Glucose regulation
The nurse teaches which action to the diabetic client who self-injects insulin to prevent local irritation at the injection site? Be sure to aspirate prior to injecting insulin. Massage the site after injecting insulin. Use a 1-inch needle for the injection. Allow the insulin to warm to room temperature before injecting it.
Cold insulin from the refrigerator is the most common cause of irritation. Aspiration of insulin is not recommended; massaging the site can cause irritation; and a 1-inch needle is the improper size for insulin injections.
A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this patient about exercise? "Jogging for 20 minutes 5 to 7 days a week would most efficiently help you to lose weight." "One hour of vigorous exercise daily is needed to prevent progression of disease." "Avoid all forms of exercise because of your diabetic complications." "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."
Exercise is not contraindicated for this client, but modifications are necessary to prevent further injury. Swimming or water aerobics provides support for the joints and muscles while increasing the uptake of glucose and promoting cardiovascular health. Jogging, vigorous exercise, or no exercise would increase the pathologies of this patient.
Based on the nurse's assessment of a diabetic patient, which finding indicates the need for avoidance of exercise at this time? Ketone bodies in the urine Blood glucose level of 155 mg/dL Pulse rate of 66 beats per minute Weight gain of 1 pound over the previous week's weight
Exercise would lead to further elevations in blood glucose levels due to inadequate insulin to promote intracellular glucose transport and uptake. Assessing for ketones in the urine may indicate insulin deficiency.
what can the brain use as fuel?
Fatty acids do not serve as fuel for the brain, because they are bound to albumin in plasma and so do not traverse the blood-brain barrier. In starvation, ketone bodies generated by the liver partly replace glucose as fuel for the brain.
poluria
GLYCOSURIA. also creates an osmotic pull of water to be excreted in urine. This is POLYURIA. (This is why frequent urination is a symptom of diabetes) High concentration of glucose molecules in urine leading to polyuria—frequent urination
Which clinical manifestation of decreased renal function in the diabetic clinic should the nurse anticipate as a potential problem? Elevated specific gravity Ketone bodies in the urine Glucose in the urine Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg
Hypertension is both a cause and a result of renal dysfunction in the diabetic client. Although ketones and glucose in the urine are findings in diabetes mellitus, they are not specific for renal function. Specific gravity is elevated with dehydration.
A diabetic patient is receiving intravenous insulin. Which laboratory results should the nurse anticipate as a potential problem? Serum chloride level of 90 mmol/L Serum calcium level of 8 mg/dL Serum sodium level of 132 mmol/L Serum potassium level of 2.5 mmol/L
Insulin activates the sodium-potassium adenosine triphosphatase (ATPase) pump, which increases the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. The chloride, calcium, and sodium levels are in normal parameters.
The nurse should institute which precaution for the hypoglycemic patient receiving intramuscular glucagon due to an inability to swallow the oral form? Elevate the head of the bed. Have a padded tongue blade at the bedside. Position the client face down or in a side-lying position. Apply pressure and massage the injection site for 5 minutes.
Intramuscular injection of glucagon often causes vomiting, increasing the patient's risk for aspiration. Elevating the head of the bed, instituting the use of a padded tongue blade, or applying pressure at or massaging injection site is not a safe nursing practice.
Kussmaul breathing
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. Treatment is IV insulin to correct DKA
HYPOGLYCEMIA Symptoms include:
Nervousness Dizziness Palpitations Drowsiness Sweating Irritability Hunger Loss of coordination Weakness Seizures Coma • Happens much faster than ketoacidosis & is an urgent/emergent situation
Know your normal !!! Normal serum glucose levels
Newborn, 1 day: 2.2 - 3.3 mmol/L Newborn, > 1 day: 2.8 - 5.0 mmol/L Child: 3.3 - 5.5 mmol/L Adolescent: 3.9 - 5.8 mmol/L Adult: 3.6 - 5.3 mmol/L If the mother had gestational diabtes we check the newborsn blood sugar frequently
When planning care for a diabetic patient with microalbuminuria, it is important to include which goal to reduce the progression to renal failure? Decrease the total percentage of calories from carbohydrates Decrease the total percentage of calories from fruits Decrease the total percentage of calories from proteins Decrease the total percentage of daily caloric intake
Restriction of dietary protein to 0.8 g/kg body weight per day is recommended for clients with microalbuminuria to reduce the progression to renal failure. All other choices can increase blood glucose and total body weight but are not specific for progression to renal failure.
