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1) It is a disease that affect metabolism of carbohydrate. 2) Usual age of onset is 40 to 60, newborn, very old people. Many cases only know during routine examination (to get insurance before operation). It is a hereditary ailment. Both parents have, likely the children will get it. If 1 parent get, the ratio will be 1:5 for children. Under normal circumstances, carbohydrate (bread, potato, rice) are broken down in the bowel and absorbed into the blood as glucose. Glucose is then carried to the liver where it is stored as glycogen by the action of insulin. Only enough glucose is left in the blood for the provision of normal metabolism. Insulin regulates how much glucose must be available in the blood for energy and how much is stored away in the liver as glycogen for later use. Insulin is a hormone produced by special collection of cells in the pancreas known as islet of Langerhans. The islets of Langerhans pour a lot of insulin into the blood stream after a large carbohydrate meal has been eaten, since large quantities of insulin are necessary to store excessive glucose in the liver. In diabetes, either the pancreas gland does not produce enough insulin or if insulin is produced, it is ineffective (ma doesn’t noe the cause). In either event, there is not enough insulin available and instead of excess glucose being stored in the liver, it simply accumulates in the blood. When the sugar in the blood rises above a certain level or threshold, the kidney excretes the excess sugar in the urine. Hence, large quantities of urine are passed to get rid of the excess sugar. This excessive urination soon leads to thirst while the continuous drain of glucose from the body depletes the tissue of their vital energy supplies. In severe cases, since carbohydrates are no longer available for adequate metabolism, fat is used instead. Improper fat metabolism leads to the formation of toxic ketone bodies and it is the excessive production of these toxic acids (ketosis) which may lead to diabetic coma. Cause The real cause is unknown. Hereditary predisposition, persistent overeating and obesity may lead to the onset of the diabetes. Sometimes the onset is precipitated by an infection, operation or pregnancy but in children, there is no obvious cause. Signs and Symptoms 1) Mild cases, no symptoms only first diagnosed by routine examination (sugar in the urine, blood sugar is raised) 2) Polyuria( keep on urinating) leads to great thirst 3) The feeling of hunger is often unsatisfied by food – polyphagia 4) Loss of weight 5) Loss of energy 6) In elderly women, pruritus vulvulae (itchiness around the vulva) is common and disturbs sleep. 7) Infections such as boils and carbuncles are liable to occur. They are prone to tuberculosis.
the blood sugar levels return to normal and no sugar in the urine. Pale colour. has high specific gravity due to sugar contained. The symptoms of thirst. loss of weight and weariness are usually marked and this patient is obliged to seek medical advice. If they neglect themselves or develop infection eg pyelitis or gastro-enteritis. Childhood diabetes and diabetes in young people is always of this type. (1030-1040) The test for sugar is positive. rather than different kinds of diabetes. the supply of insulin from the pancreas is regulated by the food eaten. Blood (there may be newer methods) 1) Normally the fasting blood sugar is about 80 mg per 100 ml and this rises to 120 mg after a meal. 3) Moderate diabetes Moderate diabetes occurs in middle age people. diabetics can be divided into 3 types. but this level is exceeded when diabetes is persistent. pruritus vulvulae is common. Types of diabetes Depending on the age of the patient and severity of symptoms. polyuria. Following a large carbohydrate meal. 2) Mild Diabetes It is associated with obesity. 1) Severe diabetes Can occur at any age. all requiring different treatment. Urine 1) 2) 3) 4) The urine is greatly increased. Symptoms are usually not severe and the urine contains sugar without acetone. They are prone to diabetic coma. The diet must be sufficient to keep the weight at a normal level and tablets should be taken to reduce the blood sugar to a normal range. In women. Dietary Regime In normal people. Normally. In diabetes. If no food is taken. (u change it to mmol coz we r lazy to convert =)(It is a smiley face) ). very little insulin is secreted. the blood sugar does not rise above 180 mg per 100 ml. the pancreas produce considerable amounts of insulin. 2) Glucose tolerance test – the suspected diabetic patient is given a drink containing 50 g of glucose and blood is taken for the estimation of sugar at intervals thereafter. Once a normal weight has been achieved. Acetone and diacetic acid (ketone bodies) may also be present in the more severe cases. They do not respond to tablets. The patient must adhere to a low calorie diet in order to lose weight. These types represent different degrees of the same disease process. Patient in this class need insulin and a full diet. In diabetes. the fasting blood sugar may be over 200 mg per 100 ml and even higher after food.Diagnosis Diagnosis is made from clinical picture and by testing urine and the blood for sugar. Thirst and polyuria gradually develop. These patients are usually middle aged or elderly and symptoms may be absent or mild. Not associated with obesity. . even after taking glucose.
