Download Diabetes Mellitus

DIABETES
MELLITUS
PREPARED BY:
RESURRECCION, CARLS BURG A.
SAMSON, AIZA
SANTOS, MARK FRANCIS
TALAUE, TYRONE JIG
TANSECO, MA. SHIELA
TOLENTINO, RYAN JOE
PREPARED TO:
MR. JEFF SAPLALA, R.N
OVERVIEW
Diabetes mellitus is a group of metabolic diseases characterized by increased levels of glucose in
the blood (hyperglycemia) resulting fromdefects in insulin secretion, insulin action, or both. Normally,a
certain amount of glucose circulates in the blood. The major sources of this glucose are Absorption of
ingested food in the gastrointestinal tract and Formation of glucose by the liver from food substances.
Insulin, a hormone produced by the pancreas, controls the level of glucose in the blood by
regulating the production and storage of glucose. In diabetes,the cells may stop respnding to insulin or the
pancreas may stop producing insulin entirely. This leads to hyperglycemia,which may results in acute
metabolic complications such as diabetes ketoacidosis (DKA) and hyperglycemic hyperosmolar non-ketotic
syndrome (HHNS).
Impact on health of population
•
Sixth leading cause of death due to cardiovascular effects resulting in atherosclerosis, coronary
artery disease, and stroke
•
Leading cause of end stage renal failure
•
Major cause of blindness
•
Most frequent cause of non-traumatic amputations
•
Diabetes affects estimated 15.7 million people (10.3 million are diagnosed; 5.4 million are
undiagnosed)
•
Increasing prevalence of Type 2 Diabetes in older adults and minority groups (African American,
American Indian and Hispanic populations)
TWO TYPES OF DIABETES MELLITUS
1. TYPE 1 DIABETES (insulin dependent diabetes mellitus)

About 5% to 10% of diabetic patients have type 1diabetes. Beta cells of the pancreas that
normally produce insulin are destroyed by an autoimmune process. Insulin injections are
needed to control the blood glucose level.

Type 1 diabetes has a sudden onset, usually before the age of 30 years.

Factors are contribute to beta cell destruction
>Combined genetic
>Immunologic
>Possibly environmental (viral)

Generally accepted that a genetic susceptibility is common underlying factor in the
development of type1 diabetes.

This genetic tendency has been found in people with certain human leukocyte antigen (HLA)
types.

HLA refers to a cluster of genes responsible for transplantation antigens and other immune
processes.

Specific cause
>The destruction of the beta cells results in the decreased insulin production
>Unchecked glucose production by the liver and
>Fasting hyperglycemia

In addition, glucose derived from food cannot be stored in the liver but instead remain in the
bloodstream and contributes to postprandial (after meals) hyperglycemia

If the concentration of glucose in the blood exceeds the renal threshold for glucose, the
kidneys may not reabsorb all the filtered glucose; the glucose then appears in the urine
(glycosuria).

When excess glucose is excreted in the urine, it is accompanied by excess loss of fluid and
electrolytes. This is called osmotic diuresis
2. TYPE 2 DIABETES (non-insulin dependent diabetes mellitus)

About 90% to 95% of diabetes have type 2 diabetes it results from a deceased sensitivity to
insulin resistance or a decreased of amount of insulin production.

Insulin resistance
> Major defect in individuals with type 2 diabetes
>Reduced biological response to insulin
>Strong predictor of type 2 diabetes
>Closely associated with obesity

In type 2 diabetes , these intracellular reactions are diminished , making insulin less
effective at stimulating glucose uptake by the tissues and at regulating glucose release by
the liver

Increase amounts of insulin must be secreted to maintain the glucose level at a normal. If
the beta cells cannot keep up with the increased demand for insulin, the glucose level rises
and type2 diabetes develops.

Uncontrolled type 2 diabetes may lead to another acute problem-DKA,HHNS

Type 2 diabetes is first treated with diet and exercise, then oral hypoglycemic agents as
needed

Type 2 diabetes occurs most frequently inpatients older than 30 years of age and in obese
patients.
3. GESTATIONAL DIABETES

Gestational diabetes is characterized by any degree of glucose intolerance with onset during
pregnancy (second or third trimester).

Hyperglycemia develops during pregnancy because of the secretions of the placental
hormones, which causes insulin resistance

It occurs in women 25 years of age or older, women younger than 25 years of age who are
obese , women with a family history of diabetes in first degree relatives , or members of
certain ethnic racial groups.
CLINICAL MANIFESTATION (all types)

“3 Ps”
>Polyuria( increase urination)
>Polydipsia(increase thirst)
>Polyphagia(increase appetite)
 Fatique
 Weakness
 Sudden vision changes
 Tingling or numbness in hands or feet
 Dry skin
 Skin lesions or wounds that are slow to heal
 Recurrent infection
 Onset of type 1 diabetes may be associated with nausea, vomiting, or stomach pains.
 Type 2 diabetes results from a slow(over years), progressive glucose intolerance and result in long
term complications if diabetes goes undetected for many years (eye disease, peripheral neuropathy,
peripheral vascular disease). Complication may have developed the actual diagnosis is made.
 Sign and symptoms of DKA include abdominal pain, nausea ,vomiting, hyperventilation and fruity
breath odor. Untreated DKA may result in altered level of consciousness, coma and death.
PATHOPHYSIOLOGY
Insulin is secreted by beta cells, which are one of four types of cells in the islets of Langerhans
in the pancreas. Insulin is an anabolic, or storage, hormone. When a person eats a meal, insulin secretion
increases and moves glucose from the blood into the muscle, liver, and fat cells. In those cells, insulin;

