A chronic multi-system disease related to abnormal insulin production or impaired insulin
What are the 4 risk factors for type 1 diabetes?
•Medication Induced; removal of pancreas
Does Type 1 Diabetes pts have insulin?
Absent or insufficient insulin
What are the 8 risk factors for type 2 diabetes?
–Family Hx. of diabetes
–Obesity esp. abdominal and visceral adiposity.
•Hispanics more prone to having diabetes
–GDM or babies > 9 lbs.
–HTN > 140/90 mm Hg
•73% of adults will have
–Triglycerides > 200mg/dL
–Prev. impaired glucose tolerance
BMI greater than what is a risk factor for type 2 diabetes?
HTN greater or equal to what, you are at risk of type 2 diabetes?
What are the 3 Metabolic processes?
What is glycolysis?
Glycolysis: the process through which glucose is broken down into water and carbon dioxide with the release of energy
Why are the 3 metabolic processes important?
They are important in ensuring a supply of glucose for body fuel.
What is glycogenolysis?
the breakdown of stored glycogen (from the liver or skeletal muscles)
Glycogenolysis is controlled by what 2 hormones?
epinephrine and glucagon
What does epinephrine do?
Epinephrine breaks down glycogen in the muscle
What does glucagon do?
breaks down glycogen in the liver
What is gluconeogesis?
The building of glucose from new sources like amino acids, lactate and glycerol can
be converted into glucose.
What 3 hormones stimulate gluconeogensis?
Glucagon, Glucocorticoids, Thyroid
Where does gluconeogensis mostly occur?
What do counterregulatory hormones do?
They work to oppose the effects of insulin. These hormones work to increase blood glucose levels by stimulating glucose production and output by the liver and decreasing the movt of glucose into the cells.
What are the 4 counterregulatory hormones?
What does insulin do?
Controls blood glucose levels by regulating glucose production and storage in the liver
Beta cells produce what?
produce insulin in the islets of langerhans
When is insulin normally released?
normally released in small increments when food is ingested
How can the amount of insulin a person is secreted be tested?
The amt of insulin a person is secreting can be tested by checking the levels of C peptide
What is the stimulus for insulin?
high blood glucose
Depends on what blood sugars are on
how much the body is going to be making insulin
2nd beta cell hormone
What are the two effects of amylin?
•Amylin and insulin work together to
suppress the secretion of glucagon by the liver
•Amylin slows the transfer of nutrients to
Glucagon acts in the opposition of what?
What is produced by the alpha cells?
What does glucagon stimulate?
Stimulates the break-down of glycogen and fats to glucose and promotes gluconeogensis from fats and proteins.
What are the two catecholamines?
epinephrine and norepinephrine
Epinephrin and norepinephrine maintain glucose levels during stressful situations by?
Inhibiting insulin release and decreasing movement of glucose into the cells
How many types of diabetes are there?
Type 1, type 2, gestational
Secondary diabetes is due to what?
injury to the pancreas
–Form estrogen containing preparations
–Once you stop the medication or correct the problem then the blood sugar should go back to normal
Pre-diabetes is a fasting blood sugar of what?
Type 1 diabetes involves destruction of what?
Destruction of their pancreatic cells, genetic, immunologic, and possibly environment
Destruction of beta cells by auto immune antibodies= what?
no insulin= rapid onset=life-threatening condition called DKA
Type 1 diabetes used to be called what?
•Used to be called juvenile diabetes
•Insulin dependent diabetes mellitus (IDDM)
•Now known as Type 1
Dramatic weight loss is associated with which type of diabetes?
Type 1 Diabetes
What are the reasons for weight loss in type 1 diabetes?
–2. Loss of fluids from vomiting
–3. Loss of body tissue because body has to use fat stores and cellular protein as
fuel source because of lack of insulin.
Does type 1 diabetes have a slow or rapid onset?
What are the 3 P's?
Which type of diabetes are they a S/S of?
–Polydipsia- extreme thirst caused by dehydration
–Polyuria produced by osmotic effect of glucose, glycosuria >excessive loss of F & E > dehydration
–Polyphagia-cellular malnutrition body starving for energy turns fat to fat
stores and protein
type 1 diabetes
Weakness and fatigue are a manifestation of which type of diabetes?
type 1 diabetes
Honeymoon phase (remission) is a characteristic of which type of uncontrolled diabetes?
uncontrolled type 1 diabetes
What is honeymoon phase (remission)?
time of diagnosis of type 1 with symptomatic hyperglycemia
Also helps to decrease weight, decrease stress, and maintains well being.