It is most important for the nurse to include which risk factors in a teaching plan associated with the development of type 2 diabetes mellitus? (Select all that apply.) Hypertension History of pancreatic trauma Weight gain of 30 pounds during pregnancy Body mass index greater than 25 kg/m Triglyceride levels between 150 and 200 mg/dL Delivery of a 4.99-kg baby
Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby weighing over 9 pounds, a history of vascular disease, a body mass index greater than 25 kg/m, and triglyceride levels over 200 mg/dL.
Which clinical manifestation indicates to the nurse a patient's hyperosmolar nonketotic syndrome (HNKS) therapy needs to be adjusted? Ketone bodies in the urine have been absent for 3 hours. Blood osmolarity has decreased from 350 to 330 mOsm. Serum potassium level has increased from 2.8 to 3.2 mEq/L. The Glasgow Coma Scale is unchanged from 3 hours ago.
Slow but steady improvement in central nervous system functioning should be seen with effective therapy for HNKS. An unchanged level of consciousness may indicate inadequate rates of fluid replacement. Ketone bodies, blood osmolarity, and serum potassium levels are consistent with improvement.
Hyperglycemia definition and signs and symptoms :
State of elevated blood glucose levels, defined as more than 5.6 mmol/L in a fasting state or 7.8 mmo/L when not fasting signs and symptoms: polyuria,polydipsia, dehydration, fatigue, fruity odor to breath, kussmaul breathing, weight loss, hunger, pour wound healing
Hypoglycemia definition and signs and symptoms
State of insufficient or low blood levels, defined as less than 3.9 mmol/L signs and symptoms: reduced cognition, tremors, diaphoresis (sweating), weakness, hunger, headache, irritability, seizures
Which priority intervention will the nurse initiate for the patient having Kussmaul's respirations due to diabetic ketoacidosis? Administration of oxygen by nasal cannula at 15 L/min Intravenous infusion of 10% glucose Implementation of seizure precautions Administration of intravenous insulin
The Kussmaul's respirations pattern is the body's attempt to reduce the acids produced by utilization of fat for fuel. Administration of insulin will reduce this respiration pattern by assisting glucose transport back into cells to be used for fuel instead of fat. Nasal cannula oxygen is given at 1 to 6 L per minute; intravenous glucose administration will not have the desired effect of treatment; and although seizure precautions may be implemented, they will not have any effect on glucose transport into cells.
KETONURIA
The body also tries to compensate by breaking down body fats into fatty acids and ketone bodies. • Excess ketones are then eliminated in urine - KETONURIA.
polyphagia
The body tries to compensate for nutritional losses of glucose by breaking down (catabolizing) protein stores, which can then be converted to glucose by the liver--gluconeogenesis. This triggers the hunger mechanism, called
The nurse recommends the pen-injector insulin delivery system for the client with which clinical presentation? Confusion and reliance on another person for insulin injections Requirements for intensive therapy with small, frequent insulin doses Visual impairment affecting the ability to draw up insulin accurately Frequent episodes of hypoglycemia
The pen injector allows greater accuracy with small doses of less than 5 units. It is not recommended for those with cognitive or visual impairments or those who suffer frequent hypoglycemic episodes.
electrolyte imbalances
This washout of glucose and fluids also results in the loss of other essential electrolytes, creating electrolyte imbalances.
GLYCOSURIA
When blood glucose levels rise above their renal threshold, glucose 'spills' into the urine. This is GLYCOSURIA. (Why sweet smelling urine that is also sticky is a symptom of diabetes.) Glucose in the urine filtrates in the bowman's capsule. normally its taken back into the blood stream in the proximal tubule but when glucose exceeds 8.9 to 10 mmol/L it cannot all be absorbed back and ends up in the urine.
