Diabetis mellitus week 7 study guide review
• Illustrate the key pathophysiologic features of diabetes mellitus-2
•acute
§HHNS
§Hypoglycemia
•chronic complications
§Stroke
• Identify points in the pathophysiology connecting the disorders.
•DM, obesity, cardiovascular disease, stroke
• Plan nursing care targeted at reducing the progression of the disorders.
•Dietary, Safety, Psychosocial
• Distinguish the impact of medications and other therapeutic interventions used and the points
of the pathophysiology where these interventions have their greatest effect.
•Antihypertensives
•Type 2 DM medications
•Lifestyle modifications
• Analyze available diagnostic results in terms of the disease and the care of the patient.
DM
- Pathophysiology
- Insulin is a hormone produced by the pancreas that controls blood glucose levels
by regulating the production, use, and storage of glucose. It is secreted by beta
cells, in the islets of Langerhans of the pancreas. In patients with diabetes glucose
metabolism is disrupted due to a decrease or absence of insulin production, a
reduction in insulin efficacy at the level of the receptor (commonly known as
“insulin resistance”), or both. Insulin is an anabolic, or storage, hormone. When a
person eats a meal, insulin secretion increases and moves glucose from the blood
into muscle, liver, and fat cells. Once inside the cells, insulin functions in the
following ways:
- Facilitating Glucose Uptake: Insulin enables muscle and fat cells to
absorb glucose from the bloodstream, where it is used for immediate
energy or stored for later use.
, - Promoting Glycogenesis: In the liver and muscles, insulin stimulates
the conversion of excess glucose into glycogen, which serves as a
storage form of energy.
- Inhibiting Gluconeogenesis: Insulin suppresses the liver's production of
new glucose from non-carbohydrate sources, preventing excessive
glucose release into the bloodstream.
- Enhancing Lipogenesis: Insulin promotes the storage of excess glucose
as fat in adipose tissue, ensuring energy is available when needed.
- Reducing Lipolysis: Insulin inhibits the breakdown of stored
fat, preventing the release of free fatty acids into the
bloodstream.
- Stimulating Protein Synthesis: Insulin encourages the uptake of
amino acids into cells and enhances protein synthesis, which is
essential for tissue growth and repair
- Another hormone involved in glucose regulation is glucagon. Glucagon is
secreted by the alpha cells of the islets of Langerhans in the pancreas and
stimulates the liver to release stored glucose (glycogen), thereby increasing
the blood sugar. Insulin and glucagon work together to maintain normal serum
glucose levels.Glucagon is a catabolic hormone.
- In people with diabetes, hyperglycemia occurs when one or more of the
following changes occur: reduction or loss of insulin production, resistance to
insulin at the level of the cell, inappropriate secretion of glucagon.
- Type 1 DM
- Type 1 diabetes affects 5% to 10% of people with diabetes, primarily
impacting children and young adults. It involves the autoimmune
destruction of pancreatic beta cells, specifically type 1a diabetes,
which accounts for 5% to 10% of new diagnoses. The cause is
immune- mediated, where the body’s immune system attacks its own
tissues, including beta cells, potentially triggered by genetic,
immunologic, and environmental factors like viruses or toxins. Certain
human leukocyte antigen (HLA) types increase the risk, though the
disease itself is not inherited.
- This destruction leads to hyperglycemia due to insufficient insulin
production and unregulated glucose production by the liver. When blood
glucose exceeds the renal threshold, it causes glycosuria, resulting in
osmotic diuresis (excessive urine production). Insulin deficiency also
allows glycogenolysis and gluconeogenesis to occur, raising glucose
levels further. Additionally, fat breakdown leads to ketone production,
potentially causing ketoacidosis.
- Glucose levels can be measured via serum testing, capillary glucose,
hemoglobin A1c, and continuous glucose monitoring (CGM). Each
method offers different benefits, with serum testing being
laboratory-
, based, capillary glucose offering home testing, A1c reflecting long-term
glucose control, and CGMs providing real-time data.
- Type 2 DM
- Type 2 diabetes accounts for 90% to 95% of diabetes cases and is
increasingly affecting younger individuals. It is primarily caused by
insulin resistance, where cells become less sensitive to insulin, impairing
glucose uptake and liver glucose regulation. The exact cause of insulin
resistance is unclear, but factors such as age, weight, lack of exercise, and
genetics are believed to contribute. To compensate for insulin resistance,
the body secretes more insulin, but when the pancreas can’t meet the
demand, hyperglycemia develops.
- Diabetic ketoacidosis (DKA) is rare in type 2 diabetes because there
is usually enough insulin to prevent ketone production. However,
severe hyperglycemia can lead to hyperglycemic hyperosmolar
nonketotic syndrome (HHNS), a serious complication.
- Type 2 diabetes often develops slowly and may go unnoticed for years,
with symptoms such as fatigue, irritability, increased urination, thirst, poor
wound healing, frequent infections, and vision changes. Many people are
diagnosed through routine tests, and by the time of diagnosis,
microvascular (retinopathy, neuropathy, nephropathy) and macrovascular
(coronary disease, stroke, peripheral vascular) complications may have
already occurred.
