Diabetes Mellitus Types 1 and 2
Define type 1 diabetes mellitus.
a metabolic disorder resulting from the body's inadequate insulin production.
Define type 2 diabetes mellitus.
A metabolic disorder resulting from the body's inability to have the cells respond to insulin that is present.
Type 1 DM is an autoimmune dysfunction involving the destruction of the ___________ cells which produce insulin in the _______ __ _________ in the pancreas.
Islets of Langerhans
Type 2 DM is a progressive condition due to increasing inability of cells tor respond to insulin. This is known as what?
What is a precursor to T2DM?
What is metabolic syndrome?
a collection of manifestations that predispose an individual to the development of DM
what factors contribute to metabolic syndrome?
elevated lipid/triglyceride levels
What races and gender does DM primarily affect?
More common in men that women
DM has a wide range of systemic effects. It can contribute to what other diseases?
peripheral vascular disease
Women who have _________ __________ syndrome or delivered infants weight over _____ pounds are at risk.
These two diseases can be a secondary cause of diabetes.
What two deficits can interfere when trying to educate a patient on their DM?
Hearing and vision
____________ deterioration secondary to aging can affect the clients ability to perform ADL's.
This problem can mean that there limited funds for buying diabetic supplies, wound care supplies or medications.
A fixed income
What are some risk factors for older clients?
inability to drive to HCP or to pick up medication
Altered metabolism due to medication due to decreased liver and kidney function
Vision alterations which can affect the ability to accurately read doses
Hyperglycemia generally occurs when BG levels are greater than ______.
What are the three "P"'s that you would expect to find in a patient with diabetes?
What causes polyuria in a DM patient?
Besides excessive thirst, what are some other things you would see with polydipsia?
loss of skin turgor
skin warm and dry
dry mucous membranes
rapid weak pulse
What causes ketosis in a diabetic client?
the body's use of protein and fat for energy
What causes metabolic acidosis in a DM patient?
Ketones accumulate in the blood due to the breakdown of fatty acids when insulin is not available.
When a patient is in metabolic acidosis, what kind of breathing can they have?
Kussmaul respirations - increase respiratory rate in an attempt to excrete carbon dioxide and acid
What are some signs and symptoms to let you know if a person has DM?
inability to concentrate
slow healing wounds
decreased levels of consciousness
seizures leading to a coma
Lab tests to confirm DM include tow findings on two separate days of at least one of these.
HGBA1C greater than 6.5%
2 hr Glucose greater than 200 mg/dL (oral)
Fasting BG of greater than 126
Manifestations of diabetes plus casual BG concentration greater than 200 mg/dL
For a fasting blood glucose test, what is the recommended fasting time?
8 hours prior to the test
what test is used to diagnose gestational diabetes?
Oral glucose tolerance test
How long should a pregnant lady fast before the glucose tolerance test?
10-12 hours prior to test
What education would you give a client who is going to take a fasting glucose tolerance test?
1. Consume a balanced diet for three days prior to test
2. Fast for 10-12 hours prior to test
3. Absolutely nothing besides water during the test
What are the expected ranges for a HGBA1C in a person who is NOT diabetic?
What are the expected HGBA1C ranges for a person who is diabetic and is controlling it?
6.5-8% with a target goal of less than 7%.
How far apart should HGBA1C's be drawn?
every 120 days
How often should a diabetic get their A1C checked?
quarterly or twice yearly depending on the glycemic levels
High ketones in the urine are associated with _______________ and is a medical emergency.
What is considered a high ketone level in the urine?
exceeding 300 mg/dL
Who uses insulin to treat their diabetes?
Type 1 and some type 2 diabetics
Who can use medications such as oral hypoglycemics to treat their DM?
Type 2 diabetics
What are the four kinds of insulin?
When do type 2 diabetics use insulin?
When glycemic control is not obtained through diet, exercise, and oral hypoglycemic agents.
Which kind of diabetic would wear and insulin pump?
How often should the needle on a insulin pump be changed to prevent infection?
every 2-3 days
What are some complications of an insulin pump?
accidental cessation of insulin
obstruction of tubing/needle
What is the range of units on an insulin pen?
what are the advantages of an insulin pen?
used if only one insulin is given at a time
convenient for travel
used for clients who have vision impairments or problems with dexterity
Will oral hypoglycemic agents alone help manage diabetes?
No, it must be used with diet and exercise
what are the three kinds of rapid acting insulin?
