Chapter 51 Diabetes , Part 1

- time course of action -species (source) and -manufacturer.

A number of insulin preparations are available. They vary according to three main characteristics:

- before meals and snacks - before prescribed insulin injections - for patients on an insulin pump

when to do self monitoring of blood glucose

When carbohydrate counting is used, reading labels on food items is the key to success. Knowing what the "carbohydrate budget" for the meal is and knowing how many grams of carbohydrate are in a serving of a food, the patient can calculate the amount in one serving.

45 to 60 g

- Fasting plasma glucose -Random Plasma Glucose - 2 hour postload ( glucose level 2 hours after receiving glucose)

3 ways of diagnosing Diabetes

- 3 P's polyuria, polydipsia, polyphagia - fatigue and weakness - sudden vision changes - tingling or numbness in the hand or feet - dry skin - skin lesions or wounds that are slow to heal - recurrent infections

Clinical Manifestations of Diabetes

DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated

DKA

The breath has a characteristic fruity odor due to the presence of ketoacids.

DKA

highly acidic ketone bodies are formed, and metabolic acidosis occurs.

DKA

Family history of diabetes (e.g., parents or siblings with diabetes) • Obesity (i.e., ≥20% over desired body weight or body mass index ≥30 kg/m2) • Race/ethnicity (e.g., African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders) • Age ≥45 years • Previously identified impaired fasting glucose or impaired glucose tolerance • Hypertension (≥140/90 mm Hg) • High-density lipoprotein (HDL) cholesterol level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride level ≥250 mg/dL (2.8 mmol/L) • History of gestational diabetes or delivery of a baby over 9 lb

Diabetes Risk factors

- improper application of blood ( drop to small) - damage to the reagent strips caused by heat or humidity - the use of outdated strips - improper meter cleaning and maintenance

Errors that may occur from SMBG

-visual activity - fine motor coordination - cognitive ability - comfort with technology and willingness to use it -cost

Factors affecting SMBG

Exercise 3 times each week with no more than 2 consecutive days without exercise. • Perform resistance training twice a week (for people with type 2 diabetes). • Exercise at the same time of day (preferably when blood glucose levels are at their peak) and for the same duration each session. • Use proper footwear and, if appropriate, other protective equipment (i.e., helmets for cycling).Glycated hemoglobin is the same as A1C • Avoid trauma to the lower extremities, especially in patients with numbness due to peripheral neuropathy. • Inspect feet daily after exercise. • Avoid exercise in extreme heat or cold. • Avoid exercise during periods of poor metabolic control.

General Considerations for Exercise in People With Diabetes

Advantages of exercise in this population include a decrease in hyperglycemia, a general sense of well-being, and better use of ingested calories, resulting in weight reduction.

Geriatrics

Initial management includes dietary modification and blood glucose monitoring. If hyperglycemia persists, insulin is prescribed. Goals for blood glucose levels during pregnancy are 105 mg/dL (5.8 mmol/L) or less before meals and 130 mg/dL (7.2 mmol/L) or less 2 hours after meals

Gestational Diabetes

is any degree of glucose intolerance with its onset during pregnancy

Gestational diabete

Hyperglycemia develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance.

Gestational diabetes

is a measure of glucose control that is a result of the glucose molecule attaching to hemoglobin for the life of the red blood cell

Glycated hemoglobin

When there is almost no effective insulin available, the body starts to break down stored fat for energy.

Ketones

they accumulate in the blood and urine.

Ketones

are by-products of fat breakdown

Ketones (or ketone bodies)

The meal plan may include the use of some nonanimal sources of protein (e.g., legumes, whole grains) to help reduce saturated fat and cholesterol intake.

Protein

SMBG is a useful tool for managing self-care for everyone with diabetes

SMBG is recommended for patients with the following conditions

the most important objectives in the dietary and nutritional management of diabetes are control of total caloric intake to attain or maintain a reasonable body weight, control of blood glucose levels, and normalization of lipids and blood pressure to prevent heart disease.

Success in this area alone is often associated with reversal of hyperglycemia in type 2 diabetes.

- onset - peak -duration of action

Time course of action

. If the concentration of glucose in the blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL (9.9 to 11.1 mmol/L), the kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine (glycosuria).

Type 1 diabetes

In addition, fat breakdown occurs, resulting in an increased production of ketone bodies, a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin.

Type 1 diabetes

In addition, glucose derived from food cannot be stored in the liver but instead remains in the bloodstream and contributes to postprandial (after meals) hyperglycemia.

Type 1 diabetes

People do not inherit type 1 diabetes itself but rather a genetic predisposition, or tendency, toward development of type 1 diabetes. This genetic tendency has been found in people with certain human leukocyte antigen types. There is also evidence of an autoimmune response in type 1 diabetes. T

Type 1 diabetes

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. This is called osmotic diuresis.

Type 1 diabetes

affects approximately 5% to 10% of people with the diseas

Type 1 diabetes

diabetes related absence of insulin production and destruction of beta cells

Type 1 diabetes

genetic susceptibility is a common underlying factor in the development of type 1 diabetes.

Type 1 diabetes

gentic, immunologic, and possibly environmental (e.g., viral) factors are thought to contribute to beta-cell destruction.

Type 1 diabetes

is a metabolic derangement that occurs most commonly in persons with type 1 diabetes and results from a deficiency of insulin

Type 1 diabetes

the destruction of the beta cells results in decreased insulin production

Type 1 diabetes

To overcome insulin resistance and to prevent the buildup of glucose in the blood, increased amounts of insulin must be secreted to maintain the glucose level at a normal or slightly elevated level

Type 2 Diabetes

affects approximately 90% to 95% of people with the disease

Type 2 diabetes

- retinopathy - nephropathy - neuropathy

complications of diabetes

insulin resistance impaired insulin secretion

two main problems related to Type 2 diabetes

-obesity -a personal history of gestational diabetes, glycosuria -or a strong family history of diabetes.

gestational diabetes risk factors

High-risk ethnic groups include Hispanic Americans, Native Americans, Asian Americans, African Americans, and Pacific Islanders

gestational diabetes risk factors

is used to describe how much a given food increases the blood glucose level compared with an equivalent amount of glucose.

glycemic index

the kidney cells are damaged)

nephropathy

(nerve cells are damaged)

neuropathy

have few or no calories

nonnutritive sweeteners

contain calories

nutritive sweeteners

(small blood vessels that nourish the retina in the eye are damaged),

retinopathy

is a method of capillary blood glucose testing in which the patient pricks his or her finger and applies a drop of blood to a test strip that is read by a meter

self-monitoring of blood glucose (SMBG)

diabetes is the leading cause of nontraumatic amputations, blindness in working-age adults, and end-stage kidney disease (ESKD).

side effects of diabetes