endo dm type 1 and 2
DESCRIPTION
dmTRANSCRIPT
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DIABETESDM Type 1 and DM Type 2Diabetes affects 25.8 million people; accounting for 8.3% of the U.S. population http://diabetes.niddk.nih.gov/dm/pubs/statistics/#fast
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http://www.nyc.gov/html/doh/html/pr2007/pr060-07.shtmlThe Yearly Toll of Diabetes in New York City
http://www.cdc.gov/obesity/data/adult.html
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Risk for Diabetes Quiz: Answer yes or no I have a parent, brother, or sister with diabetes.My family background is African-American, American Indian, Asian American, Hispanic or Pacific Islander.I have had gestational diabetes or gave birth to at least one baby weighing nine pounds or more.I have pre-diabetes (FBS of 100-126).I am overweight.I am fairly inactive & exercise < 3 times per week.I have high BP.My cholesterol levels are abnormal. My LDL is > 100; my HDL is < 35; my triglyceride level is 250 or >.
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Answers to Diabetes QuizIf you answered Yes to one or more questions, you are at risk for type 2 diabetes.Your chance of getting diabetes are higher if you answered Yes to three or more.
Check your levels are regular intervals and make changes in your eating and exercise habits.
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PancreasIs an exocrine glandReleases digestive enzymesIs an endocrine glandBeta calls in the Islets of Langerhans Produce & secrete insulin in response to rising blood sugars
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HOW GLUCOSE GETS INTO THE BLOOD STREAM:- Intestines: absorption of simple sugars- Liver: Glycogen --> glucose(glycogenolysis)- Protein catabolism(glyconeogenesis)WHAT IS GLUCOSE USED FOR?- In tissues: oxidation(CO2 + H2O + E)- In liver glycogen formed- Converted to fat- In muscles (stored as glycogen)- Excreted in urine(BS level is > 200)
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What does Insulin do?Transports & metabolizes glucose for EStimulates the storage of glucose in the liver --> glycogen (Glycogenesis)Enhances the storage of fat in adipose tissueTransports amino acids & glucose into the cellsInhibits the breakdown of stored glucose, protein, & fat
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FastingPancreas releases insulin+Pancreas releases Glucagon (glycogenolysis)=Constant level of BS
8-12 hrs w/o food Glyconeogenesis
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TYPE 1 Diabetes Mellitus (DM)Pathophysiology:Destruction of beta cellGlucose not stored as glycogenGlycogenolysis & gluconeogenesis occur unrestrainedFat breakdown occursALL --> HYPERGLYCEMIA
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TYPE 2 Diabetes Mellitus (DM)Etiology:Insulin resistanceAND/ORDecreased production of Insulin
ALL --> HYPERGLYCEMIA
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DM Diagnostic Tests:
Fasting glucose level of 126 mg/dL or >
Random glucose level of 200 mg/dL or > on more than one occasion
Hemoglobin A1C > 6.5 or 7
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Nursing Interventions for HyperglycemiaCheck blood sugarType 1 DM: 2-4/day
Type 2 DM: 2-3/wk One 2hr postprandial
Type 1 or 2 hospitalized:FractionalsAC & bedtimeFractionals or Sliding scale:BSInsulin dose150-1992 units200- 2494 units250-2996 units300-3498 units350-39910 units> 400Call MD
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Nursing Interventions for Hyperglycemia 2. Fluids3. Airway4. Patient teaching5. Diet- CHO 50%, Protein 25%, Fat 25%, Fiber*WEIGHT CONTROL*6. Activity & exercise7. Oral meds (Type 2 only)8. Decrease stressOral meds for Type 2 DM:1. For Insulin ResistanceAntihyperglycemic agents- Glucophage, Precose, Glycet, Actos, Avandia2. For Decrease Insulin production:Hypoglycemic agents- Diabinase, Glucotrol, Micronase, Prandin
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IMPAIRED INSULIN PRODUCTION: ORAL HYPOGLYCEMICSCATAGORYDRUGACTIONADESulfonylureasPrototype: glipizide (Glucotrol)
Glyburide (Miconase, DiaBeta) Insulin productionHypoglycemiaCommon: N, abd fullnessMegitinideRepaglinide (Prandin)Nateglinide (Starlix) Insulin productionHypoglycemia
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DECREASE INSULIN RESISTANCE: ANTIHYPERGLYCEMICSCATEGORYDRUGACTIONADEThiazolidinedionesPioglitazone (Actos)) Insulin resistanceincidence of angina, MIBiguanidePrototype: metformin (Glucophage) Insulin resistance, hepatic glucose prodBlack box: lactic acidosisCommon: N, V, abd discomfortAlpha-Glucosidase InhibitorsMiglitol (Glyset)Acarbose (Precose)Delays GI absorption of glucoseAbd discomfort, D, flatulence
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Things to know about Insulin
TIME
AGENT
ONSET
PEAK
DURAT
INDICA.
