Diabetes Overview and Types

Diabetes Overview

• Diabetes results from the body's inability to regulate blood sugar levels effectively.
• Two main types: Type 1 and Type 2, with a third type known as Gestational diabetes.
• Homeostatic mechanism: Insulin lowers blood sugar after eating, while Glucagon raises it during fasting.

Type 1 and Type 2 Diabetes

• Type 1 Diabetes:
  • Can be genetic or autoimmune.
  • Results in little to no insulin production due to pancreatic damage.
• Type 2 Diabetes:
  • Often linked to lifestyle factors such as diet and exercise.
  • Characterized by insulin resistance where cells do not respond effectively to insulin.
• Gestational Diabetes:
  • Mimics Type 2 and typically resolves after childbirth.
• Pre-diabetes:
  • Elevated blood sugar levels that may progress to Type 2 if untreated, but can be reversible with lifestyle changes.

Blood Glucose Monitoring

• Normal blood glucose levels:
  • Targeted between 4mmol/L and 7mmol/L before meals, and 8-9mmol/L after meals.
• Hypoglycemia: Blood sugar below 4mmol/L.
• Hyperglycemia: Blood sugar above 7mmol/L after fasting or over 11mmol/L during other tests.

Insulin Types and Characteristics

• Rapid-Acting Insulin (e.g., Lispro, Novolog):
  • Onset: 30 minutes
  • Peak: 1-2 hours
  • Duration: 3-5 hours
• Short-Acting Insulin (e.g., Actrapid, Humulin):
  • Onset: 30-60 minutes
  • Peak: 3 hours
  • Duration: 8 hours
• Intermediate-Acting Insulin (e.g., Humulin I):
  • Onset: 1-2 hours
  • Peak: 10 hours
  • Duration: 11-24 hours
• Long-Acting Insulin (e.g., Detemir, Glargine, Degludec):
  • Onset: 30-40 minutes
  • No peak; duration of 24 hours.

Hyperglycaemic Episodes

• Symptoms: Excessive urination, fatigue, increased thirst and hunger.
• Common causes: Infections, surgery stress, missed insulin doses, and corticosteroids.
• Treatment: Administer insulin to lower blood glucose levels.

Long-Term Complications

• Chronic high blood sugar can lead to vascular damage, risking strokes and organ failure.
• Increased susceptibility to infections due to excess glucose.
• Potential outcomes include Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS).

Nursing Interventions

• Monitor blood glucose levels regularly.
• Assess patient symptoms and check for DKA.
• Administer fast-acting insulin (e.g., Novarapid) as per protocol.
• Provide IV fluids and potassium supplements if critically low.
• Encourage hydration if the patient is conscious.
• Evaluate insulin delivery systems for functionality.
• Document all symptoms and nursing actions for team awareness.