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Diabetes Mellitus

Diabetes Mellitus. Dr Ibrahim Bashaireh, RN, PhD. Diabetes Mellitus Definition. A multisystem disease related to: Chronic disorder Abnormal metabolism of fuels glucose and fat An endocrine disorder causes Abnormal insulin production Impaired insulin utilization

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Diabetes Mellitus

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  1. Diabetes Mellitus Dr Ibrahim Bashaireh, RN, PhD

  2. Diabetes MellitusDefinition • A multisystem disease related to: • Chronic disorder • Abnormal metabolism of fuels glucose and fat • An endocrine disorder causesAbnormal insulin production • Impaired insulin utilization • Both abnormal production and impaired utilization

  3. Diabetes MellitusDefinition • Leading cause of heart disease, stroke, adult blindness, and nontraumatic lower limb amputations

  4. Diabetes MellitusEtiology and Pathophysiology • Normal insulin metabolism • Produced by the  cells in the islets of Langherans of the pancreas • Facilitates normal glucose range of 70 to 120 mg/dl

  5. Insulin Secretion Fig. 47-1

  6. Diabetes MellitusEtiology and Pathophysiology • Normal insulin metabolism • Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell

  7. Diabetes MellitusEtiology and Pathophysiology • Normal insulin metabolism •  Insulin after a meal: • Stimulates storage of glucose as glycogen • Inhibits gluconeogenesis

  8. Diabetes MellitusEtiology and Pathophysiology • Normal insulin metabolism •  Insulin after a meal: • Enhances fat deposition in adipose tissue • Increases protein synthesis

  9. Type 1 Diabetes Mellitus • Formerly known as “juvenile onset” or “insulin dependent” diabetes • Most often occurs in people under 30 years of age • Peak onset between ages 11 and 13

  10. Type 1 Diabetes MellitusEtiology and Pathophysiology • Progressive destruction of pancreatic  cells • Autoantibodies cause a reduction of 80% to 90% of normal  cell function before manifestations occur

  11. Type 1 Diabetes MellitusEtiology and Pathophysiology • Causes: • Genetic predisposition • Related to human leukocyte antigens (HLAs) • Exposure to a virus

  12. Type 1 Diabetes MellitusOnset of Disease • Manifestations develop when the pancreas can no longer produce insulin • Rapid onset of symptoms • Present at ER with ketoacidosis

  13. Type 1 Diabetes MellitusOnset of Disease • Weight loss • Polydipsia • Polyuria • Polyphagia

  14. Type 1 Diabetes MellitusOnset of Disease • Diabetic ketoacidosis (DKA) • Occurs in the absence of exogenous insulin • Life-threatening condition • Results in metabolic acidosis

  15. Type 2 Diabetes Mellitus • Accounts for 90% of patients with diabetes • Usually occurs in people over 40 years of age • 80-90% of patients are overweight

  16. Type 2 Diabetes MellitusEtiology and Pathophysiology • Pancreas continues to produce some endogenous insulin • Insulin produced is either insufficient or poorly utilized by the tissues

  17. Type 2 Diabetes MellitusEtiology and Pathophysiology • Insulin resistance • Body tissues do not respond to insulin • Results in hyperglycemia

  18. Type 2 Diabetes MellitusEtiology and Pathophysiology • Impaired glucose tolerance (IGT) • Occurs when the alteration in  cell function is mild • Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes

  19. Type 2 Diabetes MellitusEtiology and Pathophysiology • Inappropriate glucose production by the liver • Not considered a primary factor in the development of type 2 diabetes

  20. Type 2 Diabetes MellitusEtiology and Pathophysiology • Insulin resistance syndrome (syndrome X) • Cluster of abnormalities that act synergistically to  the risk of cardiovascular disease

  21. Type 2 Diabetes MellitusOnset of Disease • Gradual onset • Person may go many years with undetected hyperglycemia • Marked hyperglycemia (500 to 1000 mg/dl)

  22. Gestational Diabetes • Develops during pregnancy • Detected at 24 to 28 weeks of gestation •  Risk for cesarean delivery, perinatal death, and neonatal complications

  23. Secondary Diabetes • Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels • Cushing syndrome • Hyperthyroidism • Parenteral nutrition

  24. Clinical ManifestationsType 1 Diabetes Mellitus • Polyuria • Polydipsia (excessive thirst) • Polyphagia • Weight loss • Weakness and fatigue • Ketoacidosis

  25. Clinical ManifestationsType 2 Diabetes Mellitus • Non-specific symptoms • Fatigue • Recurrent infections • Prolonged wound healing • Visual changes