What is onset, peak, and duration for a rapid acting insulin?
Onset: <15 minutes
Peak: 1-2 hours
Duration: 3-4 hours
When should rapid acting insulin be administered?
Before meals to control the postprandial rise in BG.
You can administer rapid acting insulin with what other two kinds of insulin?
Intermediate or long lasting to provide glycemic control between meals and at night
Short acting insulin is also known as what?
What is onset, peak, and duration for short acting insulin?
Onset: 30 min -1 hour
Peak: 2-3 hours
Duration: 3-6 hours
when should Short acting insulin be taken?
30-60 minutes before a meal
Regular insulin is available in two concentrations. What are they and when are they used?
U-500: reserved for the client who is insulin resistant. NEVER USED IV.
U-100: for most clients and may be used IV.
What is another name for intermediate acting insulin?
When is intermediate acting insulin given?
between meals and at night
What is the onset, peak, and duration of intermediate insulin?
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-16 hours
What causes the delay in the action of the intermediate insulin?
Protamine cause the delay in the insulin absorption and extends the action of it
Short acting insulin can ONLY be administered with what?
Intermediate acting insulin
NPH or intermediate acting insulin can only be administered how?
Name the long acting insulins.
when should a long acting insulin be administered?
Once a day, at the same time each day
What is the MOA of glargine insulin?
forms microprecipitates that dissolve slowly over a 24 hour period and maintain steady blood sugar with no peaks or troughs.
What is the MOA of detemir insulin?
has an added fatty-acid chain that delays absorption. while it does not always have a peak, duration is dose dependent. 12-24 hours.
Where should detemir and glargine be administered?
Sub-Q only. NEVER IV.
What is the onset, peak, and duration of a long lasting insulin?
Detemir (Levimire): 3/4 - 2 hours
Glargine (Lantus): 2-4 hours
What client education should you give to a patient who is on insulin for DM?
Rotate site injections
Inject at 90 degree angle
When mixing a rapid or short acting insulin w a longer acting insulin, draw up the shorter acting insulin first
Eat at regular intervals
wear a medical identification wristband
What is biguanide and what is its MOA?
Reduces production of glucose by the liver
Increases tissue sensitivity to insulin
Slows carb absorption in intestines
What are the second generation sulfonylureas and their MOA?
Stimulates insulin release from pancreas to decrease BG
increases tissue sensitivity to insulin
What are meglitinides and their MOA?
Stimulates insulin release from pancreas
What is a thiazolidinediones and the MOA?
Reduces the production of glucose by the liver
increases tissue sensitivity to insulin
What is a alpha-glucosidasie inhibitor and its MOA?
Slow carb absorption in GI tract
Reduces post meal hypoglycemia
What are dipeptidyle peptidase and what is it MOA?
Promotes release of insulin and decreases secretion of glucagon
What is incretin mimetic and its MOA?
Mimics the function of intestinal incretin hormone by decreasing glucagon secretion and gastric emptying
what is amylin mimetic and what is its MOA?
A synthetic amylin hormone found in the beta cells of the pancreas. it suppresses glucagon secretions and controls postprandial BG levels
What is a sodium glucose cotransporter 2 inhibitor and what is its MOA?
blocks reabsorption in the kidneys
What education should you give for foot care in a diabetic patient?
Inspect feet daily and wash w/mild soap and warm water
Pat feet dry, especially between the toes
Use mild foot powder with sweating feet
Best time for nail care is after a bath or shower when nails are soft.
Avoid open toed/heeled shoes
Don't go barefoot
avoid prolong sitting/standing
What nutritional guidelines should a diabetic patient follow?
Consult a dietician
Plan meals to achieve appropriate timing of food intake
Count grams of carbohydrates consumed
Know that 15 g of carbs is equal to 1 carb exchange
Restrict calories and decrease physical activity
Include fiber and use artificial sweetners
What client education should you give concerning illnesses?
Monitor BG every 3-4 hrs when sick
Continue to take DM medications
Consume 4 oz of sugar free noncaffeinated liquid to prevent dehydration
Meet carb needs through soft foods 6-8 times per day
Test urine for ketones and report to provider if they are outside expected ranges
What is diabetic retinopathy?
impaired vision and blindness due to DM
what is diabetic neuropathy?
caused from damage to sensory nerve fibers resulting in numbness and pain
Diabetic neuropathy is progressive and can affect every aspect of the body and lead to ________ and ____________.