Diabetes Mellitus

1
Diabetes Mellitus

• Dr. Belle Erickson
• With thanks to
• Karen McKenna, MSN, RN

2
PANCREAS - An Endocrine Gland

• Islets of Langerhans
• Beta Cells
• INSULIN
• Alpha Cells
• GLUCAGON

3
INSULIN

• Lowers blood sugar by
• Transporting glucose into cell
• Receptor sites
• Converting glucose to glycogen for storage in
  muscle and liver tissue(glycogenesis)
• Converting excess glucose into fat cells, forming
  lipids from fatty acids (lipogenesis) and
  promoting storage in adipose tissue

4
GLUCAGON

• Known as Hyperglycemic agent
• Promotes activities that raise blood sugar- - -
• Converting of stored glycogen to glucose
  (Glycogenolysis)
• Formation of glucose from protein and fat sources
  (Gluconeogenesis)

5
Hormones affecting CHO metabolism

• ACTH (Adrenocorticotropic hormone) and
  Glucocorticoids
• enhances gluconeogenesis
• Epinephrine
• enhances glycogenolysis

6
Vocabulary

• Glucose
• Glucagon
• Glycogen
• Glycogenesis
• Gluconeogenesis
• Glycogenolysis
• Lipogenesis
• Glycolysis

7
Carbohydrate Metabolism

• Active transport of glucose into cells
  metabolism of glucose with release of energy
• Storage of glucose
• Conversion of glycogen back to glucose
• Conversion of proteins to glucose

8
CHO (not enough)

• Decreased blood sugar depleted glycogen stores
• Unable to use available glucose

9
Body needs energy source

• Catabolism of fats and proteins
• Where?
• Ketones

10
Diabetes Mellitus

• Chronic disorder characterized by hyperglycemia
• Imbalance between Insulin supply demand
• Abnormal metabolism of fat, carbohydrate,
  protein

11
Types of DM

• Type 1 (IDDM) 10 - 15 of all Diabetics
• Type 2 85 - 90- of all cases
• Secondary
• Gestational
• (High Risk) Impaired Glucose Tolerance

12
Type l (Type I)IDDM Insulin Dependent
Diabetes MellitusJuvenile Diabetes

• Body produces NO INSULIN
• Must take at least one injection of insulin per
  day to control blood sugar
• Usually occurs before 30 years old
• Body weight thin or ideal
• Onset abrupt

Know This Stuff
13
TYPE 2Type IIAdult/Maturity OnsetNIDDM Non
Insulin Dependent Diabetes Mellitus
Know This Stuff

• Body does not produce enough insulin
• and/or
• Body cannot use the insulin it has made

14
TYPE 2 Type IIAdult/Maturity OnsetNIDDM Non
Insulin Dependent Diabetes Mellitus
Know This Stuff

• May control blood sugar with diet and exercise
  alone (but may take oral meds. or insulin)
• Clients usually gt 35/40 years old
• Clients usually overweight/obese
• 1/2 go undiagnosed for years by then
  complications can be underway

15
(No Transcript)
16
RISK FACTORS

• _____Type______
• 1 2
• 1 caucasions 2
• 2
• 2
• ? 2
• 1
• 2
• 1 2
• 1

• Heredity
• Race
• Increased Age
• Obesity
• Stress
• Viruses
• Diet
• Auto-immune
• Environment

African,Hispanic, Asian, Native Americans
17
DM - Pathophysiology

• Lack of Insulin
• ? Glucose
• Where?
• ECF
• Fat Protein breakdown
• Ketosis Negative Nitrogen balance
• Hyperglycemia - - - WHY?

