar

60-100 mg/dl

What blood glucose indicates diabetes

126 mg/dl or more

Nursing considerations for FBS

if they are getting insulin not to give it

Casual blood glucose (bedside)

200 mg/dl or greater- drawn anytime

OGTT (oral glucose tolerance test)

response to a specific amount of glucose

Nursing considerations for OGTT

\--Draw fasting first, then sugar drink, draws 30 min then hourly x3

\--Still high 200 < after 2hrs considered diabetic

SMBG (self-monitoring of blood glucose)

how often is dependent on severity of DM

Nursing considerations for SMBG

If ill they need to test more often

Glycosylated hemoglobin test (HbA1C)

\--State of hyperglycemia over the length of the life of the RBX (120 days)- glucose attaches to cell and stays until used or cell dies

\--See how well DM is controlled-

Urine examination

not a definitive test- used for screening

Nursing considerations for urine examination

\--Ketodiastix, clinitest, acetone test

\--If sugar > 140 you will see glucose in urine

\--Should be looking for ketones if sick, when you don't have glucose you use fat and produce ketone

Symptoms of diabetes

\-Polyuria

\-Polydipsia

\-Polyphagia

\-Loss of weight

\-Irritability

\-Weakness

\-Infections

\-Pruritus'

\-Visual disturbances

Symptoms of diabetes in children

\--Bedwetting

\--Irritability

\--Decreased attention span

Polyuria

excessive urination

Polydipsia

excessive thirst

Polyphagia

excessive hunger