Overview of Diabetes Mellitus

NUR 106 Concepts of Medical Surgical Nursing Care Spring 2004

Pancreas

Endocrine Islets of Langerhans

Alpha cells produce glucagon Delta cells produce somatostatin Beta cells produce insulin

Diabetes Mellitus

Improper metabolism of carbohydrates, fats, proteins Due to a decrease in insulin, absolute lack of insulin or development of resistance to insulin Type I formerly juvenile diabetes ; insulin dependent diabetes (IDDM) Type II formerly non-insulin dependent diabetes (NIDDM)

Type I

No insulin produced Autoimmune beta cells destroyed Exogenous insulin required for life

Type II

Inadequate insulin Resistance to insulin Found in adults and children Can be diet controlled Exercise Oral antidiabetic agents Exogenous insulin

Risk Factors for Type II Diabetes

Family History 20% or higher over desired body weight Age forty or older Race / Ethnicity History of glucose intolerance Hypertension History of Gestational diabetes History of giving birth to baby over 10 lbs. High density lipoprotein less than or equal to 35 mg/dl Triglyceride level greater than or equal to 250 mg/dl

Clinical Manifestations of Diabetes

Classic signs of diabetes:

Polyuria Polydipsia Polyphagia

Weight loss Frequent infections Fatigue Dry skin Blurred vision

Diagnosis of Diabetes

Fasting serum glucose of 126 mg/dl or higher Random serum glucose of 200 mg/dl or higher Oral glucose tolerance test glucose greater than 200 Symptoms

Management of Diabetes

Nutritional management

Goal is to maintain a reasonable weight Prevent wide fluctuations in glucose levels Decrease serum lipid levels Well balanced diet without concentrated sweets

Exercise Medication

Insulin Oral agents

Acute Complications of Diabetes Mellitus

Hypoglycemia

Hyperglycemia

Diabetic Ketoacidosis Hyperglycemic Hyperosmolar Nonketotic Syndrome

Hypoglycemia

Blood glucose levels below 60 mg/dl, however.. Causes overdose of insulin; not enough food; overactivity; illness Patho glucagon impairment Clinical Manifestations

Adrenergic-shakiness, irrritability, nervousness, tachycardia, tremors, diaphoresis, paleness Neuroglycopenic headache, slurred speech, confusion, irritability

Management of Hypoglycemia

Mild Hypoglycemic Reaction

10-15g of simple carbohydrates 20-30g carbohydrates Glucagon 1mg SC or IM 10-25g of 50% dextrose

Moderate Hypoglycemic Reaction

Severe Hypoglycemic Reaction

Other Hypoglycemic Events

Hypoglycemic unawareness

Somogyi Effect
Dawn Phenomenon

Long Term Complications

Microvascular

Retinopathy Nephropathy Atheroscerosis

Macrovascular

Neuropathic

Neuropathy

Foot Complications