DIABETES MELLITUS

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DIABETES MELLITUS

• Rachel S. Natividad RN, MSN, NP

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Review AP
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Physiology Role of Insulin
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Physiology Cont Insulin

• Basal (continuous)
• Prandial (Bolus)

Blood glucose increases within 10 minutes the
beginning of a meal
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Diabetes Mellitus

• A disorder of carbohydrate, protein, and fat
  metabolism resulting from an imbalance between
  insulin availability and insulin need. (Porth,
  2002)
• End Result HYPERGLYCEMIA

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Classifications

• Type 1 (no insulin)
• Type 2 (some insulin insulin resistance)
• Gestational Diabetes (pregnancy-related)
• Secondary Diabetes (Cushings disease,
  pancreatitis, etc.)

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Pathophysiology
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Normal
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Patho DM Type 1
No Insulin
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Patho-Cont.DM Type 2
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The big difference
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Case Study
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Clinical Manifestations
THE 3 POLYs
POLYDYPSIA
POLYURIA
POLYPHAGIA
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Clinical ManifestationsCont Signs and Symptoms

• Early signs
• 3 Polys
• Weight loss
• Fatigue/Always tired
• Visual Blurring
• Late signs
• Any of the 3 Polys
• Infections
• Numbness/ tingling of feet or leg pain
• Slow healing wounds
• Chronic Complications

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Diagnostic Tests

• Fasting Blood Glucose (FBG) 70-110 mg/dL
• Random/Casual Blood Glucoselt200 mg/dL
• Oral Glucose Tolerance Test (OGTT)
• Glycosylated Hemoglobin (HgbA1C)
• Normal -4-6
• Target range DM patient 6-8

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Criteria for the Diagnosis of Diabetes Mellitus

• Normal
• FPG lt110 mg per dL
• 2hr OGTT lt140 mg per dL
• Diabetes- positive findings from any two of the
  following tests on different days
• Symptoms of diabetes mellitus plus casual
  (random) plasma glucose concentration gt200 mg /
  dL
• or
• FPG gt126 mg per dL
• or
• 2hr OGTT gt200 mg per dL after a 75-g glucose
  load

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Diagnostic Tests Cont.Is it Diabetes Yet?
IGT
IFG
Impaired Glucose Tolerance
Impaired Fasting Glucose
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Acute Complications

• Diabetic Ketoacidosis (DKA)
• BS gt 300 mg/dL
• Classic symptoms
• Ketosis

• Hyperglycemic-Hyperosmolar Nonketotic Syndrome
  (HHNS)
• BS gt 800 mg/dL
• Similar symptoms
• No Ketosis

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Chronic Complications - Macrovascular

• Cardiovascular
• Cerebrovascular
• Peripheral vascular

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Chronic Complications-Microvascular

• 1. Diabetic Retinopathy

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Chronic Complications-Microvascular

• 2. Nephropathy

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Chronic Complications-Microvascular

• 3. Diabetic Neuropathy

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Chronic Complications-Microvascular
Amputation of Toes
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MANAGEMENT OF DM
Exercise
Diet
Blood Glucose Monitoring
Drug Therapy
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Management Diet Exercise
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Diet Cont Diabetes Food Pyramid
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Diet Cont What to do???
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Diet Cont.Carb-Counting
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Diet Cont.Getting the balance right

• Get your portions right!!

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Management Exercise

• Helps regulate blood glucose

• Increases insulin effectiveness and sensitivity
  in the body.
• Must monitor insulin and food intake to match
  exercise regimen.

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Drug Therapy

• Insulin
• Types
• Rapid-acting or regular insulin are used to lower
  blood sugar after eating a meal.
• Intermediate or long-acting types of insulin are
  used to lower blood sugar throughout the day and
  night
• Onset - how soon it starts to work in the blood
• Peak - when the insulin has the greatest effect
  on blood sugar levels
• Duration how long it keeps working
• Oral Antidiabetic Agents

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Drug Therapy ContGoal of Insulin Therapy
Basal and Bolus Insulin Coverage
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Drug Therapy ContSample Insulin Regimen
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Drug Therapy ContRapid Acting Lispro/Aspart

• Ideal for meal coverage
• Give the shot while the plate is hot!

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Drug Therapy ContFast Acting Regular Insulin

• ? Its time give you your regular insulin ?
• ? Its time to give it 30 minutes before your
  plate is in ?
• ? Come back to check you in 2 (hours) ?
• ? Watch out for shakes and sweats too ?
• ? If your lucky youll have no clue!!!! ?

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Insulin Acute Complication Hypoglycemia
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Drug Therapy ContIntermediate acting NPH
Insulin

• covers blood sugar between meals
• satisfies overnight insulin requirement
• Need snack if NPH given at 5 pm
• Ideal to be given at 9 pm (HS) to address Dawn
  Phenomenon

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Peakless Insulins!!!

• Do not mix with other insulins
• Lantus (insulin glargine)
• Levimir (insulin detimir)

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Drug Therapy ContOther Methods of Administration
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Drug Treatment Cont.

• Oral Antidiabetic agents
• (see handout)

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Administer meds (see Simons MAR)

• Things to Ponder
• Look at MAR and decide which meds youll
  administer at what time.
• What are your concerns with Simons schedule of
  meds?
• Hint look at onset/peak of Diabetes meds
• It is now 0745 and the BS at 0700 173 mg/dL,
  what would you do?
• What do you need to monitor for and when?
• Why is Simon on insulin and oral diabetes meds?

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Discussion (see Simons MAR)

• Nurse decided to administer 4 units of Reg
  insulin at 0800 and Glyburide and Metformin at
  1000 as scheduled.
• Simon calls at 1130 c/o shaking, sweating. (What
  do you do?)
• BS at 1130 62 mg/dL (What do you do?)

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Insulin

• Acute
• Complication
• Hypoglycemia
• Tx (15/15 or 20/20
• Rule)
• Give 15/20 g simple
• carb and recheck
• BG in 15/20 minutes

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Discussion (see Simons MAR)

• Nurse decided to hold PO meds.
• At 1130 BS489
• What do you do?

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Hyperglycemia
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Diabetic TeachingNeeds

• Disease process
• S/S of hyperglycemia and hypoglycemia
• Blood sugar monitoring
• Diet
• Exercise
• Drug therapy
• Sick Day Rules
• Complications (acute and chronic)
• Prevention Foot care, eye exam etc.

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DIABETES can be controlled!!!