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Diabetes Mellitus I & II

Diabetes Mellitus I & II. What is diabetes?. Normal Blood Glucose: 80-120 mg/ dL What are the 3 key symptoms of diabetes? When the body does not produce or properly utilize insulin What does insulin do? 2 kinds Type 1 – Insulin dependent Type 2 – Non - insulin dependent

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Diabetes Mellitus I & II

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  1. Diabetes Mellitus I & II

  2. What is diabetes? • Normal Blood Glucose: 80-120 mg/dL • What are the 3 key symptoms of diabetes? • When the body does not produce or properly utilize insulin • What does insulin do? • 2 kinds • Type 1 – Insulin dependent • Type 2 – Non - insulin dependent • Gestational diabetes mellitus (GDM)

  3. What does insulin do? • Transports & metabolizes glucose • Stimulates the liver & muscle to convert glucose into glycogen • Enhances storage of fat in adipose tissue • Accelerates transport of amino acids into cell

  4. Type 1 Diabetes • Classified as requiring insulin injections to control blood sugar levels • Acute onset before the age of 30 • Approximately 5 – 10% population due to autoimmune destruction of the insulin – producing pancreatic beta cells • Usually genetic (most common), immunological or environmental (ie virus, etc) • Genetic is that the patients carry HLA (human leukocyte antigen) • Patients are usually thin when diagnosed

  5. When the blood glucose level exceeds 180 – 200; glucosuria occurs • Insulin also prevent glycogenolysis & glucogenesis • Without it, fat is broken for energy producing ketones • S & S • Wasting away of muscle and/or subcutaneous fat • Polydipsia • Polyphagia • Polyuria • N & V • Joint pain

  6. DKA • Diabetic KetoAcidosis • The level of ketones are so high in the blood that it disrupts the acid- base balance • S & S • Abdominal pain • N & V • Hyperventilation • Fruity odor of the breath • Altered level of consciousness • coma • Treatment – lower blood sugar levels with insulin; acid – base balance

  7. Hypoglycemia • Too low of glucose in the blood • May result of too much insulin by the body or given in the treatment of DM

  8. Type 2 • Approximately 90 – 95% of diabetes patients • Results from a decreased sensitivity to insulin (insulin resistance) or decrease in production • First line of treatment – Diet & exercise • Most common in individuals over 30 or obese • Ketosis does not occur due to the presence of insulin (just not enough to lower blood sugar levels)

  9. S & S • Fatigue • Irritability • Polyuria • Polydipsia • Poor wound healing • Vaginal infections • Blurred vision

  10. Treatment • Weight loss • Exercise (enhances the effectiveness of insulin) • Oral anti-diabetic meds

  11. Gestational Diabetes • Occurs during pregnancy • Hyperglycemia is a result of placental hormones that are secreted • Screening between the 24 – 28 weeks gestation • Initial management – diet changes (usually ADA) • Usually resolves after delivery

  12. Testing for DM • Random glucose level equal to or above 200 mg/dL • Fasting blood sugar level equal to or greater than 126 mg/dL • Blood glucose level at or above 200 on the 2nd hour of a glucose tolerance test • Urinalysis showing acetone in the urine

  13. Screening guidelines • Adults over the age of 45 should be screened every 3 years • Fasting glucose level greater or equal to 126 mg/dL on at least 2 occurrences • Patients at high risk should be tested more frequently. Patient groups such as: • Native Americans • African Americans • Asian • Hispanics • Anyone overweight • HTN • Strong family history of DM

  14. Diagnosing DM • Symptoms present • Random blood sugar readings at 200 mg/dL or greater • Fasting plasma glucose level equal or greater 126 mg/dL • Glucose tolerance test: 2nd hour reading of 200 or higher • Others: • Urinalysis for acetone • Ophthalmologic exam showing diabetic retinopathy

  15. Treatments • Diet & Weight Control • Provide needed nutrients • Achieve reasonable weight • Meet energy needs • Prevent wide fluctuating blood glucose levels • Decrease cholesterol • American Diabetes Association Diet Plan • Exercise • Increases the uptake of insulin & promotes sugar to be utilized by the muscles • Increases HDL’s & lowers LDL’s • Should not exercise if blood sugar is above 250 (spilling ketones)

  16. Foods recommended by the ADA • Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. • Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals. • Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. • Include dried beans (like kidney or pinto beans) and lentils into your meals. • Include fish in your meals 2-3 times a week. • Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey. • Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese. • Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. • Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats. • Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream. • Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

  17. Self glucose Monitoring • Allows patients to know their blood glucose levels at any point & time; adjust treatment as necessary • Education of patients is key to accurate readings • Patients usually check their blood sugars on a schedule (2 – 4 times a day); usually prior to meals & at bedtime

  18. Medication Management • Insulin therapy • Rapid acting - Humalog • Short acting - Regular • Intermediate acting - NPH • Long acting – Lente or Ultralente • Insulin is usually kept refrigerated • Injection dosage is determined by the blood glucose level • Usually based on a scale

  19. Example of a Sliding scale • 0-60 Initiate Hypoglycemic Protocol (see below) • 61-150 1No Insulin • 151-200 13 units SQ • 201-250 15 units SQ • 251-300 18 units SQ • 301-350 10 units SQ • 351-400 12 units SQ • >400 15 units SQ and call MD

  20. Insulin Pen • Looks like a pen with 150 – 300 units in a pre-filled syringe • Disposable needle is attached at the end for injections • All insulin is Injected SQ • What are the locations for injecting SQ?

  21. Insulin Pump • Continuous infusion of insulin into the subcutaneous tissue • 3 ml syringe attached to tubing with a needle under the skin (needle is changed q 3 days) • Usually contains Regular insulin • Usually rate is .5 – 2 units /hour • Prior to meals, the patient pushes a button to deliver a bolus

  22. Oral Medications • Glucophage (metformin) • Category: biguanides • Usually used in insulin resistance Type 2 • Must have insulin present in blood to work • Complication: Lactic Acidosis • Other uses: aids in treatment of Polycystic Ovary Disease

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