Exercise alter blood ___ levels?
How does exercise alter blood lipid levels?
–Increases levels of high density lipo-protein (HDL)
–Decreases total cholesterol and triglyceride levels
Important to patients with diabetes with
an increase risk of cardiovascular disease.
If blood glucose levels are what you should not exercise until they come down to a normal range?
greater than 250 mg/dL
It is important that diabetic pts have what kind of shoes when exercising?
proper fitting shoes
If a pt has what in their urine they should not exercise?
•Should not exercise until urine test negative for ketones
When is the best time to exercise?
1-2 hrs after a meal
Exercise does what to blood glucose?
Exercising increases blood glucose when it is elevated prior to exercising
How does exercising increase blood glucose?
Exercising increases the secretion of glucagon, growth hormone and catecholamines
Liver releases more glucose resulting in
an increase in blood glucose level.
Carbs need to be replaced during exercise, True or False?
What does exercise do for obese people with type 2?
–Exercise and dietary management improves glucose metabolism and enhances loss of body fat
–Improves insulin sensitivity and may decrease the need for insulin or oral agents.
What are the 3 recommendations for exercising?
•Exercise at the same time each day.
•Exercise the same amount of time each day.
•If patient has diabetes complications, alter the exercise type and amount as necessary. Increased B/P assoc. with exercise may aggravate diabetic retinopathy
How many minutes a day is recommended to exercise? Can you break this time up?
30 mins a day and yes you can break this time up
Exercising can cause hemorrhage to what part of the body?
eyes, so make sure you know your pts risk
True or False, you should start slowing and gradually increase your exercise?
ADA recommendations of physical activity?
The ADA recommends to advise people with to perform at least 150 min/wk of moderate-intensity aerobic physical activity (50-70% of max. heart rate), spread over at least 3 days a week with no more than 2 consecutive days w/o exercise
In absence of contraindications, people with type 2 DM should be encouraged to perform resistance training at least 2 times per week
Is self-monitoring of blood glucose recommended by the ADA?
Yes, Blood glucose monitoring is a cornerstone in diabetes management
When picking a glucometer, what should the pt consider?
Glucometers-Pick the one that best suits the patient. Consider ease of use, skill level,cost of strips, visual numbers etc….
Potential hazards of SMBG- patients may report erroneous blood glucose values as a result of using incorrect technique such as what 4 things?
•Improper application of blood-most common
•Improper meter cleaning
•Damage to reagent strips
•Coding of meter
The newer glucometers do not require what two things?
cleaning or coding
When a pt receives a glucometer it is essential that a nurse does what after explaining to the pt about it?
Nurses should evaluate the technique of patient’s while they use the SMBG for the first time
Candidates for SMBG include what 5 types of pts?
•A tendency for hypoglycemia
•Patients on insulin
–Illness leads to higher blood glucose
What 5 things are the diabetics pts using SMBG really monitoring for?
–To identify and treat hypoglycemia
–To make decisions regarding food intake and med adjustment when exercising
–Determine the effect of food/glucose
–To manage intermittent illness
What is glycated hemoglobin?
•Referred to as HgbA1c or A1C
•Reflects average blood glucose levels over a period of approximately 2 to 3 months, (ADA, 2004)
Mild hypoglycemia- sympathetic nervous system is stimulated- surge of epinephrine and norepinephrine
What are the S/S of adrenergic hypoglycemia?
S/S- sweating, tremor, tachycardia, palpitations, nervousness, and hunger.
What is moderate hypoglycemia and what system does it include?
Central nervous system
Moderate hypoglycemia- deprives the brain cells of needed fuel for functioning
What are the S/S of moderate hypoglycemia?
S/S- inability to concentrate, headache, lightheadedness, confusion, memory lapse, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision and drowsiness
What are the 6 cause of hypoglycemia?
•Frequent insulin adjustment
•Irregular timing of insulin dosage
•Failure to lower dose when eating less
•Irregular timing of meals
•Delaying of meal after taking insulin
Treat hypoglycemia using the rule of what?
Rule of 15?
What 3 things should you teach a hypoglycemic pt?
