1
NRSG 3320 Adult Health 1 - Exam 2 Review
Adult Health – Exam 2 Review Mod 5 - 8
Module 5
Diabetes
• A group of diseases characterized by hyperglycemia caused by defects in insulin
secretion, insulin action, or both
• Affects nearly 25.8 million people in the United States; one third of the cases are
undiagnosed
• Prevalence is increasing
• Minority populations and older adults are disproportionately affected
Classifications of Diabetes
• Type 1 diabetes
• Type 2 diabetes
• Latent autoimmune diabetes of adults (LADA)
• Gestational diabetes
• Diabetes associated with other conditions or syndromes
• Refer to Table 51-1
TABLE 51-1 Classification of Diabetes and Related Glucose Intolerances
Current Classification Clinical Characteristics and Clinical Implications
Type 1 (5% of all diabetes; previously Onset any age, but usually young (<30 years)
classified as juvenile diabetes, Usually thin at diagnosis; recent weight loss
juvenile-onset diabetes, ketosis- Etiology includes genetic, immunologic, and environmental
prone diabetes, brittle diabetes, factors (e.g., virus)
and insulin-dependent diabetes Often have islet cell antibodies
mellitus [IDDM]) Often have antibodies to insulin even before insulin treatment
Little or no endogenous insulin
Need exogenous insulin to preserve life
Ketosis prone when insulin absent
Acute complication of hyperglycemia: diabetic ketoacidosis
Type 2 (95% of all diabetes: obese— Onset any age, usually >30 years
80% of type 2, nonobese—20% of Usually obese at diagnosis
type 2; previously classified as Causes include obesity, heredity, and environmental factors
adult-onset diabetes, maturity- No islet cell antibodies
onset diabetes, ketosis-resistant Decrease in endogenous insulin, or increased with insulin resist
diabetes, stable diabetes, and non– Most patients can control blood glucose through weight loss if
insulin-dependent diabetes obese
mellitus [NIDDM]) Oral antidiabetic agents may improve blood glucose levels
if dietary
modification and exercise are unsuccessful
May need insulin on a short- or long-term basis to prevent
hyperglycemia
, 2
NRSG 3320 Adult Health 1 - Exam 2 Review
TABLE 51-1 Classification of Diabetes and Related Glucose Intolerances
Current Classification Clinical Characteristics and Clinical Implications
Ketosis uncommon, except in stress or infection
Acute complication: hyperglycemic hyperosmolar syndrome
Diabetes associated with other Accompanied by conditions known or suspected to cause the di
conditions or syndromes pancreatic diseases, hormonal abnormalities, medications such
(previously classified as secondary corticosteroids and estrogen-containing preparations
diabetes) Depending on the ability of the pancreas to produce insulin, the
may require treatment with oral antidiabetic agents or insulin.
Gestational diabetes Onset during pregnancy, usually in the second or third trimeste
Because of hormones secreted by the placenta, which inhibit th
of insulin
Above-normal risk for perinatal complications, especially macro
(abnormally large babies)
Treated with diet and, if needed, insulin to strictly maintain nor
glucose levels
Occurs in about 18% of pregnancies
Glucose intolerance transitory but may recur:
In subsequent pregnancies
35–60% will develop diabetes (usually type 2)
within 10 to 20 years, especially if
obese
Risk factors include obesity, age >30 years, family history of dia
previous
large babies (>9 lb)
Screening tests (glucose challenge test) should be performed on
pregnant women between 24 and 28 weeks of gestation
Should be screened for diabetes periodically
Prediabetes (previously classified as Previous history of hyperglycemia (e.g., during pregnancy or illn
previous abnormality of glucose Current normal glucose metabolism
tolerance) Impaired glucose tolerance or impaired fasting glucose screenin
age
40 years if there is a family history of diabetes or if symptomati
Encourage ideal body weight, because loss of 10–15 lb may imp
glycemic control
, 3
NRSG 3320 Adult Health 1 - Exam 2 Review
Functions of Insulin
• Transports and metabolizes glucose for energy
• Stimulates storage of glucose in the 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 the breakdown of stored glucose, protein, and fat
Type 1 Diabetes
• Insulin-producing beta cells in the pancreas are destroyed by a combination of genetic,
immunologic, and environmental factors
• Results in no insulin production, unchecked glucose production by the liver and fasting
hyperglycemia - Affects 5% of adults with diabetes
Type 2 Diabetes
• Insulin resistance and impaired insulin secretion
• Affects 95% of adults with diabetes, onset over age 30 years, increasing in children r/t
obesity
• Slow, progressive glucose intolerance and may go undetected for years
• Pathogenesis of Type 2 Diabetes
Latent Autoimmune Diabetes of Adults (LADA)
• Subtype of diabetes in which progression of autoimmune beta cell destruction in the
pancreas is slower than in types 1 and 2 diabetes
• Not insulin dependent in the initial 6 months of disease onset.
