Chp.41 Diabetes Type 1 and 2

Focus onDiabetes Mellitus : 

Focus onDiabetes Mellitus ~Chapter 41~ Medical-Surgical Nursing 1

Functions of Insulin : 

Functions of Insulin 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 the storage of dietary fat in adipose tissue Accelerates transport of amino acids into cells Inhibits the breakdown of stored glucose, protein, and fat

Definition of Diabetes : 

Definition of Diabetes A chronic multisystem disease related to Abnormal insulin production Impaired insulin utilization Or both 3

Long-term Complications : 

Long-term Complications Leading cause of End-stage renal disease Adult blindness Nontraumatic lower limb amputations Major contributing factor Heart disease Stroke 4

Diabetes Mellitus : 

Diabetes Mellitus Two most common types Type 1 Type 2 Other types Gestational Prediabetes Secondary diabetes 5

Risk Factors : 

Risk Factors Type 1: not inherited but a genetic predisposition combined with immunologic and possibly environmental (viral) factors Type 2: family history of diabetes, obesity, race/ ethnicity, age greater than 45 years, previously identified impaired fasting glucose or impaired glucose tolerance, hypertension ≥140/90, HDL ≤35, and/or triglycerides ≥250, history of gestational diabetes, and babies over 9 pounds See Chart 41-1

Type 1 Diabetes : 

Type 1 Diabetes Formerly known as “juvenile diabetes” Requires insulin, as little or no insulin is produced Onset is acute and usually occurs before age 30 5% to 10% of persons with diabetes

Type 1 Diabetes Mellitus : 

Type 1 Diabetes Mellitus Long preclinical period Antibodies present for months to years before symptoms occur Manifestations develop when pancreas can no longer produce insulin Rapid onset of symptoms Present at ER with ketoacidosis 8

Type 1 Clinical Manifestations : 

Type 1 Clinical Manifestations Classic symptoms-The 3 P’s Polydipsia Polyuria Polyphagia History of recent, sudden, weight loss Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections Will require exogenous insulin to sustain life 9

Type 2 Diabetes : 

Type 2 Diabetes Insulin produced is either insufficient or poorly utilized by tissues Most prevalent type of diabetes Usually occurs in people over the age of 30 Obesity (abdominal/visceral) Most powerful risk factor Slow, progressive glucose intolerance Treated initially with diet and exercise Oral hypoglycemic agents and insulin may be used

Type 2 Diabetes Mellitus : 

Type 2 Diabetes Mellitus Gradual onset Person may go many years with undetected hyperglycemia Osmotic fluid/electrolyte loss from hyperglycemia may become severe Hyperosmolar coma 11

Type 2-Clinical Manifestations : 

Type 2-Clinical Manifestations Nonspecific symptoms May have classic symptoms of type 1 Fatigue Recurrent infections Recurrent vaginal yeast or monilia infections Prolonged wound healing Visual changes 12

Differentiating Type 1 and Type 2 Diabetes : 

Differentiating Type 1 and Type 2 Diabetes Age Body weight Glutamic acid decarboxylase antibodies and pancreatic islet cell antibodies Positive in 85%-90% of Type 1 diabetics C-peptide levels 13

Prediabetes : 

Prediabetes Known as impaired glucose tolerance or impaired fasting glucose At greater risk for developing diabetes Periodic blood glucose screening after 40 if there is a familial history or is symptomatic Known as “borderline” diabetic 14

Secondary Diabetes : 

Secondary Diabetes Results from: Another medical condition Cushing syndrome, Pancreatitis, Hyperthyroidism Treatment for a medical condition that may increase blood glucose level Corticosteriods, Thiazides, Dilantin, Clozapine Usually resolved when underlying condition is treated 15

Diabetes Mellitus : 

Diabetes Mellitus Three methods of diagnosis Fasting plasma glucose level >126 mg/dl Random or casual plasma glucose measurement ≥ 200 mg/dl plus symptoms Two-hour OGTT level ≥ 200 mg/dl using a glucose load of 75 g 16

Diabetes Mellitus : 

Diabetes Mellitus Hemoglobin A1C test Useful in determining glycemic levels over time Not diagnostic but monitors success of treatment Shows the amount of glucose attached to hemoglobin molecules over RBC life span 90 to 120 days Ideal goal is ≤ 7 % Normal A1C reduces the risk of long term diabetic complications 17