–Teach patients to carry some form of simple sugar with them at all times.
–Avoid over treating hypoglycemia
–Consistent pattern of eating and administering of insulin
For pts who are unconscious and cannot swallow, you should give what?
Glucagon 1 mg injection can be given sub q
It is important to give a pt what after glucagon? Why?
Remember: pt is given complex carbohydrate after to help restore liver glycogen and prevent continued hypoglycemia
What is hypoglycemia unawareness?
–No warning signs and symptoms of hypoglycemia
Why is hypoglycemia unawareness not good?
Increase risk of dangerously low BS
What drug masks symptoms of hypoglycemia?
Beta Blockers (olol) propranolol (Inderal)
–Mask S/S of low blood glucose
Hypoglycemic unawareness is related to what kind of neuropathy?
Gastroparesis can present itself with
bloating after eating.
•Unexplained swings of
What are the 3 potential complication of hypoglycemia unawareness?
•Fluid Overload- Administering fluids rapidly to treat DKA or HHNS
•Hypokalemia-due to treatment of DKA-loss of potassium- may need K+ replacement
-- May result form dehydration and excess urine output
•Cerebral Edema-cause unknown, may be by rapid correction of hyperglycemia- resulting in fluid shift- assess mental status.
What is diabetic ketoacidosis?
A metabolic derangement in type 1 diabetes that results from deficiency of insulin, highly acidic ketone bodies are formed, resulting in acidosis, requiring hospitalization for treatment. IV fluids and insulin drip.
DKA is mostly seen in who, when?
Seen mostly in adolestants, a lot of young girls don’t want to gain weight from insulin so they stop taking insulin and go into DKA.
Patho of DKA
Insulin deficit promotes metabolism of fat stores which produce large amounts of acidic ketones leading to metabolic acidosis
What are the 3 causes of DKA?
–DKA caused by an absence or markedly inadequate amounts of insulin.
–Disorders in the metabolism of fats, CHO, and proteins.
–Illness or infection
How does illness or infection cause DKA?
Insulin resistance→Increase hormones (glucagon, epinephrine cortisol)→increase glucose production by liver→ interfere with glucose usage by muscle & fat tissue.
Undiagnosed and untreated DKA may be initial manifestation of
If a pt is N/V, replace fluids with what?
carbohydrate juices to prevent DKA
What are the S/S of DKA?
–Due to Na and K+ loss in urine clients experience
•Cardiac arrhythmias can lead to cardiac arrest
•Acidosis-fruity breath, tachycardia and hypotension
Why is dangerous if DKA or acidosis is not corrected?
If acidosis is not corrected it can lead to a coma of severe acidosis
What are the main causes of DKA?
–Decreased or missed dose of insulin
–Not drawing adequate dose
–Illness or infection
–Undiagnosed or untreated diabetes
•IV fluid and electrolyte replacement
DKA treatment involves correcting what two things?
•Correct fluid and electrolytes
DKA treatment involves providing what?
•Provide adequate insulin
–When giving insulin drip monitor for
–Do not infuse fluids too rapidly to
prevent cerebral edema 1-2 L in 1-2
What are the treatment goals of DKA?
Treat K but the main thing is to hydrate!
Treatment goals for DKA include:
•Provide adequate fluid to dehydrate Correct dehydration first
•Provide adequate insulin to restore and maintain normal glucose metabolism
•Correct electrolyte deficits and acidosis
•Provide source of glucose when needed
•Provide patient education
All pts with DKA need what?
All pts with DKA will need insulin (use insulin drip more often)
When glucose reaches 250, then they will go to 5-10% dextrose added to normal saline
Potential complications of DKA are these 3 things?
•Hypokalemia-due to treatment of DKA- loss of potassium
–If potassium is low need to correct this first.
–Cause unknown, may be by rapid correction of hyperglycemia- resulting in fluid shift-assess mental status
A DKA pt needs to monitor their blood glucose how often in order to have a successful treatment?
Monitor blood glucose 1-2 hrs in order to have successful treatment
Sick day rules for Type 1 and type 2 diabetes:
What is Hyperglycemia hyperosmolar nonketotoic syndrome (HHNS)?
•Serious condition – Blood glucose 800-1000 mg/dl
•Ketosis usually minimal or absent
•Defect or lack of effective insulin (insulin resistance)