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Diabetes Mellitus

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Diet. Lower calorie. Fewer foods of 'high glycemic index' Spread meals ... Type II diabetic, makes enough insulin to avoid ketones, but sugar guilds up to ... – PowerPoint PPT presentation

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Title: Diabetes Mellitus


1
Diabetes Mellitus
  • Barbara S. Hays
  • Winter, 2006

2
Blood Glucose(normal serum level 65 105 mg)
  • Inside CNS
  • Brain uses glucose as primary fuel
  • Brain cannot store/produce glucose
  • Outside CNS
  • Fatty acids stored as
  • Glycogen (liver/muscles)
  • Triglycerides (fat cells)

3
Blood glucose, cont.
  • Outside CNS, continued
  • Endocrine portion of pancreas Islets of
    Langerhans
  • Alpha cells make glucagon
  • counterregulatory, acts opposite of insulin
  • Beta cells make insulin
  • Allows body cells to store and use carbohydrate,
    fats, and protein

4
Hyperglycemia
  • When blood glucose becomes high
  • INSULIN allows glucose to enter cells
  • Liver
  • Production /storage of glycogen
  • Inhibits glycogen breakdown
  • Increased protein fat synthesis (VLDL
    formation)
  • Muscles
  • Promotes protein and glycogen synthesis
  • Fat cells
  • Promotes storage of triglycerides

5
Hyperglycemia
  • Drowsy
  • Flushed
  • Thirsty

6
Hypoglycemia
  • Glucagon causes release of glucose from liver
  • glycogenolysis (breakdown of glycogen to
    glucose)
  • glyconeogenesis of glucose not available
  • Lipolysis (breakdown of fat)
  • Proteolysis (breakdown of amino acids)

7
Hypoglycemia
  • Weak, sweaty
  • Confused/irritable/ disoriented

8
Diabetes Mellitus(problem with glucose
metabolism)
  • Major health problem US/worldwide
  • Complications lousy blood vessels
  • Blindness
  • Renal failure
  • Amputations
  • heart attacks and strokes
  • OB/neonatal complications

9
Diabetes Mellitus
  • The good news
  • Blood glucose control reduces complications of
    Diabetes!

10
Diabetes Mellitus
  • Absence (or ineffectiveness of ) insulin
  • Cellular resistance
  • Cells cant use glucose for energy
  • Starvation mode
  • Compensatory breakdown of body fat/protein
  • Ketone bodies from faulty fat breakdown
  • Metabolic acidosis, compensatory breathing
    (Kussmals breathing)

11
Diabetes Mellitus
  • HYPERGLYCEMIA fluid/electrolyte imbalance.
  • Polyuria
  • Sodium, chloride, potassium excreted
  • Polydipsia from dehydration
  • Polyphagia cells are starving, so person feels
    hungry despite eating huge amounts of food.
    Starvation state remains until insulin is
    available.

12
Diabetes Mellitus
  • Complications of chronic hyperglycemia
  • Macrovascular complications
  • Cardiovascular disease (heart attack)
  • Cerebrovascular disease (strokes)
  • Microvascular
  • Blindness (retinal proliferation, macular
    degeneration)
  • Amputations
  • Diabetic neuropathy (diffuse, generalized, or
    focal)
  • Erectile dysfunction

13
Classifying Diabetes Mellitus
  • Type I Diabetes autoimmune
  • Beta cell destruction in genetically susceptible
    person
  • Some viral infections

14
Classifying Diabetes Mellitus
  • Type II Diabetes
  • Reduction in ability of most cells to respond to
    insulin
  • Poor control of liver glucose output
  • Decreased beta-cell function (eventual failure)

15
Diabetes Mellitus
  • Major risk factors
  • Family history
  • Obesity
  • Origin (Afro-American, Hispanic, Native American,
    Asian-American)
  • Age (older than 45)
  • History of gestational diabetes
  • High cholesterol
  • Hypertension

16
Diabetes Mellitus
  • Prevention of effects combination approach
  • Increased exercise
  • Decreases need for insulin
  • Reduce calorie intake
  • Improves insulin sensitivity
  • Weight reduction
  • Improves insulin action

17
Triad of Treatment
  • Diet
  • Medication
  • Oral hypoglycemics
  • Insulins
  • Exercise

18
Diabetes treatment
  • Exercise
  • Under physician supervision
  • Check glucose prior

19
Diabetes treatment
  • Diet
  • Lower calorie
  • Fewer foods of high glycemic index
  • Spread meals evenly

20
Diabetes treatment
  • Anti-Diabetic medications
  • Oral hypoglycemic agents (Easy p 297)
  • Sulfonylureas
  • Thiazolidinediones
  • Biguanides
  • Alpha-glucosidase inhibitors
  • D-phenylalinine derivatives
  • Combinations
  • Insulins (Easy Prototype Pro p 393)

