Diabetes Mellitus
- 2. Introduction Diabetes is a disorder characterized by hyperglycemia or elevated blood glucose (blood sugar). Our bodies function best at a certain level of sugar in the bloodstream. If the amount of sugar in our blood runs too high or too low, then we typically feel bad. Diabetes is the name of the condition where the blood sugar level consistently runs too high. Diabetes is the most common endocrine disorder.
- 3. Definition Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both. Note: The chronic hyperglycemia of diabetes is associated with relatively specific long-term microvascular complications affecting the eyes, kidneys and nerves, as well as an increased risk for cardiovascular disease (CVD).
- 4. Types Type 1 diabetes: It is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood. A number of medical risks are associated with type 1 diabetes. Many of them stem from damage to the tiny blood vessels in your eyes (called diabetic retinopathy), nerves (diabetic neuropathy), and kidneys (diabetic nephropathy). Even more serious is the increased risk of heart disease and stroke.
- 5. Cont…. Type 2 diabetes: • The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). With Type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body's needs, or the body's cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells.
- 6. Cont…. Gestational Diabetes:- This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy.
- 7. Pathophysiology Due to any factor Deficiency of insulin due to glucose enter the cells, remaining glucose enter the blood. Hyperglycemia, by the renal tubules and Diversion of water it leads to osmotic changes. Decreased water reabsorption. Polyuria
- 8. Cont…. Dehydration takes places Polydipsia Muscle protein breakdown by it changes glucose to fatty acids by gluconeogenesis Hyperglycemia Glucose is completely absent fat is act as a glucose and fat broken down by fatty acids
- 9. Cont…. Glycerol convert Ketone bodies Ketoneuria Decreased pH level in the blood Ketoacidosis Cardiac Arrest
- 10. Clinical Manifestation Polydipsia Polyphagia Polyuria Weightloss Blurred Vision Ketone Urine Pruritis Skin infestation Vaginitis Weakness Fatique Poor wound healing Recurrent infection Hyperglycemia Depression
- 11. Diagnostic Evaluation i)Fasting Blood Sugar:- Over night nil per oral - 8hrs, then find out the blood sugar. Avoid smoke because vaso-construction occur in the blood vessels. ii) Random Blood Sugar:- Any time random blood sugar can be taken. iii) Oral glucose Tolerance Test:- Evaluate insulin response to glucose loading FBS is obtained before the ingestion of a 50 to 200g glucose load and blood samples are drawn at ½ , 1, 2, 3hrs (may be 4 or 5hrs sampling)
- 12. Cont…. iv) Glycated Hemoglobin:- Measures glycemic control over the period of irreversible reaction of glucose hemoglobin through freely permiable. v) C – Peptide Assay (Connecting Peptide Assay):- Cleaved from the pro- insulin molecules during its conversion to insulin. C- Peptide act as a marker for endogenous insulin production. Test can be performed after an overnight fast or after stimulation with sustacal, IV glucose or 1mg of glucagon subcutaneously.
- 13. Medical Management Oral Anti diabetic Agents: Ist Generation:- 1.Tolbutamide – 500-2000mg/day-QSH 2. Chloropromide-100-500mg/day-od 3. Tolasamide-100mg/day-(od or bd) Action: Stimulate beta cells of pancreas to secrete insulin. Mild Diuretic.
- 14. Cont…. II Generation:- 1.Glipizide – 2.5 to 40mg/day (bd) 2.Glyburide – 1.5 to 12mg/day (bd) Action: Increase tissue response to insulin. Mild Diuretic.
- 15. Cont…. III Generation:- Alpha-Glucosidase Inhibitors = Biguanides (Precose) – 75 to 100mg/day Action: Increase tissue response to insulin and decrease hepatic production of glucose.
- 16. Cont…. IV. Meglitinides:- Prandin – 1-3 times/ day-Stimulate insulin secretion. V. Thiazolodine-diones:- Avandia (od)- Increase insulin action at receptors.
- 17. Insulin Therapy Duration of action: Short, Intermediate and Long acting Drugs: Short acting=> Humalog (insulin lispro injection) Intermediate=> Lente-Regular Long-acting => Ultralente-Regular The starting dosage: 0.5units/kg/day. Sites: * Inside and Outside of Upper arm * Except Umbilicus – around the abdomen * Thigh and Gluteal
- 18. Diet Management • Improving good glucose and lipid levels. • Providing consistency day to day food intake. • Facilitating weight management. • Providing adequate nutrition for all stages of life.
- 19. Nursing Management Closely monitor blood glucose levels to detect Hypoglycemia. A program planned exercise according the tension. To reduce stress and tension. Check feet and legs for skin temperature, sensation and dryness. Teach the action, use and side – effect of diabetes on life style, finances, family life etc.
- 20. Nursing Diagnosis Nutrition more than body requirement r/t intake in excess of activity expenditures. Risk for injury r/t effects of insulin, inability to eat. Activity intolerance related to poor glucose control. Risk for impaired skin integrity related to decreased sensation and circulation to lower extremities. Knowledge deficit r/t use of oral hypoglysemic agents.
- 21. Complication Acute: Hypoglycemia Diabetic Keto-acidosis Cataract Pyodermia Chronic: Retinopathy Nephropathy Cardiopathy