- Signs/Symptoms
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
- Dehydration
- Weight loss
- Fatigue
- Weakness
- Transient vision changes
- Tingling or numbness in hands or feet
- Dry skin
- Skin lesions\
- Slow-healing wounds
- Recurrent infections
- Diagnostics
- A1c of 6.5% or greater
- Or
, - Symptoms of diabetes plus random plasma glucose concentration equal to or
greater than 200 mg/dL (11.1 mmol/L). “Random” is defined as any time of day
without regard to time since last meal. The classic symptoms of diabetes
include polyuria, polydipsia, and unexplained weight loss.
- Or
- Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for at least 8 hours.
- Or
- Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/L)
during an oral glucose tolerance test. The test should be performed as described
by the World Health Organization, using a glucose load containing the
equivalent of 75 g anhydrous glucose dissolved in water.
- In the absence of unequivocal hyperglycemia with acute metabolic
decompensation, these criteria should be confirmed by repeat testing on a
different day. The fourth measure is not recommended for routine clinical
use.
- According to ATI:
- Diagnostic criteria for diabetes include two findings (on separate days) of at
least one of the following.
- Manifestations of diabetes plus casual blood glucose concentration
greater than 200 mg/dL (without regard to time since last meal)
- Fasting blood glucose greater than 126 mg/dL (no caloric intake within
8 hr of testing)
- 2-hr glucose greater than 200 mg/dL with oral glucose tolerance test
- Glycosylated hemoglobin (A1C) greater than 6.5%
- Treatment/ Interventions
- Rapid-acting insulin (e.g., Lispro, Aspart): Starts working within 15 minutes,
peaks in 1-2 hours, and lasts for 3-5 hours. It's typically used before meals to
control postprandial glucose spikes.
- Short-acting insulin (Regular insulin): Takes effect within 30 minutes, peaks in 2-
3 hours, and lasts 5-8 hours. It’s often used before meals.
- Intermediate-acting insulin (e.g., NPH): Begins working in 1-2 hours, peaks in 4-
12 hours, and lasts 12-18 hours. It’s usually given twice a day to control baseline
blood glucose levels.
- Long-acting insulin (e.g., Glargine, Detemir): Starts working in 1-2 hours and
provides a steady release of insulin for up to 24 hours, with no peak. It's often
used for basal insulin needs.
- Pre-mixed insulin: A combination of rapid- or short-acting insulin with
intermediate-acting insulin, providing both quick and sustained insulin coverage
in one injection.
- Nursing Actions
- Patient Teaching
• Illustrate the key pathophysiologic features of diabetes mellitus-2
•acute
§HHNS
§Hypoglycemia
•chronic complications
§Stroke
• Identify points in the pathophysiology connecting the disorders.
•DM, obesity, cardiovascular disease, stroke
• Plan nursing care targeted at reducing the progression of the disorders.
•Dietary, Safety, Psychosocial
• Distinguish the impact of medications and other therapeutic interventions used and the points
of the pathophysiology where these interventions have their greatest effect.
•Antihypertensives
•Type 2 DM medications
•Lifestyle modifications
• Analyze available diagnostic results in terms of the disease and the care of the patient.
DM
- Pathophysiology
- Insulin is a hormone produced by the pancreas that controls blood glucose levels
by regulating the production, use, and storage of glucose. It is secreted by beta
cells, in the islets of Langerhans of the pancreas. In patients with diabetes glucose
metabolism is disrupted due to a decrease or absence of insulin production, a
reduction in insulin efficacy at the level of the receptor (commonly known as
“insulin resistance”), or both. Insulin is an anabolic, or storage, hormone. When a
person eats a meal, insulin secretion increases and moves glucose from the blood
into muscle, liver, and fat cells. Once inside the cells, insulin functions in the
following ways:
- Facilitating Glucose Uptake: Insulin enables muscle and fat cells to
absorb glucose from the bloodstream, where it is used for immediate
energy or stored for later use.
, - Promoting Glycogenesis: In the liver and muscles, insulin stimulates
the conversion of excess glucose into glycogen, which serves as a
storage form of energy.
- Inhibiting Gluconeogenesis: Insulin suppresses the liver's production of
new glucose from non-carbohydrate sources, preventing excessive
glucose release into the bloodstream.
- Enhancing Lipogenesis: Insulin promotes the storage of excess glucose
as fat in adipose tissue, ensuring energy is available when needed.
- Reducing Lipolysis: Insulin inhibits the breakdown of stored
fat, preventing the release of free fatty acids into the
bloodstream.
- Stimulating Protein Synthesis: Insulin encourages the uptake of
amino acids into cells and enhances protein synthesis, which is
essential for tissue growth and repair
- Another hormone involved in glucose regulation is glucagon. Glucagon is
secreted by the alpha cells of the islets of Langerhans in the pancreas and
stimulates the liver to release stored glucose (glycogen), thereby increasing
the blood sugar. Insulin and glucagon work together to maintain normal serum
glucose levels.Glucagon is a catabolic hormone.