Lipolysis
breakdown of fats and other lipids and involves hydrolysis of other triglycerides into glycerol and free fatty acids---adipose tissue
Glycogenolysis
breakdown of glycogen to glucose: It is also stimulated by the sympathetic nervous system so the body can have glucose made available for fight or flight.
metabolic acidosis
decreased pH in blood and body tissues as a result of an upset in metabolism due to Excess fatty acids contribute to a drop in the body's pH called To compensate for the metabolic acidosis, the respiratory system steps up respiratory rate and depth to eliminate CO2. This characteristic hyperventilation of uncontrolled Type 1 diabetes are called KUSSMAUL'S RESPIRATIONS.
DIABETIC KETOACIDOSIS
is a complete state of insulin deficiency. It is a medical emergency requiring insulin administration, fluids to restore volume loss, and electrolyte, especially potassium, replacement. If insulin is not administered—ketoacidosis----medical emergency---Iv insulin, Iv fluids—to restore electrolyte imbalance
Gluconeogenesis
is a metabolic pathway that result in the generation of glucose from certain non-carbohydrate carbon substrates e.g glycerol, aminoacids
Insulin resistance
is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Type 2 diabetes.
3 P's are signs of diabetes: POLYURIA, POLYDIPSIA, POLYPHAGIA
o POLYURIA frequent urination and is usually the result of drinking excessive amounts of fluids o POLYDIPSIA is excessive thirst or excess drinking. o POLYPHAGIA excessive hunger and abnormally large intake of solids by mouth. Effects continued
insulin replacement
prescribed by an endocrinologist, is tailored to the needs of each individual child based on systematic home blood glucose monitoring. • Different forms (short acting, intermediate acting, long acting) measured in UNITS with 100 units per milliliter. • Injected into subcutaneous fat and not muscle, using rotating sites. • Newer technologies have made injection protocols a bit simpler (e.g. NovoPen... insulin pumps), usually for better control. • Subcutaneous sites---fat not on the muscle
Counterregulatory hormones
that work against the action of insulin, raising blood glucose levels in response to hypoglycemia (low blood sugar). The main ones are glucagon, epinephrine (also known as adrenaline), cortisol, and growth hormone
Risk for impaired glucose regulation
• Age- Age is affected due to organ atrophy, weight loss and changes in receptor binding sites • Racial and ethnic groups • Family history • Lifestyle • Medical risk factors • Selected medications- prolonged corticosteroids
Injectable Antidiabetic Drugs: Mechanism of Action
• Amylin agonist • Mimics the natural hormone amylin • Slows gastric emptying • Suppresses glucagon secretion, reducing hepatic glucose output • Used when other drugs have not achieved adequate glucose control • Subcutaneous injection
Nursing Implications • Before giving drugs that alter glucose levels:
• Assess the patient's ability to consume food. • Assess for nausea or vomiting. • Hypoglycemia may be a problem if antidiabetic drugs are given and the patient does not eat. • If a patient is to take nothing by mouth (NPO) for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy. • Keep in mind that overall concerns for any patient with diabetes increase when the patient: • Is under stress • Is pregnant or lactating • Has an infection • Has an illness or trauma
how is the high carb diet causing type 2 diabetes?
• Constantly having high carbs means there is always a lot of glucose in the blood stream which means insulin is needed in large amounts and often. Over time the body is used to requiring a lot of insulin so it secretes it all the time which causes hypoglycemia-----and then feeling tired and weak so we eat more carbs. We feel better for a bit and then bottom out again. • This constant high levels of insulin and glucose over time start to store as fat which is why low fat diets don't work - they are usually high carb. With so much glucose available the cells become resistant to it and thus don't respond the way they should when insulin is present == insulin resistance. Because the cells are refusing insulin, glucose backs up in the blood. The body fights to maintain the proper level of glucose in the blood stream and gets it out by storing it as fat. The process of making fat from glucose includes conversion to triglycerides. This is why pre-diabetics have high triglycerides. You know if someone's glucose is well controlled but the level of triglycerides showing on their lab test. High levels of triglycerides contributes to a fatty liver. Something it's seen in kids now that we only saw in older adults. • insulin resistance also causes metabolic syndrome which includes high estrogen and testosterone in females and high estrogen and low testosterone in males. High estrogen is associated with weight gain. Over time the pancreas gets tired of making so much insulin and stops or reduces it. This takes decades normally but with declining diet and sedentary lifestyle we are seeing it in kids.
