which cells are responsible for insulin?

beta cells

exogenous insulin

• insulin made outside of the body
• provided by injections

endogenous insulin

• insulin produced inside the body
• body produces the insulin on its own

type 1 diabetes

• insulin dependent; IDDM; juvenile diabetes
• typically occurs before age 30
• autoimmune
• body depends on exogenous insulin
• complications- diabetic ketoacidiosis

type 2 diabetes

• non-insulin dependent; NIDDM; adult-onset diabetes
• typically occurs after age 30
• complications- hypersmolar nonketotic syndrome (HHNS)

gestational diabetes

only occurs with pregnancy

etiology & pathophysiology of diabetes mellitus

• genetic factors
• metabolic factors
• mircoiologic factors

metabolic syndrome

• hypertension
• hyperglycemia
• excess abdominal fat
• elevated cholesterol and triglycerides

diabetes mellitus S/S

• elevated blood glucose levels
• fatigue/weakness
• weight loss (type 1) or weight gain (type2)
• prone to infection
• delayed healing
• vascular issues
• polyuria
• polyphagia

diagnosis for diabetes

• screening (A&P)
• hemoglobin a1c
• fasting serum glucose
• 2 hour 75-G oral glucose tolerance test (GTT)

hemoglobin a1c

-measurement (in percentage) of blood sugar over a 3 month/ 120 day period

• normal - less than 5.7
• pre diabetic- 5.7%-6.4%
• diabetes- 6.5% and above

normal glucose range

70-100

diabetic ketoacidosis (DKA)

caused by incomplete metabolism of fats from absent or insufficient supply of insulin

• body will break down proteins and fats for energy when there is not enough insulin
• the byproducts of fat metabolism are ketones
• ketones accumulate in the body creating an acidotic state

causes of DKA

• infection
• poor compliance
• insulin pump failure

ketonuria

body will attempt to rid the body of acidosis by urinating ketones out

kussmauls respirations &fruity breath

body will increase respiratory rate in an attempt to release ketone bodies from the lungs

polyuria

kidneys exercise excess glucose and ketones as well as large qualities if water and electrolytes

DKA ketones are acidic and begin to accumulate in the blood and produce signs and symptoms

• ketonuria
• kussmauls respirations and fruity breath
• polyuria
• polydipsia
• nausea/vomiting

DKA treatment and management

• establish IV site, preferably two sites
• IV fluids
• NS,LR
• IV insulin drip (regular insulin only)
• continuous cardiac monitoring
• treat nausea/vomiting
• closely monitor blood glucose levels and BMP

factors associated with the development of DM type 2

• older age
• obesity
• family history of DM2
• history of gestational diabetes
• physical inactivity
• metabolic syndrome
• HTTN
• abdominal fat
• elevated cholesterol and triglycerides

signs and symptoms of type 2 diabetes

• excess weight gain
• fatigue
• polydipsia, polyuria, polyphagia
• blurred vision
• itching
• tingling/numbness in feet

(HHNS) hyperglycemic hyperosmolar nonketotic syndrome

aka: hyperglycemia hyperosmolar state

occurs in clients with type 2 diabetes with high blood glucose levels due to illness, infection, stress

-glucose levels greater than 600 mg/dl are typical but can reach over 1000 mg/dl

(HHNS) hyperglycemic hyperosmolar nonkektoic syndrome treatment and management

• focused on IV fluids replacement and correction of electrolyte imbalances
• monitor lung sounds
• monitor for edema
• continuous cardiac monitoring
• accurate I&O
• treat underlying cause

gestational diabetes can occur due to what?

stress of pregnancy

- may be treated with diet, oral medications, or insulin (based on patient )

there is a chance the mother can be diagnosed with type 2 diabetes In the years following delivery, as can the baby.

(t/f)

true

short term complications of diabetes

• hypoglycemia
• hyperglycemia
• somogyl effect (rebound hyperglycemia)
• dawn phenomenon

hypoglycemia

decreases in blood sugar

• <70 considered hypoglycemia
• clients/ family members to be educated on S/S of hypoglycemia and how to treat it

causes of hypoglycemia

• often a response to too much insulin or too much exercise in relation to the amount of food eaten
• overdose of insulin
• skipped or delayed meals
• strenuous exercise
• tumors of pancreas
• alcohol abuse

hypoglycemia s/s

• shaky
• tremors
• tachycardia
• diaphoresis
• weakness
• confusion
• nervousnesss
• cool,clamy skin
• headache

hyopglycemia management

• modify eating patterns
• smaller, more frequent meals
• avoid simple sugars
• diet high in proteins and low in carbohydrates
• carbs should eb complex
• carry snacks

hyperglycemia

elevation of blood sugar levels

causes of hyperglycemia

• failure to take insulin
• illness or infection
• overeating
• too many carbohydrates or simple carbs
• severe stress
• surgery, trauma, emotional

s/s of hyperglycemia

• polydipsia
• polyuria
• polyphagia
• dry mucous membranes
• weakness

treatment for hyperglycemia

• IV fluids
• corrections of electrolyte imbalances
• insulin (sub-q and iv)

Dawn phenomenon

elevated blood glucose levels in the morning

-caused by a release of growth hormone, glucagon, and epinephrine during the night

some long term diabetic complications

• cardiovascular disease
• peripheral vascular disease
• nephropathy
• retinopathy
• diabetic neuropathy

retinopathy

changes in retina vessels lead to hemorrhage and retinal detachment

-visual impairment and blindness can occur

nephropathy

develops from changes in renal blood circulation