lOMoAR cPSD| 36357603
EXAMS 3 LP 4 AND 5 – DIABETIC MEDS NOTES NURSING HEALTH ALTERATIONS
LP 4: Diabetes
● Diabetes
○ Characterized by:
■ Hyperglycemia
● Defects in insulin secretion, insulin action, or both
○ Beta cells aren’t working at all or are very sluggish
● Ethnic and racial minorities are disproportionately affected
● Leading cause of amputations
● Biggest contributor to end stage kidney disease
● Pancreas
○ Lies behind the stomach
■ Islets of langerhans has 4 types of cells:
● Alpha cells-glucagon(sugar is gone-low blood sugar)
● Beta cells-release insulin
● Delta cells-somatostatin-Digestion
● C cells
● Functions of Insulin
○ Transport and metabolize glucose for energy
○ Stimulates storage of glucose in liver and muscle as glycogen
○ Signals the liver to stop the release of glucose
○ Enhances storage of dietary fat in adipose tissue
○ Accelerates transport of amino acids into cells
○ Inhibits breakdown of stored glucose, protein, and fat
● Classifications of Diabetes:
○ Type 1
■ Usually younger(under 30), thin at diagnosis due to weight loss, often
have islet cell antibodies, little to no insulin produced, need to administer
insulin to survive, ketosis prone when insulin is absent, a complication of
hyperglycemia is diabetic ketoacidosis. No beta cells function.
○ Type 2
■ Usually get over 30, obesity present at diagnosis, no islet cell antibodies,
decrease in insulin in body or have insulin resistance, patients can control
blood sugar with weight loss in obese patients, oral antidiabetics if dietary
modifications do not work or insulin to prevent hyperglycemia, ketosis
uncommon unless under a lot of stress, acute complication is
hyperglycemic hyperosmolar syndrome.
○ Gestational
■ Onset during pregnancy(2nd or 3rd trimester), hormones are secreted by
placenta which inhibit action of insulin, treated with a strict diet. risk
factors are obesity, family history of diabetes, screening. Have a glucose
tolerance test during pregnancy. Can predispose you to type 2 diabetes
○ Prediabetes
■ Prehistory of hyperglycemia, current normal glucose metabolism,
impaired glucose intolerance or impaired fasting glucose, encourage ideal
body weight
○ Latent autoimmune diabetes of adults(LADA)
○ Diabetes associated with other conditions or syndromes
Accompanied by conditions known or suspected such as pancreatic
disease, hormonal imbalances, corticosteroids, or estrogen containing
medications
, lOMoAR cPSD| 36357603
● Type 1 Diabetes
○ Beta cells in the pancreas are destroyed/no beta cells
○ No insulin production
○ Affects 5-10% of population
■ Signs and symptoms:
● polyuria(void out extra glucose), polydipsia, polyphagia, shaky,
dizzy, tachycardic, sweating, headache, irritable, weak, blurred
vision, weight loss,usually thin, frequent infections,
nausea/vomiting, rapid onset, insulin dependent, peak incidence
from 10-15years
■ Risk Factors:
● early-onset (age < 30 years), familial, genetic predisposition,
race/ethnicity
● Type 2 Diabetes
○ Insulin resistant and impaired insulin secretion… slow, sluggish beta cells
○ Affects 90-95% of adults with diabetes
○ Onset at or over 30
○ Increases in children due to obesity
○ Slow, progressive glucose intolerance
○ Obesity usually present at diagnosis
■ Signs and symptoms:
● Sedentary lifestyle, average age over 50, familial tendency, history
of high BP, fatigue, obesity, recurrent infections, polyuria,
polydipsia, fasting blood sugar over over 126.
■ Risk Factors:
● obesity, age >30 years, previous identified impaired
fasting glucose or impaired glucose tolerance,
hypertension, HDL ≤35 mg/dL or triglycerides ≥250
mg/dL, history of gestational diabetes or babies over 9
pounds
● Latent Autoimmune Diabetes of Adults(LADA)
○ Subtype of diabetes: autoimmune beta cell destruction in the pancreas is slower
than in type 1 and 2 diabetes-usually in type 1.
○ Not insulin dependent in the initial 6 months of disease onset
○ Clinical manifestation of LADA shares the features of type 1 and 2 diabetes.
