Diabetes Mellitus PDF

11/20/23, 5:31 PM Realizeit for Student Summary Diabetes Mellitus is the Latin name for diabetes. Type 1 diabetes occurs when the body cannot produce insulin which is needed to control blood glucose levels. Type 2 diabetes, which is much more common, occurs when the body cannot produce enough insu...

11/20/23, 5:31 PM Realizeit for Student Summary Diabetes Mellitus is the Latin name for diabetes. Type 1 diabetes occurs when the body cannot produce insulin which is needed to control blood glucose levels. Type 2 diabetes, which is much more common, occurs when the body cannot produce enough insulin or the insulin is not working efficiently enough. The signs and symptoms of both types of diabetes include increased urine output and decreased appetite as well as fatigue. Diabetes is diagnosed by blood glucose testing, the glucose tolerance test, and testing of the level of glycosylated hemoglobin (hemoglobin A1C). The mode of treatment depends on the type of the diabetes. The major complications of diabetes include dangerously elevated blood sugar (hyperglycemia), abnormally low blood sugar (hypoglycemia) due to diabetes medications, and disease of the blood vessels, which can damage the eyes, kidneys, nerves, and heart. The nurse needs to understand the process of insulin utilization within the body and how the deficits can affect a patient. Knowing the types of treatments, insulins (including onset and peak times), how to mix and administer, and how to assess a blood glucose level will ensure the patient receives high quality care. Type 1, insulin dependent diabetes, accounts for approximately 10% of diabetes cases. In Type 1, the body does not produce insulin. Type 1 diabetes is usually diagnosed during childhood or young adulthood, which is why it is referred to as juvenile diabetes. This disease has a sudden onset with symptoms such as polydipsia, polyphagia, polyuria, weight loss, and fatigue. Type 1 diabetes tends to be unstable and is very sensitive to exogenous insulin and physical activity. Symptoms are caused by hyperglycemia and a breakdown of body fats. In order for proper metabolism of carbohydrates, fats, and proteins to take place, insulin must be present. If insulin is not present, multiple changes in the products of metabolism will occur. Hypoglycemia: The most frequent cause of hypoglycemia in the diabetic patient is self-administration of insulin. This could be a result of an improper insulin regimen, dietary omission, or excessive physical activity. Regardless of its cause, the symptoms of hypoglycemia are the same. In mild hypoglycemia, the patient experiences the following: Perspiration https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 1/5 11/20/23, 5:31p PM Realizeit for Student Tremors Blurred vision Impaired mental function Hunger Weakness Type 1 Diabetes– Insulin Dependent Diabetes A regimen of insulin injections, diet, exercise, and monitoring of blood glucose levels is used in treating Type I diabetes. The diabetic must learn to balance insulin, food and exercise. Successful treatment of diabetes mellitus requires a combined effort by the following: The physician having a complete understanding of the particular problems in each case The nurse educator, and how well the patient has been instructed The patient's conscientious following of instructions Diabetics can lead a relatively normal life if they are well informed concerning their disease and how it should be managed. Treatment Goals for Type I Diabetes Nursing Implications: Insulin injections are necessary for Type I, since the body is unable to produce insulin to transport glucose into the cells. Diet for the diabetic is well balanced, and controls the types and amounts of food eaten. Exercise improves muscle tone, strength, and the feeling of well-being, while reducing insulin requirements. Monitoring blood glucose is essential in order to design a diabetic care program and maintain good control. Complication - Diabetic Ketoacidosis (DKA): As insulin deficiency persists, hyperglycemia and glucosuria intensifies as ketonemia develops. Symptoms continue to progress to dehydration, resulting in low blood volume, increased pulse rate, and dry flushed skin. The plasma pH begins to drop as acetone and ketones breakdown. When the plasma pH level reaches 7.2, the respiratory center is stimulated, and the patient's breathing becomes shallow and rapid (Kussmaul’s respiration) with a fruity odor. This is the body's way of trying to prevent a further decline in pH. A continued decline in pH with progression of symptoms including stomach pains, vomiting, and decreased level of consciousness, results in diabetic ketoacidosis coma (DKA) and death. Factors in development of DKA are the following: Failure to take insulin Insufficient amount of insulin taken Infection Nausea/ vomiting with omission of insulin since food is not eaten https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 2/5 11/20/23, 5:31 PM Realizeit for Student Resistance to endogenous insulin produced by the body Type 2 Diabetes - Non-Insulin Dependent Diabetes Mellitus Approximately 85% to 90% of all diabetics have Type 2 diabetes, or non-insulin dependent diabetes. Type 2 diabetics are usually over 40 and usually overweight. Type 2 diabetes often goes undetected for long periods of time, since symptoms are usually not pronounced. Insulin is produced, but it is not enough, or it does not work properly to transport glucose through the receptor cells. Type 2 diabetics can often be controlled with a carefully planned diet, an exercise program, oral medication, or insulin, used as necessary. Uncontrolled Type 2 diabetes results in hyperglycemia. Some of the following symptoms that may be experienced include polydipsia, polyuria, increased fatigue, blurred vision, slow-healing cuts or sores, dry, itchy skin, numbness and tingling feet. Left uncontrolled for a long period of time, Type 2 diabetics develop more serious symptoms such as severe hyperglycemia, dehydration, confusion, and shock. This is called "hyperglycemic hyperosmolar non-ketotic coma." These symptoms are most common in the elderly population and people suffering from illness or infection. Treatment Goals for Type 2 Diabetes