Self-management of DM
• Daily blood glucose monitoring and logging results are also essential to management of diabetes. • Daily food journals • Diabetic teaching nurses and/or nutritionists are usually involved in helping children and families understand and assume the daily self-management of life with diabetes - insulin, nutrition, exercise, emotions, coping. • Chems check—keep data • Diabetic teaching—dietician, nurses, diabetic clinic, physcians
Clinical Management: Primary Prevention
• Diet • Exercise • Weight control
Clinical Management: Collaborative Interventions
• Education about glucose regulation • Nutrition therapy • Pattern management: monitoring meal-related blood glucose values • Pharmacological agents • Oral hypoglycemic agents- type 2 diabetes • Insulin- type 1 diabetes
Hormone secretion • Pancreas: Endocrine and exocrine functions-
• Endocrine functions carried out by the Islets of Langerhans which produce insulin and glucagon (regulate blood glucose levels). • Exocrine cells secrete digestive enzymes into the small intestine. • trypsin and chymotrypsin digest proteins. • pancreatic amylase digest carbohydrates • pancreatic lipase - digest fats
Fixed-Combination Insulins
• Fixed combinations • Humulin 30/70 • Novolin 30/70, 40/60, 50/50- cloudy • NovoMix® 30- cloudy • Humalog Mix25® • Humalog Mix50® Long acting is normally cloudy and short acting is clear. When drawing up insulin you always draw up the clear then the cloudy.
Glucose and effects Hyperglycemia
• Glycosuria • polyuria • electrolyte imbalances. • POLYDIPSIA. • POLYPHAGIA. • KETONURIA. • METABOLIC ACIDOSIS. - KUSSMAUL'S RESPIRATIONS. If this pattern is not reversed through insulin administration, progressive deterioration will lead to electrolyte disturbances causing cardiac arrhythmias, progressive acidosis (DIABETIC KETOACIDOSIS), coma, and death
hyperglycaemia definition:
• INSULIN is needed to support the metabolism of carbohydrates, fats, and proteins, primarily by facilitating the entry of these substances into the cell. With a deficiency in insulin, glucose cannot enter the cell and therefore its concentration in the blood rises. This is HYPERGLYCEMIA
• Signs and symptoms of hyperglycaemia
• Increased thirst (polydipsia) • Headaches. • Trouble concentrating. • Blurred vision. • Frequent maturation (polyuria) • Fatigue (weak, tired feeling) • Weight loss. • Blood sugar more than 180 mg/dL. • Microvascular damage leads to • Diabetic retinopathy affects blood vessels in the light-sensitive tissue, the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults. • Diabetic retinopathy may progress through four stages: Mild nonproliferative retinopathy. Small areas of balloon-like swelling in the retina's tiny blood vessels, called microaneurysms, occur at this earliest stage of the disease. • Diabetic nephropathy is another common complication of diabetes, types 1 and 2. Over time the high blood sugar associated with untreated diabetes causes high blood pressure. This in turn damages the kidneys by increasing the pressure in the delicate filtering system of the kidneys. • Peripheral neuropathy is a long-term complication of diabetes. Exposure to high blood glucose levels over an extended period of time causes damage to the peripheral nerves - on the arms, hands, legs, and feet. • Diet and exercise helps control and significantly reduce diabetes type II but for someone with all these conditions then safe exercise like swimming would be recommended. • High blood sugar interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients. • High glucose levels reduce the levels of the powerful vasodilator nitric oxide in blood vessels, a shortfall that increases the risk of high blood pressure and eventually narrows down the vessels
Intermediate-Acting Insulins
• Insulin isophane suspension (also called NPH) • Cloudy appearance • Often combined with regular insulin • Onset: 1 to 3 hours • Peak: 5 to 8 hours • Duration: up to 18 hours • (Know) Often combined with regular insulin---draw up clear first (regular insulin) then the cloudy NPH insulin
Types of Antidiabetic Drugs
• Insulins • Oral hypoglycemic drugs- normally for type 2 but sometimes type 1 • A combination of oral antihypoglycemic and insulin controls glucose levels. • Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugs.
