Diabetes Mellitus

DIABETES MELLITUS ,[object Object],MA. TOSCA CYBIL A. TORRES, RN, MAN ,[object Object]

Review of Anatomy and Physiology ,[object Object],PANCREAS,[object Object],HORMONES:,[object Object],INSULIN BY BETA CELLS,[object Object],GLUCAGON BY ALPHA CELLS,[object Object]

Pancreas secretes 40-50 units of insulin daily in two steps:,[object Object],Secreted at low levels during fasting ( basal insulin secretion),[object Object],Increased levels after eating (prandial),[object Object],An early burst of insulin occurs within 10 minutes of eating,[object Object],Then proceeds with increasing release as long as hyperglycemia is present,[object Object]

Insulin ,[object Object],Insulin allows glucose to move into cells to make energy,[object Object],Inhibits glucagon activity ,[object Object]

Insulin (normal values) ,[object Object]

DIABETES MELLITUS ,[object Object], is a chronic disorder of carbohydrate, protein, and fat metabolism resulting from insulin deficiencyor abnormality in the use of insulin,[object Object]

Types,[object Object],Type I,[object Object],[object Object]

Autoimmune (Islet cell antibodies)

Early introduction of cow’s milk and cereals

Intake of medicine during pregnancy

Indoor smoking of family members

destruction of beta cells of the pancreas  little or no insulin production

may occur at any age, usually appears below age 15,[object Object]

disturbance in insulin reception in the cells

 number of insulin receptors

loss of beta cell responsiveness to glucose leading to slow or  insulin release by the pancreas

occurs over age 40 but can occur in children

w/ some circulating insulin present, often do not require insulin ,[object Object]

Who are at risk? ,[object Object],?,[object Object]

Risk Factors,[object Object],Obesity ,[object Object],Race ,[object Object],History of CVD,[object Object],HTN ,[object Object],Physical inactivity,[object Object],Familial history ,[object Object],Polycystic Ovary Syndrome,[object Object],Gestational Diabetes,[object Object],?,[object Object],?,[object Object],?,[object Object],?,[object Object],?,[object Object],?,[object Object],?,[object Object]

Clinical Manifestations ( Signs and Symptoms),[object Object],- Polyuria - weakness,[object Object],- Polydipsia - fatigue,[object Object],- Polyphagia -  blood sugar / glucose level,[object Object],- weight loss - (+) glucose in urine (glycosuria),[object Object],[object Object],- changes in LOC (severe hyperglycemia),[object Object], (sleepiness, drowsiness  coma),[object Object],- recurrent infection, prolonged wound healing,[object Object],[object Object], infection (glucose inhibits the phagocytic action of WBC  ,[object Object], resistance),[object Object],[object Object], presenting symptom in women),[object Object]

Fasting Plasma Glucose ,[object Object]

Oral Glucose Tolerance Test (OGTT),[object Object]

GlycoselatedHemoglobin (HbA1c),[object Object],HbA1c is a test that measures the amount of glycatedhemoglobin in your blood. Glycatedhemoglobin is a substance in red blood cells that is formed when blood sugar (glucose) attaches to hemoglobin.,[object Object]

GlycoselatedHemoglobin (HbA1c) ,[object Object]

Urinalysis ,[object Object],Glycosuria,[object Object],Ketone bodies ,[object Object]

Diagnostic Criteria ,[object Object],Classic signs of HYPERGLYSEMIA with CPG ≥200mg/dL,[object Object],OGTT ≥200mg/dL,[object Object],FPG ≥126mg/dL,[object Object],A1C ≥ 6.5%,[object Object]

Interventions for Diabetes Mellitus,[object Object],A.Dietary Management,[object Object],Follow individualized meal plan and snacks as scheduled,[object Object],[object Object]

diet based on pts. size, wt., age, occupation and activity2. Pt. must have adequate CHO intake to correspond to the time when insulin is most effective,[object Object],Routine blood glucose testing before each meal and at bedtime is necessary during initial control, during illness and in unstable pts.,[object Object],Do not skip meals,[object Object],Measure foods accurately, do not estimate ,[object Object],Less added fat, fewer fatty foods and low-cholesterol,[object Object]

Interventions for Diabetes Mellitus,[object Object],A.Dietary Management,[object Object],Advise use of complex carbohydrates to help stabilize blood sugar. Meal should include more fiber and starch and fewer simple or refined sugars.,[object Object],Avoid concentrated sweets, high in sugar (jellies, jams, cakes, ice cream),[object Object],If taking insulin, eat extra food before periods of vigorous exercise,[object Object],Avoid periods of fasting and feasting,[object Object],Keep weight at normal level, obese diabetics should be on a strict weight control program and should lose weight.,[object Object]

B. Teach pt. on correct administration of insulin and other hypoglycemic agents.,[object Object],insulin in current use may be stored at room temp., all others in ref. or cool area,[object Object],avoid injecting cold insulin  lead to tissue reaction,[object Object],roll insulin vial to mix, do not shake, remove air bubbles from syringe,[object Object],press (do not rub) the site after injection (rubbing may alter the rate of absorption of insulin),[object Object],avoid smoking for 30 mins. after injection (cigarette smoking absorption),[object Object]

