Diabetes mellitus

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enoughinsulin, or because cells do not respond to the insulin that is produced. Types of diabetes mellitus and there symptoms  Type 1 Sign and symptoms:
        

extreme thirst frequent urination sudden unexplained weight loss extreme fatigue blurred vision muscle cramps nausea vomiting constant hunger

 Type 2  increased thirst  frequent urination  feeling tired and lethargic  always feeling hungry

 having cuts that heal slowly  itching  skin infections  blurred vision  gradually putting on weight  mood swings  headaches  feeling dizzy  leg cramps Complications od diabetes mellitus Diabetic complications can be classified broadly as microvascular or macrovascular disease.1 . nephropathy (kidney disease) and vision disorders (eg retinopathy. Microvascular complications include neuropathy (nerve damage). DIAGNOSTIC TEST: Several blood tests are used to measure blood glucose levels. glaucoma. stroke and peripheral vascular disease (which can lead to ulcers. blood can be drawn at any time throughout the day. metabolic difficulties. autonomic neuropathy and pregnancy problems.  Random blood glucose test — for a random blood glucose test. cataract and corneal disease). Additional tests can determine the type of diabetes and its severity. Macrovascular complications include heart disease. A random blood glucose level of 200 mg/dL (11. regardless of when the person last ate. impotence. the primary test for diagnosing diabetes. Follow the links below to find information on diabetes complications. Other complications of diabetes include infections. gangrene and amputation).

A fasting blood glucose of 126 mg/dL (7. this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes. It must be repeated on another day to confirm that it remains abnormally high (see “Criteria for diagnosis” below).     The standard OGTT includes a fasting blood glucose test. It is used to monitor blood glucose control in people with known diabetes. For women who have an abnormally elevated blood glucose level. A normal fasting blood glucose level is less than 100 mg/dL. the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet. Hemoglobin A1C test (A1C) — The A1C blood test measures the average blood glucose level during the past two to three months. a second OGTT is performed on another day after drinking a 100 gram glucose . Normal values for A1C are 4 to 6 percent (show figure 3).mmol/L) or higher in persons who have symptoms of high blood glucose (see “Symptoms” above) suggests a diagnosis of diabetes. The test is done by taking a small sample of blood from a vein or fingertip.0 mmol/L) or higher indicates diabetes. but is not normally used to diagnose diabetes. a second blood glucose level is measured. and is usually cola or orange-flavored). The test is done by taking a small sample of blood from a vein or fingertip. Two hours later. Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes. However.   Fasting blood glucose test — fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight).

Glucotrol XL). glyburide (DiaBeta. Glucophage XR) is the only drug in this class available in the United States. synthetic human insulin isn’t perfect. loss of appetite. and at one. nausea or vomiting. or pain. especially during the first four months of therapy. Second-generation sulfonylureas such as glipizide (Glucotrol. insulin aspart (NovoLog) and glargine (Lantus). · Biguanides. abdominal bloating. more closely resemble the way natural insulin acts in your body. A number of drug options exist for treating type 2 diabetes. your pancreas must produce some insulin on its own. . which is chemically identical to human insulin but manufactured in a laboratory. Glynase PresTab. Unfortunately. The most common side effect of sulfonylureas is low blood sugar. Among these are lispro (Humalog). two. These medications stimulate your pancreas to produce and release more insulin. It works by inhibiting the production and release of glucose from your liver. One of its chief failings is that it doesn’t mimic the way natural insulin is secreted. MEDICATIONS: The most widely used form of insulin is synthetic human insulin. Micronase) and glimepiride (Amaryl) are prescribed most often. The blood glucose level is measured before. You’re at much greater risk of low blood sugar if you have impaired liver or kidney function. but you’re not as likely to develop low blood sugar. But newer types of insulin. Metformin (Glucophage. Meglitinides work quickly. For them to be effective. have effects similar to sulfonylureas. One advantage mnof metformin is that is tends to cause less weight gain than do other diabetes medications. which means you need less insulin to transport blood sugar into your cells.solution. known as insulin analogs. such as repaglinide (Prandin). and the results fade rapidly. and three hours after drinking the solution. including: · Sulfonylurea drugs. · Meglitinides. Possible side effects include a metallic taste in your mouth. These medications.

muscle aches. it’s important to have your liver checked every two months during the first year of therapy. If taken in high doses. Symptoms include tiredness. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage. · Alpha-glucosidase inhibitors. . These may not always be related to diabetes medications.gas and diarrhea. they may also cause reversible liver damage. such as nausea and vomiting. A rare but serious side effect is lactic acidosis. Side effects of thiazolidinediones. which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol (Glyset). These drugs block the action of enzymes in your digestive tract that break down carbohydrates. gas and diarrhea. weight gain and fatigue. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. loss of appetite. A far more serious potential side effect is liver damage. abdominal pain. include swelling. alpha-glucosidase inhibitors can cause abdominal bloating. NURSING INTERVENTIONS:  Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. · single tablet. Although safe and effective. dark urine. dizziness and drowsiness. If your doctor prescribes these drugs. · Thiazolidinediones. but your doctor will need to investigate all possible causes. These effects usually decrease over time and are less likely to occur if you take the medication with food. such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos). or yellowing of your skin and the whites of your eyes (jaundice). which results when lactic acid builds up in your body. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function. weakness. That means sugar is absorbed into your bloodstream more slowly.

dryness. Demonstrate and explain thoroughly the procedure for insulin selfinjection. pulses and deep tendon reflexes. Advice patient who smokes to stop smoking or reduce if possible. Review dosage and time of injections in relation to meals. calluses. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia. Assess feet and legs for skin temperature. which may interfere with the ability to accurately administer insulin. . Maintain skin integrity by protecting feet from breakdown. to reduce vasoconstriction and enhance peripheral flow. corns. Explain the importance of exercise in maintaining or reducing weight. activity. Help patient to achieve mastery of technique by taking step by step approach. sensation. hair distribution. and bedtime based on patients individualized insulin regimen. soft tissues injuries. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia.         Assess patients for cognitive or sensory impairments.

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