● Clinical Manifestations
○ Depends on level of hyperglycemia
○ Three P’s
■ Polyuria, polydipsia, polyphagia
■ Fatigue, weakness, vision changes, tingling or numbness in hands or
feet, dry skin, skin lesions or wounds that are slow to heal, recurrent
infections
■ Type 1 may have sudden weight loss, nausea, vomiting or abdominal
pains
● Diagnostic findings:
○ FBS of 126 or more
○ Casual glucose over 200(done anytime)
○ Two hour post glucose equal to 200 or more during an oral glucose tolerance test
○ HbA1c at 6.5% or greater
● Medical Management of Diabetes:
○ Normalize insulin activity and blood glucose levels to reduce complications
, lOMoAR cPSD| 36357603
○ The ADA now recommends HbA1c less than 6.5%
○ Diabetes management has 5 components:
■ Nutritional therapy-what are they eating
■ Exercise
■ Monitoring-how often they are checking blood sugar
■ Pharmacologic therapy-EXPENSIVE
■ Education
● Dietary Management of Diabetes:
○ Control of caloric intake to attain or maintain reasonable body weight
○ Control of blood glucose levels
○ Normalize lipids and BP to prevent heart disease
● Meal Planning
○ Consider food preferences, lifestyle, usual eating times, and cultural and ethnic
background
○ Review diet history and need for weight loss, gain, or maintenance
○ Postprandial means after eating
○ Caloric requirements and calorie distribution throughout the day; exchange lists
■ Carbohydrates: 50% to 60% carbohydrates; emphasize whole grains
■ Fat: 20% to 30%
■ Non Animal sources of protein (e.g., legumes, whole grains) and increase
fiber
● Glycemic Index
○ Combining starchy foods with protein and fat slows absorption and glycemic
response
○ Raw or whole foods tend to have lower responses than cooked, chopped, or
pureed foods
○ Eat whole fruits rather than juices; this decreases glycemic response because of
fiber (slowing absorption)
○ Adding food with sugars may produce lower response if eaten with foods that are
more slowly absorbed
■ AVOID alcohol on an empty stomach, nutritive and nonnutritive
sweeteners, and watch for misleading labels
● Exercise
○ Lowers blood glucose
○ Aids in weight loss, easing stress, maintaining a feeling of well-being
■ Do not exercise if blood sugar over 250 due to ketones
○ Lowers cardiovascular risk
○ Insulin normally decreases with exercise; patients on exogenous insulin should
eat a 15-g carbohydrate snack before moderate exercise to prevent
hypoglycemia
○ Patients with type 2 diabetes not taking insulin or an oral agent may not need
extra food before exercise
○ Potential post exercise hypoglycemia
○ Need to monitor blood glucose levels
○ Gerontologic considerations
● Insulin Therapy
○ Blood glucose monitoring:
■ Individualized treatment regimen to obtain optimal blood sugar control
■ Self-monitoring of blood glucose has dramatically altered diabetes care
○ Categories of Insulin:
■ Rapid acting-given right before meal
EXAMS 3 LP 4 AND 5 – DIABETIC MEDS NOTES NURSING HEALTH ALTERATIONS
LP 4: Diabetes
● Diabetes
○ Characterized by:
■ Hyperglycemia
● Defects in insulin secretion, insulin action, or both
○ Beta cells aren’t working at all or are very sluggish
● Ethnic and racial minorities are disproportionately affected
● Leading cause of amputations
● Biggest contributor to end stage kidney disease
● Pancreas
○ Lies behind the stomach
■ Islets of langerhans has 4 types of cells:
● Alpha cells-glucagon(sugar is gone-low blood sugar)
● Beta cells-release insulin
● Delta cells-somatostatin-Digestion
● C cells
● Functions of Insulin
○ Transport and metabolize glucose for energy
○ Stimulates storage of glucose in liver and muscle as glycogen
○ Signals the liver to stop the release of glucose
○ Enhances storage of dietary fat in adipose tissue
○ Accelerates transport of amino acids into cells
○ Inhibits breakdown of stored glucose, protein, and fat
● Classifications of Diabetes:
○ Type 1
■ Usually younger(under 30), thin at diagnosis due to weight loss, often
have islet cell antibodies, little to no insulin produced, need to administer
insulin to survive, ketosis prone when insulin is absent, a complication of
hyperglycemia is diabetic ketoacidosis. No beta cells function.
○ Type 2
■ Usually get over 30, obesity present at diagnosis, no islet cell antibodies,
decrease in insulin in body or have insulin resistance, patients can control
blood sugar with weight loss in obese patients, oral antidiabetics if dietary
modifications do not work or insulin to prevent hyperglycemia, ketosis
uncommon unless under a lot of stress, acute complication is
hyperglycemic hyperosmolar syndrome.
