University:
York University
Course:
NURSING 2534 | Pathophysiology
Academic year:

2023
Views:

97

Pages:

3
Author:

Niklas

Diabetes Mellitus Leading Cause Blindness End-stage renal disease Lower limb amputation Normal Glucose Insulin Mechanism Pancreas produces insulin Insulin helps glucose enter cells Background Metabolic disorder Causes: genetic, autoimmune, environmental Daily amount of insulin secreted by adults: 40-50 units Stabilizes glucose level in the range of 74-100 mg/dL 4 Ways to Diagnosis Fasting glucose ≥ 120 mg/dL Glycosylated Hgb (A1C) ≥ 6.5% Random blood glucose ≥ 200 mg/dL Oral glucose tolerance test ≥ 200 mg/dL Type I Type II Diabetes DM Type I: no insulin production, occurs at young age, insulin-dependent DM Type II: inadequate insulin secretion, insulin resistance, lifestyle changes, onset: gradual Insulin Resistant Overweight Sedentary lifestyle Hypertension Infections Yeast Symptoms Polyuria Polydipsia Polyphagia Fatigue Blurred vision Hyperosmolar hyperglycemia syndrome (HHS) Other: Progressive autoimmune Can be caused by hypoglycemia + ketoacidosis Metaboile Syndrome Group of metabolic risk factors that increase a person's chance of developing cardiovascular disease, diabetes Risk factors: insulin resistance, visceral fat, hypertension, triglycerides PT Teaching Shortening Lifestyle changes Monitor for symptoms Maintain healthy weight Fasting glucose: 100-125 Goal: Hemoglobin A1C < 7% Type I destruction of B cells cannot produce insulin Diabetes Mellitus Care Prevention Exercise 150 min/week Maintain healthy weight Nutrition Complex carbs Protein Low-fat Avoid smoking Nutrition Therapy Type 1 Meals with insulin Consistency Type 2 Achieving glucose, lipid, BP, and weight Mod in calories, fat Appropriate serving size Women: 1 drink/day Men: 2 drinks/day Drug Therapy Exogenous insulin Prescribed for Type 2 during times of stress Human insulin Rapid-acting: Humalog, NovoLog (onset: 10-30 min) Short: regular (Humulin R) (onset: 15 min) Intermediate: NPH Long: Lantus Basal-Bolus Regimen Basal: rapid or short-acting before meals Basal: intermediate or long-acting once daily Goal: achieve close to normal glucose level Lantus insulin Basal-acting Mimics natural insulin in response to meals Onset: 80-120 min Short-acting Humalog, NovoLog Onset: 10-30 min Intermediate Humulin N Onset: 80-120 min Most likely to cause hypoglycemia DRUG THERAPY: Insulin Storage Keep insulin pens at room temperature, 59°F to 86°F Vials may be stored in room temp up to 30 days Avoid exposure to direct sunlight Refrigerate unopened vials INSULIN ADMINISTRATION Only use one recap Site clean and dry No alcohol swabs, soap, or H2O PT Teaching Pinch skin 90° angle If very thin, use 45° Rotate injection sites Do not re-use If not premixed, draw up regular (clear) insulin Give subcutaneously Inject in abdomen Problems Newly diagnosed Cognitive Flu Hypoglycemia Allergic reactions Loss of fatty tissue (lipodystrophy) Hypertrophy (thickening of subcutaneous tissue) Somogyi effect Dawn phenomenon Abscess formation, headache, sweat, and night nightmares INHALED INSULIN Afrezza Rapid-acting inhaled insulin Administered beginning of meal or within 20 minutes Use with long-acting Not for DKA, smokers, COPD, asthma, bronchospasm