- In people with diabetes, hyperglycemia occurs when one or more of the
following changes occur: reduction or loss of insulin production, resistance to
insulin at the level of the cell, inappropriate secretion of glucagon.
- Type 1 DM
- Type 1 diabetes affects 5% to 10% of people with diabetes, primarily
impacting children and young adults. It involves the autoimmune
destruction of pancreatic beta cells, specifically type 1a diabetes,
which accounts for 5% to 10% of new diagnoses. The cause is
immune- mediated, where the body’s immune system attacks its own
tissues, including beta cells, potentially triggered by genetic,
immunologic, and environmental factors like viruses or toxins. Certain
human leukocyte antigen (HLA) types increase the risk, though the
disease itself is not inherited.
- This destruction leads to hyperglycemia due to insufficient insulin
production and unregulated glucose production by the liver. When blood
glucose exceeds the renal threshold, it causes glycosuria, resulting in
osmotic diuresis (excessive urine production). Insulin deficiency also
allows glycogenolysis and gluconeogenesis to occur, raising glucose
levels further. Additionally, fat breakdown leads to ketone production,
potentially causing ketoacidosis.
- Glucose levels can be measured via serum testing, capillary glucose,
hemoglobin A1c, and continuous glucose monitoring (CGM). Each
method offers different benefits, with serum testing being
laboratory-
, based, capillary glucose offering home testing, A1c reflecting long-term
glucose control, and CGMs providing real-time data.
- Type 2 DM
- Type 2 diabetes accounts for 90% to 95% of diabetes cases and is
increasingly affecting younger individuals. It is primarily caused by
insulin resistance, where cells become less sensitive to insulin, impairing
glucose uptake and liver glucose regulation. The exact cause of insulin
resistance is unclear, but factors such as age, weight, lack of exercise, and
genetics are believed to contribute. To compensate for insulin resistance,
the body secretes more insulin, but when the pancreas can’t meet the
demand, hyperglycemia develops.
- Diabetic ketoacidosis (DKA) is rare in type 2 diabetes because there
is usually enough insulin to prevent ketone production. However,
severe hyperglycemia can lead to hyperglycemic hyperosmolar
nonketotic syndrome (HHNS), a serious complication.
- Type 2 diabetes often develops slowly and may go unnoticed for years,
with symptoms such as fatigue, irritability, increased urination, thirst, poor
wound healing, frequent infections, and vision changes. Many people are
diagnosed through routine tests, and by the time of diagnosis,
microvascular (retinopathy, neuropathy, nephropathy) and macrovascular
(coronary disease, stroke, peripheral vascular) complications may have
already occurred.
- Signs/Symptoms
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
- Dehydration
- Weight loss
- Fatigue
- Weakness
- Transient vision changes
- Tingling or numbness in hands or feet
- Dry skin
- Skin lesions\
- Slow-healing wounds
- Recurrent infections
- Diagnostics
- A1c of 6.5% or greater
- Or
, - Symptoms of diabetes plus random plasma glucose concentration equal to or
greater than 200 mg/dL (11.1 mmol/L). “Random” is defined as any time of day
without regard to time since last meal. The classic symptoms of diabetes
include polyuria, polydipsia, and unexplained weight loss.
- Or
- Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for at least 8 hours.
- Or
- Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/L)
during an oral glucose tolerance test. The test should be performed as described
by the World Health Organization, using a glucose load containing the
equivalent of 75 g anhydrous glucose dissolved in water.
- In the absence of unequivocal hyperglycemia with acute metabolic
decompensation, these criteria should be confirmed by repeat testing on a
different day. The fourth measure is not recommended for routine clinical
use.
- According to ATI:
- Diagnostic criteria for diabetes include two findings (on separate days) of at
least one of the following.
- Manifestations of diabetes plus casual blood glucose concentration
greater than 200 mg/dL (without regard to time since last meal)
- Fasting blood glucose greater than 126 mg/dL (no caloric intake within
8 hr of testing)
- 2-hr glucose greater than 200 mg/dL with oral glucose tolerance test
- Glycosylated hemoglobin (A1C) greater than 6.5%
- Treatment/ Interventions
- Rapid-acting insulin (e.g., Lispro, Aspart): Starts working within 15 minutes,
peaks in 1-2 hours, and lasts for 3-5 hours. It's typically used before meals to
control postprandial glucose spikes.
- Short-acting insulin (Regular insulin): Takes effect within 30 minutes, peaks in 2-
3 hours, and lasts 5-8 hours. It’s often used before meals.
- Intermediate-acting insulin (e.g., NPH): Begins working in 1-2 hours, peaks in 4-
12 hours, and lasts 12-18 hours. It’s usually given twice a day to control baseline
blood glucose levels.
- Long-acting insulin (e.g., Glargine, Detemir): Starts working in 1-2 hours and
provides a steady release of insulin for up to 24 hours, with no peak. It's often
used for basal insulin needs.
- Pre-mixed insulin: A combination of rapid- or short-acting insulin with
intermediate-acting insulin, providing both quick and sustained insulin coverage
in one injection.
- Nursing Actions
- Patient Teaching