• Clinical manifestation of LADA shares the features of types 1 and 2 diabetes
• Emerging subtype has led some to propose the diabetes classification scheme should be
revised to reflect changes in the beta cells in the pancreas
Risk Factors
, 4
NRSG 3320 Adult Health 1 - Exam 2 Review
• Type 1: early-onset, familial, genetic predisposition, possible immunologic or
environmental (viral or toxins) factors
• Refer to Chart 51-1
• Type 2: obesity, age, previous identified impaired fasting glucose or impaired glucose
tolerance, hypertension ≥140/90 mm Hg, HDL ≤35 mg/dL or triglycerides ≥250 mg/dL,
history of gestational diabetes or babies over 9 pounds
Clinical Manifestations
• Depends on the level of hyperglycemia
• “Three Ps”
• Polyuria
• Polydipsia
• Polyphagia
Diagnostic Findings
• Fasting blood glucose 126 mg/dL or more
OR
• Casual glucose exceeding 200 mg/dL plus symptoms
OR
• Post-load glucose > 200 mg/dL
OR
• A1C > 6.5%
Medical Management of Diabetes
• Main goal is to normalize insulin activity and blood glucose levels to reduce the
development of complications.
• The ADA now recommends HgbA1C less than 7%
• Diabetes management has five components:
• Nutritional therapy
• Exercise
• Monitoring
• Pharmacologic therapy
• Education
Dietary Management Goals
• Control of total caloric intake to attain or maintain a reasonable body weight
• Control of blood glucose levels
• Normalization of lipids and blood pressure to prevent heart disease
Role of the Nurse
• Be knowledgeable about medical and dietary management
• Communicate important information to the dietician or other management specialists
• Reinforce patient understanding
NRSG 3320 Adult Health 1 - Exam 2 Review
Adult Health – Exam 2 Review Mod 5 - 8
Module 5
Diabetes
• A group of diseases characterized by hyperglycemia caused by defects in insulin
secretion, insulin action, or both
• Affects nearly 25.8 million people in the United States; one third of the cases are
undiagnosed
• Prevalence is increasing
• Minority populations and older adults are disproportionately affected
Classifications of Diabetes
• Type 1 diabetes
• Type 2 diabetes
• Latent autoimmune diabetes of adults (LADA)
• Gestational diabetes
• Diabetes associated with other conditions or syndromes
• Refer to Table 51-1
TABLE 51-1 Classification of Diabetes and Related Glucose Intolerances
Current Classification Clinical Characteristics and Clinical Implications
Type 1 (5% of all diabetes; previously Onset any age, but usually young (<30 years)
classified as juvenile diabetes, Usually thin at diagnosis; recent weight loss
juvenile-onset diabetes, ketosis- Etiology includes genetic, immunologic, and environmental
prone diabetes, brittle diabetes, factors (e.g., virus)
and insulin-dependent diabetes Often have islet cell antibodies
mellitus [IDDM]) Often have antibodies to insulin even before insulin treatment
Little or no endogenous insulin
Need exogenous insulin to preserve life
Ketosis prone when insulin absent
Acute complication of hyperglycemia: diabetic ketoacidosis
Type 2 (95% of all diabetes: obese— Onset any age, usually >30 years
80% of type 2, nonobese—20% of Usually obese at diagnosis
type 2; previously classified as Causes include obesity, heredity, and environmental factors
adult-onset diabetes, maturity- No islet cell antibodies
onset diabetes, ketosis-resistant Decrease in endogenous insulin, or increased with insulin resist
diabetes, stable diabetes, and non– Most patients can control blood glucose through weight loss if
insulin-dependent diabetes obese
mellitus [NIDDM]) Oral antidiabetic agents may improve blood glucose levels
if dietary
modification and exercise are unsuccessful
May need insulin on a short- or long-term basis to prevent
hyperglycemia
, 2
NRSG 3320 Adult Health 1 - Exam 2 Review
TABLE 51-1 Classification of Diabetes and Related Glucose Intolerances
Current Classification Clinical Characteristics and Clinical Implications
Ketosis uncommon, except in stress or infection
Acute complication: hyperglycemic hyperosmolar syndrome
Diabetes associated with other Accompanied by conditions known or suspected to cause the di
conditions or syndromes pancreatic diseases, hormonal abnormalities, medications such
(previously classified as secondary corticosteroids and estrogen-containing preparations
diabetes) Depending on the ability of the pancreas to produce insulin, the
may require treatment with oral antidiabetic agents or insulin.
