Diabetes 120

Diabetes is the leading cause of

kidney failure, lower limb amputation, and vision loss.

Diabetes is contrubuting factors for

heart disease, stroke, hypertension

Gentic reasoning for diabetes

includes factors such as family history, specific gene variants, and hereditary predispositions that increase the risk of developing the disease.

Autoimmune reasoning for diabetes

T-cells destory beta cells of the pancreas

Environmental reasoning for diabetes

includes factors such as diet, physical inactivity, and exposure to toxins that may influence the risk of developing diabetes.

Classes of diabetes

Type 1, Type 2, Gestational, Prediabetes, Other Types (Medical Conditions)

Exocrine function of pancreas

Refers to the pancreas's role in producing digestive enzymes that are released into the small intestine to aid in digestion.

Endocrine function of pancreas

Refers to the pancreas's role in producing hormones, such as insulin and glucagon, that regulate blood sugar levels in the body.

Glucagon

A hormone produced by the pancreas that raises blood glucose levels by promoting the conversion of glycogen to glucose in the liver. Alpha cells. When BG is low, sugar comes out of the cells and into the bloodstream.

Insulin and amylin

are hormones produced by the pancreas that help regulate blood sugar levels and aid in digestion by slowing gastric emptying. Bring glucose to the cell, beta cells

Somatostatin and Gastrin

Somatostatin inhibits the release of insulin and glucagon, while gastrin stimulates gastric acid secretion. They are the regulators, downer cells

Normal Insulin Metabolism

refers to the physiological process by which insulin regulates glucose levels in the bloodstream, facilitating cellular uptake and utilization of glucose, primarily after meals.

Normal Glucose Range

74 to 106 mg/dL

Patho of Type 1 Diabetes

is characterized by autoimmune destruction of pancreatic beta cells, leading to an absolute deficiency of insulin. This results in elevated blood glucose levels due to impaired glucose uptake and metabolism.

Risk Factors of DM1

include genetic predisposition, autoimmune factors, and environmental triggers that may lead to the development of Type 1 diabetes.

Signs and Symptoms DM1

typically include increased thirst, frequent urination, extreme hunger, weight loss, fatigue, and blurred vision.

Patho of DM2

is characterized by insulin resistance and relative insulin deficiency. This leads to elevated blood glucose levels due to impaired glucose utilization and increased hepatic glucose production.

Risk Factors for DM2

include obesity, physical inactivity, family history, and age over 45.

Signs and Symptoms for DM2

typically include increased thirst, frequent urination, increased hunger, fatigue, and blurred vision.

Gestational Diabetes

is a form of diabetes that occurs during pregnancy and usually resolves after childbirth. It is characterized by high blood sugar levels due to insulin resistance that develops during pregnancy.

When does sugar go back to normal for gestational diabetes?

Within 6 weeks post partum

Metabolic Syndrome

Need 3/5 componets to have this syndrome, Elevated FBG higher than 100, Abdominal obesity with a waist circumference greater than 40 inches in men and 35 inches in women, Hypertension, Elevated triglycerides (above 150), and Low HDL cholesterol. Women below 50 and men below 40. BMI of 25 or higher is considered overweight

Prediabetes

A1C above 5.7%, but below 6.5%. It indicates an increased risk of developing type 2 diabetes. FBG above 100 mg/dl or OGTT above 140 mg/dl.

Macrovascular complications of DM

Coronary arteries, Cerebral arteries, Peripheral vessels, Sugar gets stuck on wall and shrink vessels

Microvascualr complications of DM

Retinopathy, Neuropathy, Nephropathy these are conditions affecting small blood vessels, commonly seen in diabetes patients.

Hypoglycemia

A condition characterized by abnormally low blood sugar levels, typically below 70 mg/dl

Hypoglycemia signs and symptoms

Shakiness, Diaphoresis, Pallor, Palpitations, Nervousness

Hypoglycemia treatment

Involves the rapid consumption of fast-acting carbohydrates, such as glucose tablets or juice, to raise blood sugar levels. Severe cases may require glucagon injections.

Hyperglycemia

A condition characterized by abnormally high blood sugar levels, typically above 120 mg/dl

Hyperglycemia signs and symptoms

Weight Loss, Polyuria, Polydipsia, Polyphagia, Fatigue, Infection, Visual changes, Prolonged wound healing

Diabetic Ketoacidosis

A serious complication of diabetes resulting from high levels of ketones in the blood due to insufficient insulin. It leads to symptoms such as nausea, vomiting, abdominal pain, and can be life-threatening if not treated promptly.

DKA numbers

BG above 250, PH <7.30

DKA signs and symptoms

Kussmaul Breathing (rapid deep breath) Sweet, fruity breath (acetone) Blowing off acid, Weakness, lethargy, Poor Skin Turgor, Tachycardia, Sunken Eyes, Abdominal Pain

DKA Treatment

Fluids, IV Insulin, Electrolyte Management (Na and K), Monitor BG closely, Tele Monitor

Hyperosmolar Hyperglycemic Syndrome (HHS)

A serious condition in diabetes characterized by extremely high blood glucose levels without significant ketosis, leading to severe dehydration, electrolyte imbalances (K+) , and altered consciousness. Typically DM2.

Treatment for HHS

Fluids, Insulin Therapy, Electrolyte Replacement, Monitor Vital Signs

HHS Signs and Symptoms

include extreme thirst, frequent urination, dry skin, fever, confusion, and drowsiness.

HHS numbers

BG above 600, pH > 7.4

DM Nursing Diagnoses

Risk for Unstable Blood Glucose Level, Risk for Injury, Knowledge Deficit, Ineffective Self-Health Management, Noncompliance, Ineffective Tissue Perfusion-Renal, Delayed Surgical recovery

DM Patient Care Management and Teaching

Diabetic diet strategies, Exercise , Glucose management, Illness management, Foot care, Nursing Interventions, Expected Outcomes, Journaling, Diabetic Educator

Diabetic Diet Strategies

A meal plan that focuses on balancing carbohydrates, proteins, and fats to help manage blood sugar levels effectively.

DM Exercise Plan

The ADA recommends at least 150 minutes per week, (30 minutes/5 days a week) of a moderate-intensity aerobic physical activity

Illness Management for DM

Defect in mobilization of inflammatory cells and impaired phagocytosis, Recurring or persistent infections, Treat promptly and vigorously

Rapid Acting Insulin (Lispro)

Onset: 10-30 min

Peak: 30min - 3 hour

Dduration: 3-5 hours

Short Acting insulin (Regualr, Humulin R)

Onset: 30 min-1 hour Peak: 2-5 hours Duration: 5-8 hours

Intermediate Acting (NPH, Humulin N)

Onset: 1.5-4 hours

Peak: 4-12 hours

Duration: 12 -18 hours

Long Acting (Lantus)

Onset: 0.8-4hours

Peak: none

Duration: 16-24 hours

Local Reactions

include redness, swelling, or pain at the injection site related to insulin administration, often temporary.

Lipodystrophy

is a medical condition characterized by abnormal or degenerative conditions of the body's fat tissue, often associated with repeated insulin injections, leading to changes in fat distribution.

Dawn phenomenon

a natural increase in blood glucose levels in the early morning due to hormonal changes in the body. It can cause elevated fasting blood glucose levels in individuals with diabetes.

Somogyi’s effect

refers to a rebound increase in blood glucose levels following nighttime hypoglycemia, often due to excessive insulin administration.

Geriatric Considerations for DM

Reduced beta cell function, Decreased insulin sensitivity