Consequences: Hypoglycemia
• Irritability • Fatigue • Mental confusion • Seizures • Unconsciousness • Potentially leads to cellular death
DIABETIC KETOACIDOSIS
• Ketone bodies are produced by the liver because of things like fasting, starving, low carbohydrate diets, prolonged exercise and untreated type 1 diabetes mellitus as a result of intense gluconeogenesis and are easily picked up by cells with mitochondria and converted into acetyl-CoA and used by cells for enegry. • (acetyl coenzyme A) is a molecule that participates in many biochemical reactions in protein, carbohydrate and lipid metabolism. • When a Type 1 diabetic suffers a biological stress event (infection, heart attack, or physical trauma), or fails to administer enough insulin they may enter the pathological state of hyperglycemic ketoacidosis. Under these circumstances, the low or absent insulin levels in the blood, combined with the inappropriately high glucagon concentrations, induce the liver to produce glucose at an inappropriately increased rate, causing acetyl-CoA resulting from the beta-oxidation of fatty acids, to be converted into ketone bodies. The resulting very high levels of ketone bodies lower the pH of the blood plasma, which reflexively triggers the kidneys to excrete a very acid urine. The high levels of glucose and ketones in the blood also spill, passively, into the urine (the ability of the renal tubules to reabsorb glucose and ketones from the tubular fluid, being overwhelmed by the high volumes of these substances being filtered into the tubular fluid). The resulting osmotic diuresis of glucose causes the removal of water and electrolytes from the blood resulting in potentially fatal dehydration.
Clinical Management: Screening
• Laboratory tests • Hemoglobin A1c • Cholesterol • Microalbuminuria • Screening to detect complications • Blood pressure • Dental, foot, and eye examinations • HbA1c is a form of hemoglobin that is measured primarily to identify the three month average plasma glucose concentration. The test is limited to a three month average because the lifespan of a red blood cell is three months. • microalbuminuria blood test is a urine test that measures the amount of albumin in your urine. Albumin is a protein that your body uses for cell growth and to help repair tissues. A certain level of it in your urine may be a sign of kidney damage.
Long-Acting Insulins
• Long acting • Insulin glargine (Lantus®)- the only clear long acting medication and cannot be given with any other medication • Clear, colourless solution • Constant level of insulin in the body • Usually dosed once daily • Can be dosed every 12 hours • Referred to as basal insulin • Onset: 90 minutes • Peak: none • Duration: 24 hours • Lantus insulin----given using a separate syringe
Rapid-acting treatment for types 1 and 2 diabetes
• Most rapid onset of action (10 to 15 minutes) • Peak: 1 to 2 hours • Duration: 3 to 5 hours • Patient must eat a meal after injection • Insulin lispro (Humalog®) • Action similar to that of endogenous insulin • Insulin aspart (NovoRapid®) • Insulin glulisine (Apidra®) • May be given subcutaneously or via continuous subcutaneous infusion pump (but not intravenously)
Aging and the Endocrine System
• Organ atrophy and weight loss with vascular changes • Decreased secretion and clearance of hormones • Variable change in receptor binding and intracellular responses Age is affected due to organ atrophy, weight loss and changes in receptor binding sites
amylin
• Peptide hormone co-secreted with insulin • Delays nutrient uptake by delaying gastric emptying - gives the body time to keep up • Suppresses glucagon secretion after meals and helps you feel full
Type 2 Diabetes Mellitus:
