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Endocrine System
Secrete hormones ---> blood stream
Beta Cells
Secrete INSULIN
Alpha Cells
Secrete GLUCAGON
INSULIN
Lowers blood sugar by: Transporting glucose into cell
Receptor sites
Converting glucose (little sugar) to glycogen (big sugar) for storage in
muscle and liver tissue (glycogenesis)
Converting excess glucose into fat cells, forming lipids from fatty acids
(lipogenesis) and promoting storage in adipose tissue
INSULIN
INHIBITS activity that causes the blood sugar to rise- - -
Insulin
Glucagon
Sugars
Glucose
Glycogen
Processes
Carbohydrate Metabolism
Active transport of glucose into cells & metabolism (use) of glucose
with release of energy
Storage of glucose
Krebs Cycle!!!
Ketones (Acidic)
Diabetes Mellitus
Chronic disorder characterized by hyperglycemia
Statistics
Almost 6% of U.S. (16 million)
7th leading cause of death
Minority Populations
Types of DM
*Type 1 (IDDM) 10 - 15 % of all Diabetics
Secondary
Gestational
Type l
(Type I)
IDDM = Insulin Dependent Diabetes Mellitus
Juvenile Diabetes
TYPE 2
Type II
Adult/Maturity Onset
NIDDM = Non Insulin Dependent Diabetes Mellitus
May control blood sugar with diet and exercise alone (but may take
oral meds. or insulin)
Polydypsia
Polyphagia
Weight Loss
irritability
drowsiness
blurred vision
itching
RISK FACTORS
Heredity
Race
Increased Age
Obesity
Stress
Viruses
Diet
Auto-immune
Environment
DM - Pathophysiology
Lack of Insulin
Glucose
Where?
ECF
Fat & Protein breakdown
Hyperglycemia - - - WHY?
Glycosuria
ECF deficit
Signs of DM
Postprandial glucose
C-peptide(connecting peptide)
Proinsulin insulin
c-peptide
Ketonuria
Proteinuria
Control
Normal FBS - ACCUCHECKS
Glucose Sensor
Placed under skin. It contains particles that give off light when glucose
levels increase. An external sensor, worn like a watch, monitors for
the changes in light and sounds an alarm to warn the client PRN.
Diabetes Management
Diet management
Physical Activity
Medications
Nutrition management
GOALS FOR MEDICAL NUTRITION THERAPY
1. Maintenance of near normal blood glucose.
4. Prevention of complications.
NCS
FAT 25%
CARBOHYDRATE 60%
Starchy Vegetables
Medications
Type 1
Insulin
Administered SQ or IV NOT ORALLY
NOT IN TUBE FEEDINGS
Type 2
Insulin
Insulin
Types of insulin
Duration of action
Short - Intermediate - Long
Action
Onset - Peak - Duration
Insulin - (contd)
Concentration
Expressed in Units
U100
Insulin Order
NPH Humulin (U100) 32U SQ daily before dinner
Types of Humulin Insulin and Comparative Actions
Special Things About Regular Insulin
Only one to give IV
BG Value Dosage
150-200 0 units
201-250 2 units
251-300 4 units
301-350 6 units
351-400 8 units
repeat BS
Insulin
Dosage
Individual requirements
Individual response
Insulin Administration
Check Order
Gather equipment
Insulin - Precipitate
Administration - contd
Combining Insulins
Drawing up
Injecting
Teaching
Pathophysiology
Diet
Exercise
Diabetes Mellitus ID
Sexuality
Community Resources
Stress Management
Health Care
Teaching
Home management
Insulin
administration
storage
travel
exercise
sick days
Insulin pumps
Mimic release of pancreas
Sub-Q
Complications
Inhaled Insulin!!!
Complication of Insulin
Lipodystrophy
Atrophy
Hypertrophy
Cause
Management
metformin - (Glucophage)
enhance sensitivity of receptor sites
Alpha-glucoside inhibitors
acarbose (Precose)
slows absorption of glucose
repaglinide (Prandin)
stimulates insulin secretion
Thiazolidinedones
rosiglinitazone (Avandia)
decreases insulin resistance and
increases insulin action
(Insulin PRN)
Physical Activity
Exercise
Lowers BS levels