Gestational diabetes Onset during pregnancy, usually in the second or third trimeste
Because of hormones secreted by the placenta, which inhibit th
of insulin
Above-normal risk for perinatal complications, especially macro
(abnormally large babies)
Treated with diet and, if needed, insulin to strictly maintain nor
glucose levels
Occurs in about 18% of pregnancies
Glucose intolerance transitory but may recur:
In subsequent pregnancies
35–60% will develop diabetes (usually type 2)
within 10 to 20 years, especially if
obese
Risk factors include obesity, age >30 years, family history of dia
previous
large babies (>9 lb)
Screening tests (glucose challenge test) should be performed on
pregnant women between 24 and 28 weeks of gestation
Should be screened for diabetes periodically
Prediabetes (previously classified as Previous history of hyperglycemia (e.g., during pregnancy or illn
previous abnormality of glucose Current normal glucose metabolism
tolerance) Impaired glucose tolerance or impaired fasting glucose screenin
age
40 years if there is a family history of diabetes or if symptomati
Encourage ideal body weight, because loss of 10–15 lb may imp
glycemic control
, 3
NRSG 3320 Adult Health 1 - Exam 2 Review
Functions of Insulin
• Transports and metabolizes glucose for energy
• Stimulates storage of glucose in the 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 the breakdown of stored glucose, protein, and fat
Type 1 Diabetes
• Insulin-producing beta cells in the pancreas are destroyed by a combination of genetic,
immunologic, and environmental factors
• Results in no insulin production, unchecked glucose production by the liver and fasting
hyperglycemia - Affects 5% of adults with diabetes
Type 2 Diabetes
• Insulin resistance and impaired insulin secretion
• Affects 95% of adults with diabetes, onset over age 30 years, increasing in children r/t
obesity
• Slow, progressive glucose intolerance and may go undetected for years
• Pathogenesis of Type 2 Diabetes
Latent Autoimmune Diabetes of Adults (LADA)
• Subtype of diabetes in which progression of autoimmune beta cell destruction in the
pancreas is slower than in types 1 and 2 diabetes
• Not insulin dependent in the initial 6 months of disease onset.
• Clinical manifestation of LADA shares the features of types 1 and 2 diabetes
• Emerging subtype has led some to propose the diabetes classification scheme should be
revised to reflect changes in the beta cells in the pancreas
Risk Factors
, 4
NRSG 3320 Adult Health 1 - Exam 2 Review
• Type 1: early-onset, familial, genetic predisposition, possible immunologic or
environmental (viral or toxins) factors
• Refer to Chart 51-1
• Type 2: obesity, age, previous identified impaired fasting glucose or impaired glucose
tolerance, hypertension ≥140/90 mm Hg, HDL ≤35 mg/dL or triglycerides ≥250 mg/dL,
history of gestational diabetes or babies over 9 pounds
Clinical Manifestations
• Depends on the level of hyperglycemia
• “Three Ps”
• Polyuria
• Polydipsia
• Polyphagia
Diagnostic Findings
• Fasting blood glucose 126 mg/dL or more
OR
• Casual glucose exceeding 200 mg/dL plus symptoms
OR
• Post-load glucose > 200 mg/dL
OR
• A1C > 6.5%
Medical Management of Diabetes
• Main goal is to normalize insulin activity and blood glucose levels to reduce the
development of complications.
• The ADA now recommends HgbA1C less than 7%
• Diabetes management has five components:
• Nutritional therapy
• Exercise
• Monitoring
• Pharmacologic therapy
• Education
Dietary Management Goals
• Control of total caloric intake to attain or maintain a reasonable body weight
• Control of blood glucose levels
• Normalization of lipids and blood pressure to prevent heart disease
Role of the Nurse
• Be knowledgeable about medical and dietary management
• Communicate important information to the dietician or other management specialists
• Reinforce patient understanding