• Ranges from insulin resistance with relative insulin deficiency to insulin secretory defect with insulin resistance • Caused by genetic-environmental interaction • Risk factors are age, obesity, hypertension, physical activity, and family history • Metabolic syndrome • Insulin resistance—deficiency, secretory defect • (Know) Risk factor ;Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolality without significant ketoacidosis---like in diabetes type 1 • Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of heart disease, stroke and diabetes. starting to see more in kids- used to be older persons • Characterized by a relative deficiency in insulin, or by a resistance to insulin. Usually occurs in older people who are overweight and/or sedentary and/or have a family history of this disorder. • Can be managed by good diet, exercise, lifestyle only • Often requires oral hypoglycemics. • Sometimes requires insulin. • Can occur as early as childhood. • Family Hx, 80% to 90% twin concordance. More common in females • Islet cell antibodies >5%; human leukocyte antigen - No assoc. • Gradual onset • Reversible if in pre-diabetic stage- Type I is not
Short-Acting Insulins
• Regular insulin (Humulin R®, Novolin ge Toronto®) • Routes of administration: intravenous (IV) bolus, IV infusion, intramuscular, subcutaneous • Onset (subcutaneous route): 30 minutes • Peak (subcutaneous route): 2 to 3 hours • Duration (subcutaneous route): 6.5 hours * Please note this is the only insulin that is given intravenously to treat patients with DKA make sure the patient an eat to see if that will help before giving medications
Glucagon
• Secretion is promoted by decreased blood glucose levels • Stimulates glycogenolysis, gluconeogenesis, and lipolysis Glucagon stops insulin from continuing to move glucose out of the blood when the levels are too low. It stimulates the liver to release the stored glycogen in a process called glycogenolysis.
Islets of Langerhans cells: alpha, beta, delta and F cells
• Secretion of glucagon and insulin • Cells: • Alpha—glucagon • Beta—insulin and amylin • Delta—somatostatin and gastrin • F cells—pancreatic polypeptide • Functioning as an endocrine gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar levels throughout the day • Delta—somatostatin in response to food intake. Needed for carb fat and protein metabolism. and gastrin stimulates secretion of gastric acid. • F cells—pancreatic polypeptide released in response to hypoglycemia and protein rich meals. Inhibits gallbladder contraction and exocrine secretion by pancreas--- to maintain blood glucose levels.
Consequences: Hyperglycemia
• Short-term consequences • Inadequate glucose reaching the cells • Dehydration • Long-term consequences • End-organ disease due to microvascular damage • Retinopathy • Nephropathy • Peripheral neuropathy • Macrovascular angiopathy • Hypertension • Cardiovascular and peripheral vascular disease • Poor tissue healing and higher risk infection
Insulin
• Synthesized from proinsulin • Secretion is promoted by increased blood levels of glucose, amino acids, GI hormones • Facilitates the rate of glucose uptake into the cells of the body • Anabolic hormone • Synthesis of proteins, lipids, and nucleic acids
DIABETES MELLITUS (DM) and whats the Target blood glucose for most people with diabetes?
• The most common endocrine disorder of childhood. • DM is a chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin. • DM in children can occur at any age and has a peak incidence b/w 10-15 years. Target for most people with diabetes Fasting 4.0 to 7.0 mmol/L Random 5.0 to 10.0 (5.0 - 8.0 if A1C** targets not being met) A1C 7.0% or less A1C is a measurement of your average blood glucose control for the last 2 - 3 months and approximately 50% of the value comes from the last 30 days
Diabetes and Hypoglycemia
• The opposite of diabetic ketoacidosis • Low blood glucose. • Caused by lower intake of food, vomiting, stress, exercise and even insulin errors (giving too much)... Resulting in an ACUTE problem • Not enough in the bloodstream for use by the cells (brain). • Too much insulin for the carbohydrate/glucose that is available. • Symptoms are caused both by increased adrenergic nervous system activity and glucose deprivation to the central nervous system
polydipsia
• The urinary losses cause thirst as the body tries to compensate for the washout of fluids. This is POLYDIPSIA.
