Adult Care Nursing II/Theory - Assessment and Management of DM PDF

Adult Care Nursing II/ Theory Faculty of Nursing Prof. Mohammad Al Qadire 1  Assessment and Management of Patients With Diabetes ❖ Diabetes “A group of metabolic diseases characterized by increased levels of Glucose in the blood (hy...

Adult Care Nursing II/ Theory Faculty of Nursing Prof. Mohammad Al Qadire 1  Assessment and Management of Patients With Diabetes ❖ Diabetes “A group of metabolic diseases characterized by increased levels of Glucose in the blood (hyperglycemia) caused by defects in Insulin secretion, Insulin action, or both”. ▪ Epidemiology: Affects nearly 25.8 million people in the United States; one third of cases are undiagnosed. ▪ Worldwide; in 2000, 171 million have DM, expected by 2030 to increase to 360 million (WHO, 2012). Prevalence is increasing. Minority populations and older adults are extremely affected.  Classifications of Diabetes Type 1 Diabetes Type 2 Diabetes Gestational Diabetes: during pregnancy Diabetes associated with other conditions or syndromes Prediabetes is classified as Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG) & refers to a condition in which blood glucose concentrations fall between normal levels & those considered diagnostic for diabetes (100-125mg) The Insulin & Glucagon together maintain a constant level of glucose in blood by stimulating release of glucose from the liver.  Risk Factors of Diabetes Family history of diabetes Obesity; BMI ≥ 30 kg/m2 Race / Ethnicity (e.g; African, Asian American) Age ≥ 45 years Hypertension ≥ 140/90 mmHg High Density Lipoprotein (HDL) Cholesterol level ≤35mg/dl. History of gestational diabetes Previously identified IFG or IGT  Functions of Insulin ▪ Insulin is a hormone secreted by beta cells in the islets of Langerhans in the pancreas. ▪ After eating a meal, insulin secretion increases & moves glucose from the blood into muscle, liver, & fat cells Transports and metabolizes glucose for energy. Stimulates storage of glucose in the liver and muscle as glycogen. Signals the liver to stop the release of glucose Enhances storage of fat in adipose tissue Accelerates transport of amino acids into cells Inhibits the breakdown of stored glucose, protein, and fat Regulation (homeostasis) of blood glucose levels by Insulin and Glucagon High blood glucose is lowered by Insulin release. Regulation (homeostasis) of blood glucose levels by Insulin and Glucagon Low blood glucose is raised by Glucagon release.  Type 1 Diabetes Affects 5% to 10% of persons with diabetes. Insulin-producing beta cells in the pancreas are destroyed by an autoimmune process, genetic & possibly environmental factors (viral or toxins). Destruction of beta cells result in decrease insulin production. Glucose derived from food cannot be stored in liver, but remains in bloodstream result in postprandial (after meals) hyperglycemia. Requires insulin because little or no insulin is produced. Onset is acute and usually before the age of 30. DKA occur most commonly in type 1 diabetes.  Type 2 Diabetes Affect 90% to 95% of person with diabetes, onset over age 30 years, increasing in children, obesity. Decreased tissue sensitivity to insulin (insulin resistance) and impaired beta cell function result in decreased insulin production. Slow, progressive glucose intolerance. Treated initially with diet and exercise. Oral hypoglycemic agents initially may need to convert to insulin or use both. DKA does not typically occur in type 2 diabetes. Can be prevented with appropriate changes in lifestyle. Pathogenesis of Type 2 Diabetes  Risk Factors Type 1: early onset, Type 2: obesity, age, familial, genetic previous identified impaired predisposition, possible fasting glucose or impaired immunologic or glucose tolerance, environmental (viral or hypertension ≥140/90 mm toxins) factors. Hg, HDL ≤35 mg/dL or Triglycerides ≥250 mg/dL, history of gestational diabetes or babies over 4 kg  Clinical Manifestations “Three Ps” – Polyuria (increased urination) – Polydipsia (increased thirst) – Polyphagia (increased appetite) Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, recurrent infections. Type 1 may have sudden weight loss or nausea, vomiting or abdominal pains, if DKA has developed.  Diagnostic Findings Fasting blood glucose 126 mg/dL or more. Random glucose exceeding 200 mg/dL. Gerontologic considerations: age-related elevation of blood glucose, symptoms may be absent or nonspecific, Glucose Tolerance Test (GTT) more effective in DX than urine testing for glucose (less 140mg/dl). Physical Examination: BP, BMI, funduscopic examination, foot & skin examination, neurologic examination.  Medical Management The main goal is to normalize insulin activity & blood glucose levels to reduce the development of vascular, retinopathy, nephropathy, and neuropathy complications Treatment Goal: Maintain Normal Blood Glucose Levels (Hgb A1c