Diabetes Student Notes PDF

Diabetes (Lewis book chapter posted in Brightspace) NURS 300  Diabetes Definition Chronic multisystem disease related to Abnormal insulin production Impaired insulin utilization Or both The long-term complications of diabetes make it a deva...

Diabetes (Lewis book chapter posted in Brightspace) NURS 300  Diabetes Definition Chronic multisystem disease related to Abnormal insulin production Impaired insulin utilization Or both The long-term complications of diabetes make it a devastating disease. Diabetes is the leading cause of: Adult blindness End-stage renal disease Nontraumatic lower limb amputations Major contributing factor Heart disease Stroke  Etiology and Pathophysiology Two most common types Type 1 Type 2 Other types Gestational Prediabetes Secondary diabetes  Etiology and Pathophysiology Normal insulin metabolism Produced by the B cells beta cells Islets of Langerhans of the pancreas Released continuously into bloodstream in small increments with larger amounts released after food intake Stabilizes glucose range to 70 to 120 mg/dl Insulin Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell Decreases glucose in the bloodstream  Etiology and Pathophysiology Insulin Involvement of many body systems ↑ Insulin after a meal Stimulates storage of glucose as glycogen in liver and muscle Inhibits gluconeogenesis - the process of synthesizing glucose in the body from non-carbohydrate sources Enhances fat deposition ↑ Protein synthesis Normal Insulin Secretion Fig. 49-1  Etiology and Pathophysiology Counterregulatory hormones – Increase blood glucose levels by stimulating glucose production & output by the liver, & by decreasing the movement of glucose into the cells. Oppose effects of insulin Increase blood glucose levels Provide a regulated release of glucose for energy Help maintain normal blood glucose levels Examples Glucagon, epinephrine, growth hormone, cortisol  Type 1 Diabetes Mellitus Formerly known as “juvenile onset” or “insulin dependent” diabetes Most often occurs in people under 30 years of age Peak onset between ages 11 and 13 5-10% of all diabetics Now occurring in younger children  Type 1-Etiology and Pathophysiology End result of long-standing process body compensates for a long time Immune- mediated disease Body’s own T cells attack & destroy pancreatic beta (β)-cells, which are the source of insulin. Auto antibodies to the islet cells cause a reduction of 80% to I iii 90% of normal cell function before hyperglycemia manifestations occur Causes Genetic predisposition Related to human leukocyte antigens (HLAs) Exposure to a virus Idiopathic diabetes – not related to autoimmunity but strongly inherited  Type 1- Onset of Disease Long preclinical period Ollaus before for a long time any symptoms Antibodies for βcell distruction present for months to years before symptoms occur Manifestations develop when pancreas can no longer produce insulin Rapid onset of symptoms Present at ER with ketoacidosis  Type 1-Onset of Disease may pullingme History of recent, sudden, weight loss Classic symptoms Polydipsia – excessive thirst Polyuria – production of abnormally large amounts of urine Polyphagia – Increased appetite Will require exogenous insulin to sustain life  Type 1 - Clinical Manifestations Classic symptoms Polyuria (frequent urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) Weight loss – body cannot get glucose and uses other energy sources such as fat Weakness & fatigue – body cells lack needed energy from glucose Nonspecific symptoms May have classic symptoms of type Fatigue 3 lethargic Recurrent infections Recurrent vaginal yeast infections Prolonged wound healing Visual changes  Type 2 Diabetes Mellitus Most prevalent type of diabetes - over 90% of patients with diabetes Usually occurs in people over 35 years of age 80% to 90% of patients are overweight Prevalence increases with age Genetic basis Greater in some ethnic populations African Americans, Asian Americans, Hispanic Americans, and Native Americans Native Americans and Alaskan Natives: Highest rate of diabetes in the world  Etiology and Pathophysiology Pancreas continues to produce some endogenous (self made) insulin notworking effertively Insulin produced is either insufficient or poorly utilized by tissues or both Obesity (abdominal/visceral) Most powerful risk factor Genetic mutations Lead to insulin resistance Increased risk for obesity  Etiology and Pathophysiology Four major metabolic abnormalities 1. Insulin resistance Body tissues do not respond to insulin Insulin receptors either unresponsive or insufficient in number Results in hyperglycemia 2. Pancreas ↓ ability to produce insulin β cells fatigued from compensating β -cell mass lost  Etiology and Pathophysiology 1. Inappropriate glucose production from liver Liver’s response of release of glucose is haphazard and does not correspond to body’s needs Not considered a primary factor in development of type 2 2. Alteration in production of hormones and adipose tissue (adipokines) Adipokines play a role in glucose & fat metabolism Contribute to pathophysiology of type 2 diabetes  Type 2 - Onset of Disease Gradual onset Person may go many years with undetected hyperglycemia Osmotic fluid/electrolyte loss from hyperglycemia may become severe Hyperosmolar coma Altered Mechanisms in Type 1 and Type 2 Diabetes Fig. 49-2  Prediabetes Prediabetes – at increased risk for developing diabetes Not high enough for diabetes diagnosis Increase risk for developing type 2 diabetes If no preventive measure taken—usually develop diabetes within 10 years Long-term damage already occurring Heart, blood vessels see a cardiologist Usually present with no symptoms Must watch for diabetes symptoms Polyuria Polyphagia Polydipsia Maintaining healthy weight, exercising regularly, & a healthy diet reduce the risk of developing diabetes  Secondary Diabetes Results from Another medical condition Cushing syndrome Hyperthyroidism Pancreatitis Parenteral nutrition Cystic fibrosis Hematochromatosis Treatment of a medical condition that causes abnormal blood glucose level Corticosteroids (Prednisone) Thiazides Phenytoin (Dilantin) Atypical antipsychotics (clozapine) Usually resolves when underlying condition treated  Diagnostic Studies Random plasma glucose Normal 70-120 mg/dL Diabetes ≥200 mg/dL Fasting plasma glucose (no caloric intake for 8 hours) Normal