DIABETES

DIABETES
Diabetes mellitus is a metabolic derangement that arises from lack of insulin and inability of
cells to recognize it.
Is a group of metabolic diseases characterized by increased levels of glucose in the blood
resulting from defects in insulin secretion, insulin action, or both.
What is insulin?
Insulin stimulates the liver to form glycogen into glucose and inhibits conversion of
noncarbohydrates into glucose.
Insulin transports glucose into the cell for use as energy and storage of glycogen.
What is a glucagon?
Glucagon stimulates the liver to break down glycogen and convert certain noncarbohydrates
such as amino acids, into glucose, raising blood sugar concentration. Glucagon much more
effectively elevates the blood glucose than epinephrine.
Risk Factors for Diabetes Mellitus:
Family history of diabetes
Obesity ! "# kg$m%& ' Obesity causes resistance to endogenous insulin
(ace$ethnicity
)ge ! *+ y&
,reviously identified impaired fasting glucose or impaired glucose tolerance
-ypertension ! .*/$0/ mm -g&
-D1 cholesterol level 2 3+ mg$d1& and or triglyceride level !"+/ mg$d1&
-istory of gestational diabetes or delivery of babies over 0 lbs
,hysiological$emotional stress4 causes prolonged elevation of stress hormones which revises
glucagon
,regnancy4 increases levels of estrogen which antagonizes insulin
CASSIFICATI!"
Insulin #e$en#ent%&u'enile%T($e I Diabetes
)usually appears before age of twenty and is an autoimmune disease: the immune system destroys the
beta cells of the pancreas. This type is treated with insulin and diet.
"on)insulin #e$en#ent%*aturit()onset%T($e II Diabetes
)in these type, beta cells produces insulin, but body cells lose the ability to recognize it. The condition
usually develops gradually after age forty. Most affected individuals are overweight or obese when
symptoms begin. Treatment includes controlling of diet, exercising, and maintaining a desirable body
weight.
+estational Diabetes
)is high blood sugar that starts or is first diagnosed during pregnancy.
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DIABETES
,AT-!,-.SI!!+.
(According to patient .!"s condition#
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Predisposing Factors:
4age above */ years old
4gender
4family history mother
and sister&
Precipitating Factors:
4obesity
4physiologic and
emotional stress
4diet
Impaired insulin secretion by
pancreatic beta cells
Insulin resistance
Decreased glucose
transport into muscle
cells
5levated hepatic
glucose production
Increased
breakdown of fat
6uild4up of glucose in the blood
Increased amounts of insulin are secreted to maintain
glucose level at a normal or slightly elevated level.
7etabolic syndrome&
6eta cells cannot keep up with the increased demand
for insulin
Glucose level rises and type II diabetes develops
DIABETES
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-yperglycemia
8apillary basement membrane thickening
Diffuse glomerular sclerosis
95,-(O,):-;
5nd4stage renal disease
DIABETES
CI"ICA MA"IFESTATI!"S
T$ %&'('%A& MA(')*TAT'+(* ,!(, +( T$ !AT'(T-* &.& +) $/!01&/%M'A/
%lassic clinical manifestations of all types include the three 2!-s3
,)olyuria increased urination&
,)olydipsiaincreased thirst&
,)olyphagia increased appetite&
,atients e<perience polyuria and polydipsia as a result of the e<cess loss of fluid associated with
osmotic diuresis. ,atients also e<perience polyphagia that results from the catabolic state induced by
insulin deficiency and the breakdown of proteins and fats.
OTHER SYMPTOMS:
fatigue and weakness
sudden vision changes
tingling or numbness in hands or feet
dry skin
skin lesions or wounds that are slow to heal
recurrent infections
weight loss, nausea, vomiting, abdominal pain :ype .&
ASSESSME"T A"D DIA+"!STICS
Fasting plasma glucose F,G& greater than or e=ual to ."> mg$d1&
Glucose level " hours after receiving glucose e=ual or greater than "// mg$d1&
5valuation for complications
:est for microalbuminuria
?erum creatinine level
@rinalysis
5lectrocardiogram
MEDICA MA"A+EME"T
7ain goal of diabetes treatment is to normalize insulin activity and blood glucose levels to reduce the
development of vascular and neuropathic complications.
"0TRITI!"A T-ERA,.
9utrition and 7eal planning4 control caloric intake to attain or maintain a reasonable body
weight, control blood glucose levels, and normalization of lipids and blood pressure to prevent
heart disease.
Aeight control
,-ARMAC!!+IC T-ERA,.
'nsulin therapy
4:ype .B e<ogenous insulin must be administered for life because the body loses ability to produce
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DIABETES
insulin
4:ype "B insulin may be necessary on a long4term basis to control glucose levels if meal planning and
oral agents are ineffective.
CATE+!RIES !F I"S0I"
Ti*e course Agent In#ications
(apid acting 1ispro -umalog&
)spart 9ovolog&
Glulisine )pidra&
@sed for rapid reduction of glucose level, to treat
postprandial hyperglycemia, and$or to prevent
nocturnal hypoglycemia
?hort )cting (egular -umalog (,
9ovolin (, Iletin II
(egular&
@sually administered "/43/ minutes before a
mealC may be taken alone or in combination with
longer acting insulin
Intermediate4acting 9,- neutral protamine
-agedorn&
@sually taken after food
Dery long acting Glargine 1antus&
Detemir 1evemir&
@sed for basal dose
Oral )ntidiabetic agents biguanides, alpha4glucosidase inhibitors, first and second generations
of sulfonylurase&
,ramlintide ?ymlin&4 used to treat hyperglycemia to adults who have not achieved acceptable
levels of glucose control despite the use of insulin at mealtimes. For :ype . and :ype "
Diabetes.
5<enatide 6yetta& treatment for :ype " diabetes in combination with formin or sulfonylureas.
5nhances insulin secretion.
AC0TE C!M,ICATI!"S
hypoglycemia
diabetic ketoacidosis
hyperglycemic hyperosmolar nonketonic syndrome
!"+)TERM C!M,ICATI!"S
7acrovascular complications
7icrovascular 8omplication
4 Diabetic retinopathy
4 9ephropathy
4 Foot and 1eg problems
"0RSI"+ MA"A+EME"T
,roviding patient education
:he disease itself
InEection of insulin
diet
medications
,RE1E"TI!"
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DIABETES
8hange in lifestyle. Do e<ercises and avoid sedentary lifestyle.
7aintain weight and 67I at normal level.
Do not smoke$ ?top smoking because it increases the risk for stroke.
-ave a proper and balance diet.
RES!0RCES:
Internet:
httpB$$www.medicinenet.com$diabetesFmellitus$page".htm 23ritten: 4une 567 8598:
httpB$$www.ncbi.nlm.nih.gov$pubmedhealth$,7-///.G0G$ 2ast re'ie3e# August ;7 8598:
httpB$$emedicine.medscape.com$article$..#G+34overviewHaw"aab>b"b3 2u$#ate#: 4ul( 8<7 859<:
Books:
-ole=s Essentials of -u*an Anato*( an# ,h(siolog( 95
th
E#ition 2co$(right > 855?:
Brunner an# Su##arth=s Te@tbook of Me#ical)Surgical "ursing 98
th
E#ition 2co$(right > 8595:
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