Make sure u noe where the patient get the needle and syringes so u can advice the patient Insulin is prepared from the pancreas glands removed from cattle. Some diabetic are liable to these attacks despite all precautions. in addition to the 3 main meals of breakfast. in the early afternoon and at bedtime. The glands are immediately frozen to prevent the destruction of insulin by the digestive enzymes also present and insulin is later extracted by special methods. tea. Insulin is destroyed by the gastric juices with the result that it cannot be given by mouth and has to be administered by subcutaneous injection. there should also be snacks in the middle of the morning. mental confusion. bed-time snack…. Special diet for a day eg 2 200 calories for a day. Pure insulin. There are many types of insulin eg:1) Soluble insulin/ pure insulin 2) Insulin-zinc suspension (Lente Insulin) 3) Protamine Zinc Insulin (PZI) Hypoglycemia When the blood sugar level falls too low. Hence various forms of insulin have been prepared which prolong its action to last all day. It must contain fruit and fresh vegetables.000 calories a day. palpitation. lunch. A man doing a heavy labouring job may require 2. 800 calories or more. to satisfy his appetite and to maintain his weight at a proper level. when injected subcutaneously leads to a fall in the blood sugar. 3) Meals must be spaced during the day. dinner. The principles of the diet in patient taking must include:1) A diet sufficient in quantity to enable the patient to undertake his activities. A fixed amount of insulin is injected each day and hence the diet must not be allowed to vary in quantity. pigs and sheep after slaughter. and trembling – How to recognise? – a diabetic . Delayed meals may lead to hypoglycaemia attack (briefly inform the patients the signs and symptoms and what to do if asked or if u wanna give additional info to the patient) Arranging the Diet Go through the diet which is given by your lecturer.hehe if ur lecturer ajar lah. known as soluble insulin. symptoms of hypoglycaemia occur. Eg wat meals for breakfast. mid-morning snack. It is likely to occur 1) when meals are delayed or irregular 2) when unusual exertion or exercise is undertaken 3) when the insulin dose is excessive due to unwise attempts to ensure that all specimen of urine are free from sugar (don’t mention this if your school no longer test urine but use blood specimens instead) The earliest symptom of hypoglycaemia are sweating. A girl of slight physique leading a sedentary life may require a diet of 2. lunch and dinner.the mechanism is lost. Thus. 2) The diet must contain an adequate amount of protein (at least 75 g) and carbohydrate (at least 180 g). Insulin Read from your book and the type of insulin available in your hospital. 4) Meals must be taken at regular times. a feeling of hunger or weakness. but its effect lasts a few hours.
