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DIABETES MELLITUS

DIABETES MELLITUS. Rachel S. Natividad RN, MSN, NP. Review A&P. Role of Insulin. Insulin: Counters metabolic activity that would increase blood glucose levels Enhances transport of glucose into body cells Lowers blood glucose levels. Physiology Cont: Insulin.

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DIABETES MELLITUS

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  1. DIABETES MELLITUS Rachel S. Natividad RN, MSN, NP

  2. Review A&P

  3. Role of Insulin • Insulin: • Counters metabolic activity that would increase blood glucose levels • Enhances transport of glucose into body cells • Lowers blood glucose levels

  4. Physiology Cont: Insulin *Blood glucose increases within 10 minutes of the beginning of a meal* • Basal (continuous) • Prandial (Bolus)

  5. Diabetes Mellitus • A disorder of carbohydrate, protein, and fat metabolism resulting from an imbalance between insulin availability and insulin need. (Porth, 2002) • End Result : HYPERGLYCEMIA

  6. Physiology Cont.:Glucose Control

  7. Patho: DM Type 1

  8. Patho Cont.: DM Type 2

  9. Normal Physiology

  10. Pathophysiology-Cont.:DM Type 2

  11. DM 1&2: The big difference…

  12. Case Study

  13. Diabetes: Clinical Manifestations THE 3 POLYs POLYDYPSIA POLYURIA POLYPHAGIA 14

  14. Early signs 3 Polys Weight loss Fatigue/Always tired Visual Blurring Late signs Any of the 3 Polys Infections Numbness/ tingling of feet or leg pain Slow healing wounds Chronic Complications Diabetes Clinical ManifestationsCont: Signs and Symptoms

  15. Diabetes: Dx Tests Check MD orders or agency protocol for frequency of BS Monitoring In General: AC&HS if pt able to eat; Q4-6 hours if NPO or tube feedings • Fasting Blood Glucose (FBG): <100 mg/dL • Iggy: 70-110 mg/dL *Random/Casual Blood Glucose*:<200 mg/dL • Oral Glucose Tolerance Test (OGTT): < 140 mg/dL • Glycosylated Hemoglobin (HgbA1C): 4-6%

  16. Diabetes: Diagnostic Tests Cont. • Glycosylated hemoglobin test – Hemoglobin A1C (HbA1c) • measures the amount of glycosylated hemoglobin (hemoglobin that is chemically linked to glucose) in blood. • Normal -4-6% • Target range DM patient <7%

  17. HbA1C Control

  18. Criteria for the Diagnosis of Diabetes Mellitus Normal • FPG <110 mg per dL • 2hr OGTT <140 mg per dL Diabetes-positive findings from any two of the following tests on different days: • Symptoms of diabetes mellitus* plus casual (random) plasma glucose concentration >=200 mg / dL or • FPG >=126 mg per dL or • 2hr OGTT >=200 mg per dL after a 75-g glucose load

  19. Diagnostic Tests – Cont.Is it Diabetes Yet? >126 >200 >6 Impaired Fasting Glucose 100-125 140-200 Impaired Glucose Tolerance <100 <140 <6

  20. Diabetic Ketoacidosis (DKA) BS > 300 mg/dL Classic symptoms Ketosis Hyperglycemic-Hyperosmolar Nonketotic Syndrome (HHNS) BS > 800 mg/dL Similar symptoms No Ketosis Acute Complications Check urine for ketones

  21. (ADA)

  22. Chronic Complications of DM

  23. Effects on Blood Vessels Blood Vessel Lumen

  24. Chronic Complications - Macrovascular • Cardiovascular • heart disease • Cerebrovascular • Stroke • Peripheral vascular disease DM pts have heart disease and stroke risks 2 to 4 X higher than non-DM pts

  25. Chronic Complications-Microvascular : • Diabetic Retinopathy The leading cause of new cases of blindness in adults ages 20 - 74

  26. Chronic Complications-Microvascular Nephropathy The leading cause of end-stage renal disease (ESRD), occurs in about 20 - 40% of patients with diabetes

  27. Chronic Complications-Microvascular Diabetic Neuropathy - the poor blood supply will cause the nervous system to malfunction

  28. Chronic Complications-Microvascular Amputation of Toes

  29. Chronic Complications-Microvascular • Sexual problems for menerectile dysfunction retrograde ejaculation • Sexual problems for womendecreased vaginal lubrication decreased sexual response • Urologic problems for men and women urinary tract infections neurogenic bladder

  30. Chronic Complications-Microvascular • Gastroparesis Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly

  31. MANAGEMENT OF DM • Regular Blood Glucose Monitoring Drug Therapy Diet Exercise 32

  32. Management: Diet & Exercise

  33. Diet : Diabetes Food Pyramid

  34. Diet Cont: What to do???

  35. Diet Cont.Carb-Counting

  36. Diet Cont: Glycemic Index

  37. Diet Cont.:Getting the balance right Get your portions right!!

  38. Helps regulate blood glucose Increases insulin effectiveness and sensitivity in the body. Must monitor insulin and food intake to match exercise regimen. Management: Exercise

  39. Drug Therapy Insulin & Oral Antidiabetic Agents

  40. Drug Therapy: Insulin Types • BOLUS • Used to lower blood sugar after eating a meal • Fast-acting insulin • Rapid Acting Insulin Analogs • Aspart, Lispro, Glulisine • Regular Human Insulin • Intermediate-acting insulin • NPH Human Insulin • Pre-Mixed Insulin • Humulin 70/30, Humalog 75/25 • Long-acting insulin • Insulin Glargine, Insulin Detemir BASAL Used to lower blood sugar throughout the day and night

  41. Drug Therapy Cont.: Insulin • Onset - how soon it starts to work in the blood • Peak - when the insulin has the greatest effect on blood sugar levels • Duration – how long it keeps working

  42. Drug Therapy Cont:Goal of Insulin Therapy Basal and Bolus Insulin Coverage

  43. Drug Therapy Cont:Sample Insulin Regimen (NPH & Regular insulin)

  44. Drug Therapy-Insulin Cont:Rapid Acting “Logs” Humalog (insulin lispro) Novolog (insulin aspart) • Bolus insulin • Onset 15 min; peaks 1-2 hrs; lasts 4-6 hours • Ideal for meal coverage “Give the shot while the plate is hot!”

  45. Drug Therapy-Insulin Cont:Short Acting: Regular Insulin Regs • Bolus insulin • Onset ½-1 hr; peaks 2-4 hrs; lasts 6-8 hrs Give 30 minutes to 1 hour before a meal

  46. Drug Therapy-Insulin Cont:Short Acting: Regular Insulin ♪ It’s time give you yourregular insulin♪ ♪It’s time to give it30 minutes before your plate is in♪ ♪Come back to check you in 2 (hours)♪ ♪Watch out for shakes and sweats too♪ ♪If your lucky you’ll have no clue!!!!♪

  47. Drug Therapy-Insulin Cont:Rapid Acting (Humalog/Novolog) VS. Short Acting (Regular Insulin) Delayed onset Peaks in 2-4 hr Lasts 6-8 hours Rapid onset 1-2 hour peak Limited duration

  48. Basal insulin: covers blood sugar between meals Satisfies overnight insulin requirement Onset 1-2 hrs, peaks 6-10 hrs, lasts 12+ hrs Need snack if NPH given at 5 pm (only) Ideal to be given at 9 pm (HS) to address Dawn Phenomenon Drug Therapy-Insulin Cont:Intermediate acting: NPH Insulin

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