21
Sulfonylureas
  • Stimulate pancreas to secrete insulin
  • Glyburide (Diabeta) Prototype Pro p 393
  • Glucotrol (Glipizide)
  • Diabenese (chlorpropamide)
  • Adverse reactions
  • Hypoglycemia
  • Water retention/edema
  • Photosensitivity
  • May need to add insulin in times of stress

22
Biguanides
  • Decreases liver production of glucose
  • Decreases intestinal absorption of glucose
  • Improves cell sensitivity to insulin
  • Example Metformin
  • GI upset, flatulence
  • Cardiac (CHF, MI)

23
Thiazolidinediones
  • Increase cellular sensitivity to insulin
  • Pioglitazone (Actos)
  • Rosiglitazone (Avandia)
  • Client should have liver enzymes
  • checked periodically

24
D-Phenylalanine derivatives
  • Nateglinide (Starlix)
  • Rapid onset, short half-life
  • Good for those with rapid post prandial rise in
    blood glucose

25
Combinations
  • Glucovance
  • Glyburide and Metformin
  • Avandamet
  • Avandia and Metformin
  • come tell me when you run into this question

26
Insulin
  • Made in beta cells of the pancreas
  • Moves glucose into cells (thus acts like growth
    hormone in a way)
  • Moves potassium into cells (can buy time in
    emergencies)

27
Insulin preparations (Easy p 390)given ONLY
with syringes marked in units
  • Rapid acting (lispro, asparte)
  • Short acting (regular)
  • Intermediate acting (NPH)
  • Long acting
  • Ultralente
  • Glargine/Lantus

28
Your learning
  • Onset of action
  • Peak (blood glucose will be lowest then)
  • Duration

29
Rapid acting insulin
  • Lispro (Humolog, Novolog Aspart)
  • Onset of action
  • 15-30 minutes may come on in 5 minutes
  • Peak of action
  • 1 - 2 hours
  • Duration
  • 3 4 hours

30
Short acting insulins
  • Regular (clear so can be given IV)
  • Onset of action
  • 0.5 to 1 hour
  • Peak of action
  • 2 4 hours
  • Duration of action
  • 6 8 hours

31
Intermediate acting insulins
  • NPH, Lente (chemicals added. Cloudy)
  • Onset of action
  • 1 4 hours
  • Peak of action
  • 4 12 hours
  • Duration of action
  • 18 24 hours

32
Long acting insulins
  • Ultralente
  • Onset of action
  • 4 8 hours
  • Peak of action
  • 18 hours
  • Duration of action
  • 24 36 hours

33
Once a day insulin
  • Glargine/Lantus
  • Cannot be diluted or mixed in syringe with any
    other insulin
  • Slow, steady release
  • Daily dosing usually at bedtime
  • Refrigerated or tosses every 14 days

34
Combination insulins
  • 70/30 (70 NPH and 30 regular)
  • Humolog 70/30 (Humolog and regular)
  • Fewer injections
  • Rotate sites to decrease lipodystrophy

35
Miscellaneous
  • Byetta for type II Diabetics taking sulfonylureas
    or combination
  • Mimics physiologic glucose control
  • Inhances insulin secretion only in presence of
    hyperglycemia
  • Insulin secretion decreases as blood glucose
    approaches normal
  • Neutontin for Diabetic nerve pain

36
Some things to know
  • Insulin moves potassium into cells
  • Good for emergency situations
  • Dangerous if potassium level already low

37
Some things to know
  • HHNK (Hyperglycemic Hyperosmolar Non-Ketotic
    Coma). Also called
  • HHNK
  • HNKS syndrome
  • Like dibetic ketoacidosis, without the ketones
  • Type II diabetic, makes enough insulin to avoid
    ketones, but sugar guilds up to dangerous levels
    -gt cellular dehydration

38
Some things to know
  • Dawn Phenomenon vs Somogis effect
  • Dawn phenomenon
  • Blood sugar rises in early morning
  • Somogis (rebound) effect
  • Blood sugar rise in morning as reaction to
    hypoglycemic time during the night

39
Some things to know
  • Diabetic foot care
  • Dry, cracked skin poor circulation could loss
    of a limb
  • For the most part nurses dont trim nails of
    diabetic clients. Refer to Podiatrist.

40
Typical diabetic foot ulcer
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