Nursing Implications: Diet control helps regulate weight, which is extremely important in Type 2 diabetes. Eating healthy foods and following a diet program if overweight is essential and should be stressed in diabetic teaching. Exercise burns calories, which helps control weight. It also stimulates insulin function to allow the body's production of insulin to work more efficiently. Oral hypoglycemic agents stimulate the beta cells in the pancreas to produce more insulin and help the insulin work more effectively. Monitoring blood glucose is essential for all diabetics. Type 2 diabetes is treated with oral antidiabetic drugs and, where required, insulin. Oral and adjunctive antidiabetic drug groups include sulfonylureas (glyburide), alpha-glucosidase inhibitors [acarbose], biguanides[metformin], thiazolidinediones [rosiglitazone maleate [Avandia)], meglitinides[repaglinide], dipeptidyl peptidase 4 inhibitors [DDP-4] [sitagliptin], amylin analogs [pramlintide acetate], incretin mimetics [exenatide], sodium glucose cotransporter 2 (SGLT2) inhibitors [canagliflozin]; as well as combination therapy; angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], and HMG-CoA reductase inhibitors. Biguanide, such as metformin, work by decreasing glucose production by the liver and increase tissue response to insulin. Metformin, the first line drug to treat type 2 diabetes, does not cause significant hypoglycemia; however, it may cause GI distress including decrease in appetite, nausea, and https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 3/5 11/20/23, 5:31 PM Realizeit for Student diarrhea. Sulfonylureas, which include glipizide and glyburide, and meglitinides promote insulin secretion by the pancreas and can increase tissue response to insulin. Thiazolidinediones, such as pioglitazone, decrease insulin resistance which increases glucose uptake. Alpha-glucosidase inhibitors, which is acarbose, delay carbohydrate digestions and absorption in the GI tract, which then decreases postprandial rise in blood glucose. Because acarbose inhibits the absorption of carbohydrates, oral sucrose cannot be used to treat hypoglycemia; the patient will require oral glucose. Types of Insulin: Insulin is beef, pork, beef and pork, or human. This refers to the species of the insulin, which can be found on the label of the bottle. Manufactured insulins in the United States are produced using recombinant DNA. The important implication to administering insulin is to understand the onset, peak, and duration of the insulin. Dosing for insulin is based on the patient’s blood glucose before meals or a preset dose of injections twice a day. Human insulin accounts for more than 60% of all insulin used today. Insulin Lispro has the trade name Humalog. This insulin is man-made and similar to naturally occurring human insulin. The onset is rapid, and it has a shorter duration of action than human regular insulin. Humalog should be taken within 15 minutes of eating and is used in combination with longer-acting insulin. Humalog rapid acting insulin, such as insulin lispro, has an onset of 15-30 minutes, peak of 0.5-2.5 hours, and a duration of 3-6 hours. Short duration, regular insulin, which is also a natural insulin, has an onset of 30-60 minutes, peaks in 1-5 hours, and has a duration of 6-10 hours. Rapid acting insulins can be administered right before eating, where regular, the short duration is administered 30 minutes before meals. Regular insulin is fast acting and lasts a short time in the body. It is used in emergencies for treatment of ketoacidosis. It is used before meals to control the post meal rise in blood sugar and to lower blood sugar quickly when an immediate reaction is needed. Semi-Lente insulin is short acting, but twice as long as regular insulin. It can be used to control post-meal rises in blood sugar and may be used with Lente insulin. NPH insulin provides a basal amount of insulin. Two injections per day are usually ordered. All insulins are colorless except for NPH, the intermediate acting insulin, which is a suspension and requires gently mixing before use. Ultra-Lente insulin provides the steadiest basal amount of insulin. One injection a day is used in combination with Regular insulin before meals. 70/30 insulin (human) is a mixture of 70% NPH and 30% Regular insulin. Two injections per day are usually ordered. Insulin glargine is a long-acting insulin that has an onset of 70 minutes, no peak and lasts up to 24 hours. All insulins are administered subcutaneously. Regular insulin may also be administered IV. Insulins are packaged in vials or in cartridge syringe pens. Insulin from vial is drawn up using a designated insulin syringe, which are measured in units. Insulin cartridge pens have a dial, which when turned, will prefill the syringe with the number of prescribed units of insulin that needs to be injected. Never put a patient’s insulin pen in the sharps container unless the syringe is empty and you have been instructed by your instructor. The dosage of insulin must be individualized according to the blood glucose levels. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 4/5 11/20/23, 5:31 PM Realizeit for Student The goal of insulin administration is to alleviate the symptoms of hyperglycemia and reestablish metabolic balance without hypoglycemia. Some patients use portable insulin pumps, where the patient is attached to an insulin delivery device that allows for a continued amount of insulin or a programmed dose of insulin to administer through a catheter inserted under the skin. The goal of the patient taking insulin is to maintain blood glucose levels within normal range. The normal hemoglobin A1C level is under 7%. Patients are taught how to measure their blood glucose levels. The goal of insulin therapy is to decrease the blood glucose by increasing the uptake of glucose into cells. However, hypoglycemia, which is too low blood glucose, is an adverse side effect of insulin. Self-monitoring of blood glucose is an important tool for achieving glycemic control. It is necessary to individualize the frequency of self-monitoring of blood glucose based on type of diabetes, glucose goals, and other factors. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 5/5