Rapid acting
(clear)
Humalog
(Lispro)
10-15min
1 h
3 h
-rapid reduction of BS
Short acting
(clear)
Regular
R
1/2-1 h
2-3 h
4-6 h
Give 20-30 min ac
Intermediate
acting
(cloudy)
- NPH
Humulin N
- Lente Humulin L
3-4 h
4-12 h
16-20 h
Give pc
Long acting
(cloudy)
Ultralente
UL
6-8 h
12-16 h
20-30 h
Control s
FPG
Long acting
(clear)
glargine (Lantus)
1 h
No Peak
24 h
Do NOT mix with other insulins
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Things to know about InsulinIn General:70/30 Insulin: 70% NPH & 30% RegularRapid & short acting Insulin cover meals immediately AFTER the injectionIntermediate acting Insulin is expected to cover subsequent mealsLong acting Insulin provides a relatively constant level of Insulin and act as a basal Insulin
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Things to know about InsulinOnly Regular Insulin in given IV
Rotates site
Mixing types: clear to cloudy
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Insulin Regimes3-4 injections/day2 injections/day1 injection/dayCONVENTIONALINTENSIVE
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Things to know about InsulinInsulin Pens
Insulin Pumps
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Hypoglycemia: AssessmentToo little food/ To much Insulin or DM meds/ Extra activity1. Blood sugar < 602. Nervousness, trembling3. Increase SNS4. Moist, clammy skin5. Dizziness, anxious, hunger
6. Impaired vision7. Weakness, fatigue8. Confusion, irritable, restless9. Convulsions w/ BS < 4010. Coma --> death
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Hypoglycemia: Nursing InterventionsGive sugarGlucagon IVCheck VSMonitor BSOn going assessmentComatose - maintain airwayPatient education
Old Saying:Cold and clammy means you need some candyHot and dry your sugar is to high!
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Classifying Hypoglycemia
MILDMODERATESEVEREConsciousConsciousUnconsciousHungerDiaphoresisTremorAnxiety or drowsinessWeaknessHeadacheBehavior changeBlurred, impaired or double visionIrritation or confusion, difficulty talkingUnresponsive unable to take oral feedingSeizure activityFood with 15 grams of carbohydrates:3 to 4 chewable glucose tablets1 tablespoon of jamI tube of glucose gel4 to 6 ounces of fruit juice4 to 6 ounces of regular soft drink3 packets of sugar or 1 tablespoon of sugar1 tablespoon of honey5 to 7 hard candies
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Diabetic TestingSelf Monitoring of BSGlycosylated Hemoglobin A1CHgb A1CUrineKetonesFor Type 1 DM esp for BS>200
Correlating A1C with average BS715481839212102401126912289
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DM: Complication1. Insulin Therapy2. Diabetic KetoacidosisType 1 DM
Clinical Picture:HyperglycemiaFVDAcidosisNursing Assessment:BS of 300-800Resp: rapid & deepAcidosisKetonesFVD & electrolyte loss
Medical Management DKA:InsulinHydrationNS or 0.45NSElectrolyte loss KAcidosis
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Sick Day Rules for Type 1 and 2:
Take Insulin/oral meds as usualTest BS q 3-4 hrsType 1 BS > 200 test for ketonesReport BS > 300Small, freq mealsV or D: c cola, juice, or broth q hrReport N/V/D to MD
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DM: Complication 3. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS): Clinical Picture:HyperglycemiaFVDTachycardiaAlteration in Sensorium
Nursing assessment:- Type 2 DM- BS > 1,000 - RR: WNL - pH: WNL - No ketonesPrevention: Sick Day Rules
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ParameterDKAHHNKDiabetesType 1Type 2Serum glucose300-800Often > 1,000Arterial pHAcidicNormalSerum ketonesPositiveNegativeUrine ketonesPositiveNegativeOnsetQuickslowlyCause: Lack of Insulin breakdown of fatsLack of enough Insulin, but enough to prevent the breakdown of fatsClinical AssessmentDry skin & mucous membranes, < skin turgor, tachycardia, hypotension, altered LOCDry skin & mucous membranes, < skin turgor, tachycardia, hypotension, altered LOCKussmauls RespRegular & shallowMortality5-30%Near 50%
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DM: Complication4. MACROVASCULARCADCVDPVD
5. MICROVASCULARRetinopathyNephropathy
6. NEUORPATHIESPeripheral (sensorimotor)Autonomic: CV GIUrinary Adrenal
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DIABETES INSIPIDUSA Pituitary disorderLeads to polyuria and polydipsiaTreatment:Replace fluids,I&ODiet: Hi Na & hi KAqueous vasopressin (Pitressin) or Desmorpressin (Stimate)
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Metabolic Syndrome or Syndrome XCluster of risk factors:High Triglycerides: > 150Low HDL: < 40High BP: > 130/85Insulin-resistance: BS 110-125Waist:Females: > 35 inchesMales: > 40 inches
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**********. ****A black box warning is the sternest warning by the U.S. Food and Drug Administration (FDA) that a medication can carry and still remain on the market in the United States.A black box warning appears on the label of a prescription medication to alert you and your healthcare provider about any important safety concerns, such as serious side effects or life-threatening risks.
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***Question: What is the major difference between DKA and HHNS? Which one has a greater mortality rate and why?****