Transport and metabolizes glucose for energy

Stimulates storage of glucose in the liver and muscle (in the form of glycogen)

Signals the liver to stop the release of glucose

Enhances the storage of dietary fat in adipose tissue

Accelerates transport of amino acids (derived from dietary protein) into cells
Insulin also inhibits the breakdown of stored glucose, protein, and fat. During fasting periods
(between meals and overnight), the pancreas continuously releases a small amount of insulin (basal insulin);
another pancreatic hormone called glucagon (secreted by th alpha cells of the islets of Langerhans) is
released when blood glucose levels decrease and stimulates the liver to release storage glucose. The
insulin and glucagon together maintain a constant level of glucose in the blood by stimulating the release of
glucose from the liver.
Initially, the liver produces glucose through the breakdown of glycogen (glycogenolysis). After 8 to
12 hours without food, the liver forms glucose from the breakdown of noncarbohydrate substances, including
amino acids (gluconeogenesis).
DIAGNOSTIC TESTS
The list of diagnostic tests mentioned in various sources as used in the diagnosis
of Diabetes includes:

Physical Examination

Urine sugar test

Urine ketones test

Oral Glucose Tolerance Test (OGTT) - also called "glucose challenge" test.

Blood glucose tests
o
Fasting plasma glucose (FPG)
o
Random plasma glucose

C-peptide blood test

Insulin level blood test

Self-managed blood glucose testing

o
Finger prick blood drop blood glucose tests
o
Urine glucose home testing
o
Urine ketone home testing
Type 1 diabetes antibody tests
o
Glutamic Acid Decarboxylase (GAD) antibody tests



o
Islet cell antibody (ICA) tests
o
Insulin antibody tests
Tests for conditions related to Type 1 diabetes
o
TSH blood test - tests thyroid function
o
Vitamin B12 blood test - test for pernicious anemia and other digestive problems
Tests for ongoing monitoring of diabetes control:
o
HbA1c blood test - an average blood sugar measure over about 3 months.
o
Fructosamine blood test - an average blood sugar measure over about 2 weeks
Tests to detect initially and then regularly screen for diabetes complications:
o
Lipids and cholesterol - used to test risks of heart disease from diabetes.
o
Blood pressure tests
o
Eye tests
o
Foot tests
o
Urine protein test - tests for kidney problems.
o
Microalbumin urine test - also called "microalbuminurea" test; detects early kidney problems.
MEDICAL MANAGEMENT
 The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the
development of vascular and neuropathic complications.
 The therapeutic goal within each type of diabetes is to achieve normal blood glucose levels
(euglycemia) without hypoglycemia and without seriously disrupting the usual activities.
 There are five components of management for diabetes: nutrition, exercise, monitoring,
pharmacologic therapy, and education.
 Primary treatment of type 1 diabetes is insulin
 Primary treatment of type 2 diabetes is weight loss.
 Exercise is important in enhancing the effectiveness of insulin.
 Use oral hypoglycemic agents if diet and exercise are not successful in controlling blood glucose
levels. Insulin injections may be used in acute situations.
NURSING MANAGEMENT
Maintaining Fluid and Electrolyte Balance
 Measure intake and output
 Administer intravenous fluids and electrolytes as ordered
 Encourage fluid intake
 Measure serum electrolytes ( sodium, potassium) and monitor closely
 Monitor vital signs to detect hydration: tachycardia
Improving Nutritional intake
 Plan the diet with glucose control as the primary goal
 Take into consideration patient’s lifestyle, cultural background, activity level and food preferences
 Encourage patient to eat full meals and snacks as per diabetic diet
 Make arrangement for extra snacks before increased physical activity
 Ensure that insulin orders are altered as needed for delays in eating
Reducing anxiety
 Provide emotional support
 Clear up misconception with patients
 Assist patient and family to focus on learning self care behaviors
 Positive reinforcement
Monitoring and managing potential complication
Teaching patient about self care
 Teach preventive behaviors for long term complication and patient survival skill
 Provide special equipment for instruction on diabetic survival skills
 Tailor information
 Instruct family
 Recommends follow up education; physical impairments
Nutrition
 Eating habits, relationship of food and insulin meal plan
 Follow up education; management skills
Exercise
 Exercise is extremely important because of its effects on lowering of blood glucose levels
 Exercise is useful in losing weight and maintaining a feeling of well being
 Exercise alters blood lipids, increasing levels of high density lipoproteins and decreasing total
cholesterol and triglyceride level
Pharmacologic therapy
IDDM
•
Insulin replacement therapy (a must)
•
Insulin + Oral hypoglycemic agents (sometimes)
NIDDM
•
Oral hypoglycemic agents