6. Rotate sites,[object Object],[object Object]

Lipodystrophy – localized disturbance of fat metabolism

Ex. Lipohypertrophy – thickening of subcutaneous tissue at injection site, feel lumpy or hard, spongy result to  absorption of insulin making it difficult to control the pt.’s blood glucose,[object Object]

Insulin injection sites ,[object Object]

SLIDING SCALE ,[object Object]

Factors that influence the body’s need for insulin,[object Object], need : trauma, infection, fever, severe psychological or physical stress, other illnesses,[object Object], need : active exercise,[object Object]

Hypoglycemia,[object Object],[object Object]

results from too much insulin, not enough food, and/or excessive physical activity

may occur 1-3 hrs after regular insulin injectionS/Sx:,[object Object],Sweating, tremor, pallor, tachycardia, palpitations and nervousness,[object Object],caused by release of epinephrine from the CNS when blood glucose falls rapidly,[object Object],Headache, light-headedness, confusion, numbness of lips and tongue, slurred speech, drowsiness, convulsions and coma,[object Object],caused by depression of the CNS because of glucose supply of brain cells,[object Object]

Management of Hypoglycemia,[object Object],Give simple sugar orally if pt. is conscious and can swallow – orange juice, candy, glucose tablets, lump of sugar,[object Object],Give Glucagon (SQ or IM) if pt. is unconscious or cannot take sugar by mouth,[object Object],As soon as pt. regains consciousness, he should be given carbohydrate by mouth,[object Object],If pt. does not respond to the above measures, he is given 50 ml of 50% glucose I.V. or 1000 ml of 5%-10% glucose in water I.V.,[object Object]

ACUTE COMPLICATIONS OF DIABETES MILLETUS,[object Object],DIABETIC KETO-ACIDOSIS (DKA),[object Object],INSULIN SHOCK,[object Object],HYPERGLYCEMIC, HYPEROSMOLAR, ,[object Object], NONKETOTIC (HHONK) COMA ,[object Object],DAWN PHENOMENON,[object Object],SOMOGYI EFFECT,[object Object]

D.K.A.PATHOPHYSIOLOGY,[object Object],NO INSULIN,[object Object],OSMOTIC,[object Object],DEHYDRATION,[object Object],MARKED HYPERGLYCEMIA,[object Object],LIPOLYSIS,[object Object],GLUCOSURIA,[object Object],CELLULAR ,[object Object],HUNGER,[object Object],OSMOTIC,[object Object],DIURESIS,[object Object],WEIGHT,[object Object],LOSS,[object Object],KETOACIDOSIS,[object Object],POLYPHAGIA,[object Object],POLYURIA,[object Object],POLYDIPSIA,[object Object]

D.K.A.,[object Object],S/SX:,[object Object],S/SX OF DM +,[object Object],KETONURIA,[object Object],METABOLIC ACIDOSIS,[object Object],KUSSMAUL’S RESPIRATION,[object Object],ACETONE BREATH,[object Object],DHN,[object Object],FLUSHED FACE,[object Object],TACHYCARDIA,[object Object],CIRCULATORY COLLAPSE COMADEATH,[object Object]

D.K.A.,[object Object],MANAGEMENT:,[object Object],ADEQUATE VENTILATION,[object Object],FLUID REPLACEMENT,[object Object],INSULIN – RAPID ACTING,[object Object],ECG – ELEC IMB,[object Object]

INSULIN SHOCK,[object Object],LOW BLOOD SUGAR,[object Object],CAUSE:,[object Object],OVERDOSE OF EXOGENOUS INSULIN,[object Object],EATING LESS,[object Object],OVEREXERTION WITHOUT ADDITIONAL CALORIE INTAKE,[object Object]

INSULIN SHOCK,[object Object],S/SX:,[object Object],PARASYMPATHETIC,[object Object],HUNGER,[object Object],NAUSEA,[object Object],HYPOTENSION,[object Object],BRADYCARDIA,[object Object],CEREBRAL,[object Object],LETHARGY,,[object Object],YAWNING,[object Object],SENSORIUM CHANGES,[object Object],SYMPATHETIC,[object Object],IRRITABILITY,[object Object],SWEATING,[object Object],TREMBLING,[object Object],TACHYCARDIA,[object Object],PALLOR,[object Object],CLINICAL FINDING : ,[object Object],BLOOD GLUCOSE BELOW 55-60 mg%,[object Object]

Preventing Hypoglycemic Reactions Due to Insulin,[object Object],Instruct the pt. as follows:,[object Object],Hypoglycemia may be prevented by maintaining regular exercise, diet and insulin,[object Object],Early symptoms of hypoglycemia should by recognized and treated,[object Object],Carry at all times some form of simple carbohydrate (orange juice, sugar, candy),[object Object],Extra food should be taken before unusual physical activity or prolonged periods of exercise,[object Object],Between-meal and bedtime snacks may be necessary to maintain a normal glucose level.,[object Object]

Oral Antidiabetic Agents,[object Object]

Teach pt. to estabilish and maintain a pattern of regular exercise,[object Object],Benefits of exercise : ,[object Object],[object Object]

 the no. of functioning receptor sites for insulin

perform exercise after meals to ensure an adequate level of blood glucose

carry a rapid-acting source of glucose during exercise

Diabetes Mellitus

Diabetes Mellitus

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Diabetes Mellitus