treatment of hypoglycaemia:
• Treatment: Consume 15 grams of carbohydrate (4 ounces of regular juice or soda, 1 tablespoon honey, 2 tablespoons raisins, 7 Life Savers®, 9 Sweet Tarts®, or 3-4 glucose tablets) and retest your blood glucose in 15 minutes. • Glucose SL or injection is only used when someone is unconscious. 50% Dextrose IV push- given in the hospital
Type 1 Diabetes Mellitus
• Types: Idiopathic type 1 or Autoimmune type 1 • Pancreatic atrophy and specific loss of beta cells; hyperglycemia when 80%-90% cells lost • Alterations in insulin, amylin, glucagon • Genetic susceptibility • Environmental factors • Immunologically mediated destruction of beta cells Macrophages, T-cytotoxic cells, antibodies •Manifestations:Hyperglycemia, Polyphagia, Polydipsia, Weight loss, Polyuria, Fatigue •Continued hyperglycemia can lead to diabetic ketoacidosis (DKA). When there is not enough insulin the body engages in lypolysis (fat catabolism). This triggers glycogenesis (converts glycogen to glucose) in the liver because the body mistakes the catabolism of fat as a sign it needs glucose. So it releases it from the liver via glycogenesis which also produces ketone bodies that the body cannot get rid of fast enough. When ketone bodies build up the blood becomes acidic which is DKA. Kussmaul respirations happen because the body is trying to compensate for the acidic state by getting rid of carbonic acid. It needs to get rid of the metabolic acids but respirations only work for carbonic acid so the pH comes down a bit but the cause is not addressed. •Characterized by destruction of the pancreatic beta cells that produce insulin, leading to absolute insulin deficiency. • Two types • Immune mediated --autoimmune destruction of ẞ cells (in slim kids but sometimes as adults) • Idiopathic -rare and cause unknown • Impacted by good diet, exercise, lifestyle but not controlled • Requires insulin s/c every day • NOT associated with obesity or sedentary lifestyle. • Sometimes a family Hx; 25% to 50% twin concordance. A bit more common in males • Islet cell antibodies in 85% cases. human leukocyte antigen -assoc • Abrupt onset. • destruction of the pancreatic beta cells
Oral Antidiabetic Drugs
• Used for type 2 diabetes • Effective treatment involves several elements: • Lifestyle changes • Careful monitoring of blood glucose levels • Therapy with one or more drugs • Treatment of associated comorbid conditions such as high cholesterol and high blood pressure • Patient education regarding side effects of oral antidiabetic meds and the signs and symptoms that patients need to report to the healthcare provider • e.g abdominal, fatigue, dizziness etc • 2013 Canadian Diabetes Association recommendations • New-onset type 2 diabetes treatment • Lifestyle interventions • Oral biguanide drug metformin • If lifestyle modifications and the maximum tolerated metformin dose do not achieve the recommended A1c goals after 3 to 6 months, additional treatment should be given with dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagonlike peptide 1 (GLP-1) receptor agonists (liraglutide, exenatide, abliglutide) or insulin. • Lifestyle modification and maximum tolerated metformin---additional medication is required
How Glucose is metabolized
• food is digested = glucose in our small intestine --absorbed into our blood. • Insulin released due to glucose in blood to move it to cells of the body. • more insulin than we need = releases glucagon to stop insulin or we would become hypoglycemic. (*• Constant level of glucose around 30 to 40% in our blood all the time as our brain requires this to function. ) • Glucose not needed is converted to glycogen and stored for later. • stored primarily in the cells of the liver, the muscles, and the red blood cells as a water soluble form with potassium bound to it. to store glucose you need K+. • why a diet rich in raw vegetables is necessary for proper glucose control. • Everything else stored as fat in adipose tissue. • When we are not eating liver provides glucose. Secretes IGF (insulin-like growth factor) to convert stored glycogen into glucose.