  26. Diabetes MellitusDiagnostic Studies • Fasting plasma glucose level 126 mg/dl • Random plasma glucose measurement 200 mg/dl plus symptoms • Two-hour OGTT level 200 mg/dl using a glucose load of 75 g

  27. Diabetes MellitusDiagnostic Studies • Impaired glucose tolerance (IGT) • Fasting blood glucose level 110 mg/dl but less than 126 mg/dl • Hemoglobin A1C test: • Measures blood levels over 2-3 months (per text) • High levels of glucose will attach to hemoglobin • Helps to ensure that the patient’s gluco-meter is accurate.

  28. Diabetes MellitusCollaborative Care • Goals of diabetes management: • Reduce symptoms • Promote well-being • Prevent acute complications • Delay onset and progression of long-term complications

  29. Diabetes MellitusCollaborative Care • Patient teaching • Nutritional therapy • Drug therapy • Exercise • Self-monitoring of blood glucose

  30. Diabetes MellitusDrug Therapy: Insulin • Exogenous insulin: • Required for type 1 diabetes • Prescribed for the patient with type 2 diabetes who cannot control blood glucose by other means

  31. Diabetes MellitusDrug Therapy: Insulin • Types of insulin • Human insulin • Most widely used type of insulin • Cost-effective •  Likelihood of allergic reaction

  32. Diabetes MellitusDrug Therapy: Insulin • Types of insulin • Insulins differ in regard to onset, peak action, and duration • Different types of insulin may be used for combination therapy

  33. Diabetes MellitusDrug Therapy: Insulin • Types of insulin • Rapid-acting: Lispro (onset 15’, peak 60-90’ and last from 2-4 hours) • Short-acting: Regular (Onset is 30-60’, peak in 2-3h and last for 4-6 hours, and Regular insulin is only kind for IV use.

  34. Diabetes MellitusDrug Therapy: Insulin • Intermediate-acting: NPH or Lente Onset 3-4h, peak 4-12 hours and lst 16-20 hours. Names include Humulin N, Novolin N, Humulin L, Novolin L • Long-acting: Ultralente, Lantus Onset 6-8h, peak 12-16 h and lasts 20-30h.

  35. Diabetes MellitusDrug Therapy: Insulin • Administration of insulin • Cannot be taken orally • SQ injection for self-administration • IV administration

  36. Insulin Strengths • Insulin Strengths • 100 U per mL or 500 U per mL • Administered in a sterile, single-use, disposable syringe • All insulin given parenterally • Regular insulin: either subcutaneous or intravenous

  37. Injection Sites • Process: pinch skin, inject needle at 90-degree angle • Do not inject into muscle; do not massage after injecting • Rotate injection sites • Minimize painful injections

  38. Injection Sites Fig. 47-5

  39. Diabetes MellitusDrug Therapy: Insulin • Problems with insulin therapy • Hypoglycemia • Allergic reactions • Lipodystrophy • Somogyi effect: The tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar. nocturnal hypoglycemia followed by rebound hyperglycemia-decrease evening dose of insulin

  40. Problems with Insulin Injections • Lipodystrophy: is a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue • Lipoatrophy: is the term describing the localized loss of fat tissue.

  41. Diabetes MellitusDrug Therapy: Oral Agents • Not insulin • Work to improve the mechanisms in which insulin and glucose are produced and used by the body

  42. Diabetes MellitusDrug Therapy: Oral Agents • Sulfonylureas: Glipizide, Glyburide and Glimepiride • Meglitinides: Prandin & Starlix • Biguanides: Metformin • -Glucosidase inhibitors: Acarbose. Delay absorption of CHO • Thiazolidinediones: Pioglitazone (Actos)

  43. Diabetes MellitusDrug Therapy: Oral Agents • Other drugs affecting blood glucose levels: • -Adrenergic blockers • Thiazide • Loop diuretics

  44. Diabetes MellitusNutritional Therapy • American Diabetes Association (ADA) • Guidelines indicate that within the context of an overall healthy eating plan, a person with diabetes can eat the same foods as a person who does not have diabetes

  45. Diabetes MellitusNutritional Therapy • American Diabetes Association (ADA) • Overall goal: • Assist people in making changes in nutrition and exercise habits that will lead to improved metabolic control

  46. Diabetes MellitusNutritional Therapy • Type 1 DM • Meal plan based on the individual’s usual food intake and is balanced with insulin and exercise patterns

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