Once the weight is reduced. diabetes will result. Patient should also go for follow-up hospital clinics. side effects to explain to the patient. only weight reduction. which is less that its usual for diabetics taking insulin. feeling well and free from troublesome symptoms. with dilated pupils. Nevertheless. In practice. c) Overweight Diabetics These patients. Urine is free from sugar. In the morning for eg. most patients in thes category require a diet varying from 1 500 calories to 2 000 calories. Hypoglycemia – the patient is usually sweating. search should be made for evidence of insulin injection in the thigh at lower abdomen. Depending on the degree of obesity. Unhappily. kidneys and nerves can occur even in diabetes who have done their best to keep to their regime. Glucose must be injected intravenously and the patient soon comes round. The incidence of complications can be reduced by keeping the blood sugar level as near normal as possible. This means careful adherence to the diet and careful adjustment of the dosage of insulin. Teach the patient the name of the tablet and the dosage (mg) if possible. The ultimate aim is to reduce the risk of complications which tend to occur after diabetes has been present for many years. Patient should take a glucose drink without delay to prevent him from going to insulin coma of hypoglycaemia (Sometimes have to give glucose via ryle’s tube of i/v injection) When unconscious patient admitted to hospital. shape. the blood sugar falls to normal. permanent cerebral damage may result and recovery will not take place despite elevation of the blood sugar level to normal. normal blood pressure. in some cases who have been allowed to remain in coma for many hours. Complications of diabetes The immediate aim of the treatment in diabetes is to keep the diabetic at work. size. before lunch and before dinner. sweating. the symptoms disappear. mg in each tablet. the color. rapid pulse. pale. when to take the tablet. (Basically wat dis sentence means dat u discard the urine that is passed right after u wake up and use only the 2nd urine passed out as specimen.patient taking insulin especially before meal times may have a vacant look. the patient should discard the urine passed immediately on rising and should keep for testing a specimen passed just before breakfast. Tablets U must noe the type of tablets used in Bali. do not need insulin or tablets. He must always keep to a diet. . The breathing is quiet and there in no evidence of dehydration or collapse. the diet will vary from as little as 800 each to 1 200 calories a day. complications especially in the eyes.) b) Diabetics needing tablets Dietary regime The diet should be adequate to maintain weight at the normal standard for the patient’s age and height. Overeating places a strain on he pancreas and if the supply of insulin is limited. a) Test urine (if you still use urine to test for sugar) It is best not to test urine that has been in the bladder for many hours.
Treatment must be immediate and vigorous. Occurs in a high percentage of patients who have had diabetes for 20 years or more. pneumonia. It is best to be done by a trained chiropodist. wasting of the muscles and weakness of gait 4) Arteriosclerosis – particularly in elderly patient. gastro-enteritis. low blood pressure (these signs are due to dehydration – loss of fluid) 4) Urine contain heavy amount of sugar and ketone. many obstetricians perform Caesarean section at the 36th to the 38th week to avoid their risk. give i/v became poor absorption for subcutaneous route. sunken eyeballs. 3) Cold extremities. They must avoid cutting the toe nails too short or digging into the corner of their toes. shrivelled tongue. with earlier diagnosis and effective treatment. pyelitis. All steps must be taken as quickly as possible to restore the patient to consciousness. such as pneumonia. 2) Nephropathy – the kidneys are damaged by long-standing diabetes and the kidney disease may ultimately lead to albuminuria. young people who developed diabetes neatly always died in diabetic coma. The blood sugar rapidly rises. This may lead to gangrene with consequent amputation of the whole leg. The diabetes must be controlled throughout the pregnancy and the mother must take plenty of rest. 5) Infection – Diabetic coma is often ushered in by an infection such as tonsillitis. diabetic coma is uncommon. followed by unrousable (cannot bangun) coma. This is frequently a cause of death. hardening of the arteries of the legs leads to impoverishment of the blood supply to the feet. Oedema of the legs and high blood pressure and uraemia. Diabetic coma Before the days of insulin. ketosis occurs and coma is often ushered in by vomiting. Since the damage is done in the last month of pregnancy. 2) Set up a normal saline infusion (layman term for infusion is drip) 3) Test urine for acetone and sugar 4) Blood sugar level 5) Give glucose – careful – to prevent patient to swing over into insulin coma . Hence elderly diabetic patient may look after their feet. 3) Neuropathy – involvement of the peripheral nerves leads to loss of the reflexes. Coma is nearly always due to an accompanying infection. 6) Pregnancy – Diabetic mothers tend to have big babies (10 pounds or 4 kg or more at birth). Any minor damage to the toes takes a long time to heal and is prone to infection. dry skin. These babies are sometimes stillborn and very oedematous. They must wear comfortable shoes. In patient already known to have diabetes. 1) Insulin – large doses and at frequent intervals. 2) Deep sighing respiration with the breath smelling of acetone. Haemorrhage may occur and this may lead to blindness.1) Retinopahty – degeneration of the retina at the back of the eyes. The patient may feel too ill to eat and may mistakenly omit the usual injection of insulin. pain in the legs. Treatment of diabetic coma This is a medical emergency. Signs and Symptoms of Diabetic Coma 1) At first drowsiness with great thirst and polyuria. Nowadays.