18
Pathophysiology (contd)

• Intracellular fluid deficit
• Glycosuria
• ECF deficit
• Signs of DM

19
Four Cardinal Symptoms

• Polyuria
• Polydypsia
• Polyphagia
• Weight Loss

20
WARNING SIGNS -TYPE 1usually occur suddenly

• 3 polys weight loss
• irritability
• weakness and fatigue
• nausea and vomiting

21
WARNING SIGNS -TYPE 2 usually occur less
suddenly may be very mild

• any of the Type 1 signs
• recurring or hard-to-heal skin, gum or bladder
  infections
• drowsiness
• blurred vision
• tingling or numbness in hands or feet
• itching

22
(No Transcript)
23
Assessment - Lab Studies

• FBS
• Postprandial glucose
• Glycosylated Hgb (Hb A1c)
• normal value is 3-8
• (Oral Glucose Tolerance Test OGTT)
• (Fractionals)

24
Control

• Normal FBS
• B.S. ? 180mg 2hrs. after a meal
• Glycosylated Hgb 10 or less
• Normal weight and general good health

25
Diabetes Management

• Diet management
• Physical Activity
• Medications

26
Recommended Nutrient Intake

• PROTEIN 10 -20 of total energy intake
• FAT lt 30 (Depends on lipid glucose
  levels)
• CARBOHYDRATE 40-60 of total intake (Based on
  glucose lipid levels and clients
  habits)
• NCS
• FIBER 20-35 grams
• Fiber slows/moderates blood absorption of
  carb/glucose

27
6 MAJOR EXCHANGE LISTS

• MILK Non-Fat, Low Fat
• VEGETABLE All Non-Starchy Vegetables
• FRUIT All Fruits Fruit Juices
• BRE AD Bread, Cereal, Pasta,
• Starchy Vegetables
• Prepared Foods
• MEAT Lean Meat, Medium
• High Fat Other
• Protein Rich Food
• FATS Polyunsaturated, Saturated
  and Non Saturated

28
Medications

• Type 1
• Insulin
• Administered SQ or IV NOT ORALLY
• NOT IN TUBE FEEDINGS
• Type 2
• Oral Hypoglycemic Agents
• Insulin

29
Insulin

• Types of insulin
• Duration of action
• Short - Intermediate - Long
• Action
• Onset - Peak - Duration

30
Insulin - (contd)

• Concentration
• Expressed in Units
• U100
• Insulin Order
• NPH Humulin (U100) 32U SQ daily before dinner

31
Types of Humulin Insulin and Comparative Actions
32
Sliding Scale Insulin

• Measure BG at -7am -11am - 4pm - 9pm
• Give Humulin Regular Insulin
• BG Value Dosage
• 150-200 0 units
• 201-250 2 units
• 251-300 4 units
• 301-350 6 units
• 351-400 8 units
• over 400 call MD
• under 50 give 6oz OJ
• repeat BS

33
Insulin

• Dosage
• Individual requirements
• Individual response

34
Insulin Administration

• Check Order
• Gather equipment
• Insulin - Precipitate

35
Administration - contd

• Combining Insulins
• 30U of NPH 6U of Regular
• Drawing up
• Injecting
• NO aspiration - 900 angle not 450

36
Special Things About Regular Insulin

• Only one to give IV
• Only one to give in Emergencies
• Only one to give for coverage
• Given via Insulin Pump (or Humalog)

37
(No Transcript)
38
Teaching

• Pathophysiology
• Diet
• Exercise
• Diabetes Mellitus ID
• Sexuality
• Community Resources
• Stress Management
• Health Care

39
Teaching

• Home management
• Insulin
• administration
• storage
• travel
• exercise
• sick days

40
Insulin pumps

• Mimic release of pancreas
• electro - mechanical with computer chip
• Basal rate ()
• Sub-Q
• Complications

41
Oral Hypoglycemic Agents

• Sulfonylureas
• Insulin ?
• Functioning Beta Cells
• OOC on diet and exercise
• Action
• release insulin from beta cells
• enhance sensitivity of receptor sites
• Metformin - (Glucophage) guanidine derivative
  not a sulfonylureas

42
Physical Activity

• Exercise
• Lowers BS levels
• ? uptake of free fatty acids
• lower cholesterol triglycerides
• promote cardiac stabillity
• reduce stress ? sense of well-being