Obestity and Diabetes Mellitus

OBESITY OVERVIEW

  • Overweight: BMI 25–29.9

  • Obesity: BMI ≥ 30

    • Class I: 30–34.9

    • Class II: 35–39.9

    • Class III: ≥ 40 (severe)

  • High Risk Groups: Women, African Americans, Hispanics, low income/education

CAUSES

  • Behavioral (overeating, inactivity)

  • Environmental (food deserts, marketing)

  • Genetic + Physiologic factors

  • Medications

ASSOCIATED CONDITIONS

  • ↓ Life expectancy by 6–20 years

  • ↑ Risk: T2DM (10x), HTN, asthma (4x), Alzheimer’s (2x), cancer

ASSESSMENT

  • BMI, waist circumference (>35" women, >40" men)

  • Labs: cholesterol, triglycerides, glucose, A1C, LFTs

  • Psychosocial: RESPECT acronym (food habits, chronic diseases, family hx, etc.)

TREATMENT OPTIONS

1. Lifestyle Changes

  • Set realistic goals, diet, exercise, sleep, self-monitor

2. Medications

  • BMI >30 or >27 with comorbidities

  • Block fat absorption or suppress appetite

3. Nonsurgical

  • Vagal blocking, gastric balloon, embolization

4. Surgery (Bariatrics)

  • Indications: BMI ≥ 40 or ≥ 30 with comorbidities

  • Weight Loss: ~25–35% body weight

  • Types:

    • Roux-en-Y Gastric Bypass

    • Gastric Banding

    • Sleeve Gastrectomy

    • Biliopancreatic Diversion w/ Duodenal Switch

NURSING CARE

  • Respectful, nonjudgmental care

  • Watch for:

    • Resp issues (Fowler’s, O2, pulse ox)

    • Circulation issues (BP cuff size, DVT risk)

    • Skin integrity (pressure ulcers)

    • Drug dose changes due to weight

POST-SURGERY CONCERNS

  • Complications: hemorrhage, DVT, bile reflux, dumping syndrome, dysphagia

  • Goals: Pain control, fluid balance, diet adherence, body image support

  • Dumping Syndrome: Avoid fluids with meals, eat slowly, small meals

DIABETES OVERVIEW

  • Hyperglycemia due to ↓ insulin secretion/action

  • Types: Type 1, Type 2, Gestational, MODY, LADA

SYMPTOMS

  •  3 P’s: Polyphagia, Polyuria, Polydipsia

    • know the differences for exam!!

      • Hypoglycemia: agitated/ mild-Shaky, confused, headaches, slurred speech

        • put in lateral position

        • call provider, adminitster glucagon

      • Hyperglycemia: Hot dry skin, fruity breath

        • tet for urine ketones

        • administer insulins

        • encourage plenty of sugar free fluids

DIAGNOSTIC CRITERIA

  • A1C > 6.5%

  • FBG > 126 mg/dL

  • 2-hr glucose tolerance > 200 mg/dL

  • Symptomatic + random glucose > 200 mg/dL

COMPLICATIONS

  • Retinopathy: Leading cause of blindness

  • Nephropathy: 5 stages → ESRD

  • Neuropathy: Foot pain, gastroparesis, Charcot foot

  • PAD: Ulcers, amputations

  • Infection: UTI, skin lesions, poor wound healing

  • Sexual Dysfunction, Cognitive Issues

INSULIN

  • Types + schedules (e.g. sliding scale)

  • Rotate sites, use 90° angle

  • Complications: hypoglycemia, lipodystrophy, Somogyi/dawn phenomenon

HYPOGLYCEMIA CARE

  • Rule of 15: 15g carbs → wait 15 min → check BS → repeat if needed

  • Severe: Glucagon IM/IV or D50 IVP (hospitalized)

💧 DKA vs HHS

Feature

DKA

HHS

Type

Mostly T1DM

Mostly T2DM

Ketones

Present

Absent

pH

↓ < 7.3

Normal

Treatment

Fluids, insulin, lytes

Fluids, insulin, lytes

SICK DAY RULES

  • Don’t skip insulin

  • Monitor BS q2–4 hrs

  • Drink fluids hourly

  • Check urine for ketones

  • Call MD if vomiting/ill >24h