were you feeling hungry and often unsatisfied by food? 3) Is the onset – loss of weight. sometimes need to explain the disease clearly then ask back the questions. dun give.. 1) Form the above. I am a Fourth Medical Student of Udayana University. For example for insurance coverage u have to go for routine examination) 3) How old were you then? (Confirm diabetes) Interview session 1) Great patient. When patient regains consciousness. 2) What made you see the doctor for the first time? (Ask the patient if he himself notice that he is ill from the signs and symptoms present or he was informed by the nurse or doctor when he went for routine examination.6) May do – stomach washout to relieve abdominal distension. Good morning.. (Hello. May I speak to ……. the medication. I am doing a project about diabetic patient and would like to ask u a few quesitions regarding your condition…blabla…I main tara only lah…. whether she is complaint to the medication. what type of diabetes.Thank you very much. make patient feel comfortable or ate ease. so that patient know how to answer u. Thank patient after the interview. Muslim patient have the right to adjust medicine and diet during fasting month. if the examiner ask patient. Potassium is needed during the recovery stage of diabetic coma because there is a severe fall in the blood potassium. Any infection must be treated. Questions 1) Ask the patient questions. Take care. you will know how many years she suffered from diabetes. introduce yourself. If patient ask u ques and u r unsure. 2) Were you passing a lot of urine? Were you loosing weight? Were you feeling tired easily? Did you have itchiness around the vulva area (women)? Do you often get boils. I am Alison Chang. the ordinary treatment for diabetic is started. enema for constipation. rapid or gradual? (Young patient – onset rapid / middle aged or elderly – onset gradual or sometimes symptoms are slight or absent. the diet – how many calories.. As soon as the patient is fit. Diabetics cannot . Potassium in the form of potassium chloride or potassium citrate 2 g is given orally. 4) Find out what type of diabetes she has – severe/moderate/mild – ask the type of medication/diet (Later can give advice) 5) Any family history of diabetics 6) Did she have big babies? 7) Is she monitoring her blood sugar – glucometer (urine or blood sugar level.Tell her u will ask the doctor in charge and will call her back 2 inform her. Besides. thirst. any complications. polyuria. he will know that the patient understood you. Now Malaysia test blood sugar level using glucometer) 8) Was she seen by a dietician 9) Does she go for her regular follow-up clinic 10) How many years she has diabetes now? How is she feeling? Advice Advice must be friendly. reassuring explanation so patient can corporate. 4 hourly feeds are given.
9-7.3 3.be treated. arrange trips for short hols. How old is the patient now.5-5.9-7.4-10. food replacement (like dun want to eat rice eat brown bread) n give an example of a meal. cataract 5) Foot care 6) Exercise to prevent obesity 7) Diet – most important what food to eat. 11) Carry a card or wear a bracelet or necklace (Medic Alert) stating that the patient is a diabetic.0 * Ideal levels are similar to those seen in non-diabetic individuals and are recommended for the pregnant type 2 DM (NIDDM) . can be only controlled. The care and sterilisation of needle and syringes.patient can understand the disease and more aware of complications eg hypo and hyperglycemia and how to treat and avoid them .8 3.7 4.8 >7. Get a glucometer – to test the blood sugar when she is unwell (whether she can afford – gluco stick is expensive) or certain food (durian) which will increase sugar level.9 >3. The site of injection should be varied from day to day. Diet must be sufficient to keep weight at normal level 8) If he has infection go and see doctor 9) Patient on insulin – the insulin must be clear colour. 13) Ask whether she can understand about diabetes clearly n ask whether she has other questions Timing Prebreakfast Pre Meal Two Hour After Food 2am to 4 am Glucose Levels (mmol / L) Ideal* Acceptable 3.8 4. Patients have to pay a small fee for membership.4-6. They have gathering to exchange knowledge.8 3.8 >10.0 >3. If the patient is found confused and unconscious.5-5. Try to maintain blood sugar within normal limits (80-120 mg/l) 2) Diabetics association (Malaysia has) where patient can buy glucometer/ glucostick/needle/ syringe at a special price. (Find out whtr Bali has dis kind of association if u have time) 3) Explain the disease in the simple method. Carry sweets( glucose) 4) Check eyes to prevent retinopathy.9 Poor >7. The amount of insulin drawn out must be correct. 10) Advice patient to see doctor if she is pregnant. treatment can be given immediately) 12) Must go for follow-up appointments.
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