○ Gestational
■ Onset during pregnancy(2nd or 3rd trimester), hormones are secreted by
placenta which inhibit action of insulin, treated with a strict diet. risk
factors are obesity, family history of diabetes, screening. Have a glucose
tolerance test during pregnancy. Can predispose you to type 2 diabetes
○ Prediabetes
■ Prehistory of hyperglycemia, current normal glucose metabolism,
impaired glucose intolerance or impaired fasting glucose, encourage ideal
body weight
○ Latent autoimmune diabetes of adults(LADA)
○ Diabetes associated with other conditions or syndromes
Accompanied by conditions known or suspected such as pancreatic
disease, hormonal imbalances, corticosteroids, or estrogen containing
medications
, lOMoAR cPSD| 36357603
● Type 1 Diabetes
○ Beta cells in the pancreas are destroyed/no beta cells
○ No insulin production
○ Affects 5-10% of population
■ Signs and symptoms:
● polyuria(void out extra glucose), polydipsia, polyphagia, shaky,
dizzy, tachycardic, sweating, headache, irritable, weak, blurred
vision, weight loss,usually thin, frequent infections,
nausea/vomiting, rapid onset, insulin dependent, peak incidence
from 10-15years
■ Risk Factors:
● early-onset (age < 30 years), familial, genetic predisposition,
race/ethnicity
● Type 2 Diabetes
○ Insulin resistant and impaired insulin secretion… slow, sluggish beta cells
○ Affects 90-95% of adults with diabetes
○ Onset at or over 30
○ Increases in children due to obesity
○ Slow, progressive glucose intolerance
○ Obesity usually present at diagnosis
■ Signs and symptoms:
● Sedentary lifestyle, average age over 50, familial tendency, history
of high BP, fatigue, obesity, recurrent infections, polyuria,
polydipsia, fasting blood sugar over over 126.
■ Risk Factors:
● obesity, age >30 years, previous identified impaired
fasting glucose or impaired glucose tolerance,
hypertension, HDL ≤35 mg/dL or triglycerides ≥250
mg/dL, history of gestational diabetes or babies over 9
pounds
● Latent Autoimmune Diabetes of Adults(LADA)
○ Subtype of diabetes: autoimmune beta cell destruction in the pancreas is slower
than in type 1 and 2 diabetes-usually in type 1.
○ Not insulin dependent in the initial 6 months of disease onset
○ Clinical manifestation of LADA shares the features of type 1 and 2 diabetes.
● Clinical Manifestations
○ Depends on level of hyperglycemia
○ Three P’s
■ Polyuria, polydipsia, polyphagia
■ Fatigue, weakness, vision changes, tingling or numbness in hands or
feet, dry skin, skin lesions or wounds that are slow to heal, recurrent
infections
■ Type 1 may have sudden weight loss, nausea, vomiting or abdominal
pains
● Diagnostic findings:
○ FBS of 126 or more
○ Casual glucose over 200(done anytime)
○ Two hour post glucose equal to 200 or more during an oral glucose tolerance test
○ HbA1c at 6.5% or greater
● Medical Management of Diabetes:
○ Normalize insulin activity and blood glucose levels to reduce complications
, lOMoAR cPSD| 36357603
○ The ADA now recommends HbA1c less than 6.5%
○ Diabetes management has 5 components:
■ Nutritional therapy-what are they eating
■ Exercise
■ Monitoring-how often they are checking blood sugar
■ Pharmacologic therapy-EXPENSIVE
■ Education
● Dietary Management of Diabetes:
○ Control of caloric intake to attain or maintain reasonable body weight
○ Control of blood glucose levels
○ Normalize lipids and BP to prevent heart disease
● Meal Planning
○ Consider food preferences, lifestyle, usual eating times, and cultural and ethnic
background
○ Review diet history and need for weight loss, gain, or maintenance
○ Postprandial means after eating
○ Caloric requirements and calorie distribution throughout the day; exchange lists
■ Carbohydrates: 50% to 60% carbohydrates; emphasize whole grains
■ Fat: 20% to 30%
■ Non Animal sources of protein (e.g., legumes, whole grains) and increase
fiber
● Glycemic Index
○ Combining starchy foods with protein and fat slows absorption and glycemic
response
○ Raw or whole foods tend to have lower responses than cooked, chopped, or
pureed foods
○ Eat whole fruits rather than juices; this decreases glycemic response because of
fiber (slowing absorption)
○ Adding food with sugars may produce lower response if eaten with foods that are
more slowly absorbed
■ AVOID alcohol on an empty stomach, nutritive and nonnutritive
sweeteners, and watch for misleading labels
● Exercise
○ Lowers blood glucose
○ Aids in weight loss, easing stress, maintaining a feeling of well-being
■ Do not exercise if blood sugar over 250 due to ketones
○ Lowers cardiovascular risk
○ Insulin normally decreases with exercise; patients on exogenous insulin should
eat a 15-g carbohydrate snack before moderate exercise to prevent
hypoglycemia
○ Patients with type 2 diabetes not taking insulin or an oral agent may not need
extra food before exercise
○ Potential post exercise hypoglycemia
○ Need to monitor blood glucose levels
○ Gerontologic considerations
● Insulin Therapy
○ Blood glucose monitoring:
■ Individualized treatment regimen to obtain optimal blood sugar control
■ Self-monitoring of blood glucose has dramatically altered diabetes care
○ Categories of Insulin:
■ Rapid acting-given right before meal
