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DIABETES MELLITUS

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Diabetes- positive findings from any two of the following tests on different days: Symptoms of diabetes mellitus* plus casual (random) plasma glucose concentration ... – PowerPoint PPT presentation

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Title: DIABETES MELLITUS


1
DIABETES MELLITUS
  • Rachel S. Natividad RN, MSN, NP

2
Review AP
3
Physiology Role of Insulin
4
Physiology Cont Insulin
  • Basal (continuous)
  • Prandial (Bolus)

Blood glucose increases within 10 minutes the
beginning of a meal
5
Diabetes Mellitus
  • A disorder of carbohydrate, protein, and fat
    metabolism resulting from an imbalance between
    insulin availability and insulin need. (Porth,
    2002)
  • End Result HYPERGLYCEMIA

6
Classifications
  • Type 1 (no insulin)
  • Type 2 (some insulin insulin resistance)
  • Gestational Diabetes (pregnancy-related)
  • Secondary Diabetes (Cushings disease,
    pancreatitis, etc.)

7
Pathophysiology
8
Normal
9
Patho DM Type 1
No Insulin
10
Patho-Cont.DM Type 2
11
The big difference
12
Case Study
13
Clinical Manifestations
THE 3 POLYs
POLYDYPSIA
POLYURIA
POLYPHAGIA
13
14
Clinical ManifestationsCont Signs and Symptoms
  • Early signs
  • 3 Polys
  • Weight loss
  • Fatigue/Always tired
  • Visual Blurring
  • Late signs
  • Any of the 3 Polys
  • Infections
  • Numbness/ tingling of feet or leg pain
  • Slow healing wounds
  • Chronic Complications

15
Diagnostic Tests
  • Fasting Blood Glucose (FBG) 70-110 mg/dL
  • Random/Casual Blood Glucoselt200 mg/dL
  • Oral Glucose Tolerance Test (OGTT)
  • Glycosylated Hemoglobin (HgbA1C)
  • Normal -4-6
  • Target range DM patient 6-8

16
Criteria for the Diagnosis of Diabetes Mellitus
  • Normal
  • FPG lt110 mg per dL
  • 2hr OGTT lt140 mg per dL
  • Diabetes- positive findings from any two of the
    following tests on different days
  • Symptoms of diabetes mellitus plus casual
    (random) plasma glucose concentration gt200 mg /
    dL
  • or
  • FPG gt126 mg per dL
  • or
  • 2hr OGTT gt200 mg per dL after a 75-g glucose
    load

17
Diagnostic Tests Cont.Is it Diabetes Yet?
IGT
IFG
Impaired Glucose Tolerance
Impaired Fasting Glucose
18
Acute Complications
  • Diabetic Ketoacidosis (DKA)
  • BS gt 300 mg/dL
  • Classic symptoms
  • Ketosis
  • Hyperglycemic-Hyperosmolar Nonketotic Syndrome
    (HHNS)
  • BS gt 800 mg/dL
  • Similar symptoms
  • No Ketosis

19
Chronic Complications - Macrovascular
  • Cardiovascular
  • Cerebrovascular
  • Peripheral vascular

20
Chronic Complications-Microvascular
  • 1. Diabetic Retinopathy

21
Chronic Complications-Microvascular
  • 2. Nephropathy

22
Chronic Complications-Microvascular
  • 3. Diabetic Neuropathy

23
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24
Chronic Complications-Microvascular
Amputation of Toes
25
MANAGEMENT OF DM
Exercise
Diet
Blood Glucose Monitoring
Drug Therapy
25
26
Management Diet Exercise
27
Diet Cont Diabetes Food Pyramid
28
Diet Cont What to do???
29
Diet Cont.Carb-Counting
30
Diet Cont.Getting the balance right
  • Get your portions right!!

31
Management Exercise
  • Helps regulate blood glucose
  • Increases insulin effectiveness and sensitivity
    in the body.
  • Must monitor insulin and food intake to match
    exercise regimen.

32
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33
Drug Therapy
  • Insulin
  • Types
  • Rapid-acting or regular insulin are used to lower
    blood sugar after eating a meal.
  • Intermediate or long-acting types of insulin are
    used to lower blood sugar throughout the day and
    night
  • Onset - how soon it starts to work in the blood
  • Peak - when the insulin has the greatest effect
    on blood sugar levels
  • Duration how long it keeps working
  • Oral Antidiabetic Agents

34
Drug Therapy ContGoal of Insulin Therapy
Basal and Bolus Insulin Coverage
35
Drug Therapy ContSample Insulin Regimen
36
Drug Therapy ContRapid Acting Lispro/Aspart
  • Ideal for meal coverage
  • Give the shot while the plate is hot!

37
Drug Therapy ContFast Acting Regular Insulin
  • ? Its time give you your regular insulin ?
  • ? Its time to give it 30 minutes before your
    plate is in ?
  • ? Come back to check you in 2 (hours) ?
  • ? Watch out for shakes and sweats too ?
  • ? If your lucky youll have no clue!!!! ?

38
Insulin Acute Complication Hypoglycemia
39
Drug Therapy ContIntermediate acting NPH
Insulin
  • covers blood sugar between meals
  • satisfies overnight insulin requirement
  • Need snack if NPH given at 5 pm
  • Ideal to be given at 9 pm (HS) to address Dawn
    Phenomenon

40
Peakless Insulins!!!
  • Do not mix with other insulins
  • Lantus (insulin glargine)
  • Levimir (insulin detimir)

41
Drug Therapy ContOther Methods of Administration
42
Drug Treatment Cont.
  • Oral Antidiabetic agents
  • (see handout)

43
Administer meds (see Simons MAR)
  • Things to Ponder
  • Look at MAR and decide which meds youll
    administer at what time.
  • What are your concerns with Simons schedule of
    meds?
  • Hint look at onset/peak of Diabetes meds
  • It is now 0745 and the BS at 0700 173 mg/dL,
    what would you do?
  • What do you need to monitor for and when?
  • Why is Simon on insulin and oral diabetes meds?

44
Discussion (see Simons MAR)
  • Nurse decided to administer 4 units of Reg
    insulin at 0800 and Glyburide and Metformin at
    1000 as scheduled.
  • Simon calls at 1130 c/o shaking, sweating. (What
    do you do?)
  • BS at 1130 62 mg/dL (What do you do?)

45
Insulin
  • Acute
  • Complication
  • Hypoglycemia
  • Tx (15/15 or 20/20
  • Rule)
  • Give 15/20 g simple
  • carb and recheck
  • BG in 15/20 minutes

46
Discussion (see Simons MAR)
  • Nurse decided to hold PO meds.
  • At 1130 BS489
  • What do you do?

47
Hyperglycemia
48
Diabetic TeachingNeeds
  • Disease process
  • S/S of hyperglycemia and hypoglycemia
  • Blood sugar monitoring
  • Diet
  • Exercise
  • Drug therapy
  • Sick Day Rules
  • Complications (acute and chronic)
  • Prevention Foot care, eye exam etc.

49
DIABETES can be controlled!!!
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