Diabetes Mellitus (definition)
Disorder of hyperglycemia resulting from defects in insulin secretion, insulin action, or both, leading to abnormalities in carbohydrate, protein, and fat metabolism
Pancreas (function)
Produce hormones necessary for the metabolism and cellular utilization of carbs, proteins, and fats
Alpha Cells
Produce the hormone glucagon > stimulates the breakdown of glycogen by the liver (increase blood glucose levels)
Glycogenolysis
Breakdown of liver glycogen
Gluconeogenesis
Formation of glucose from fats and proteins
Beta Cells
Secrete insulin; lowers blood glucose when it becomes too high
Delta Cells
Produce somatostatin (believed to inhibit both production of glucagon and insulin)
Type 1 DM
- Involves the destruction of beta cells (which produce insulin)
- Usually occurs at a young age
Type 2 DM
- Insulin resistance
- Occurs later in life due to obesity, inactivity and heredity
Type 1 DM (S/S)
- Hyperglycemia (and development of ketosis)
- Polyuria
- Glucosuria
- Polydipsia
- Polyphagia (but no weight gain)
- Weight loss (as the body loses water and breaks down proteins and fats in an attempt to restore energy sources)
- Malaise, fatigue
Type 2 DM (S/S)
- Hyperglycemia
- Polyuria
- Polydipsia
- Blurred vision
- Fatigue
- Paresthesias
Type 2 DM (risk factors)
- History of diabetes in parents or siblings
- Obesity
- Physical inactivity
- Race/ethnicity
- Women (gestational diabetes, or delivering baby weighing more than 9lbs)
- HTN
- High triglyceride levels
- Metabolic syndrome
Dawn Phenomenon
- Rise in blood glucose between 4am-8am that is not a response to hypoglycemia
- Occurs in both Type 1 and 2 DM
Somogyi Phenomenon
Combo of hypoglycemia during the night with a rebound morning rise to hyperglycemic levels
Diabetic Ketoacidosis (DKA)
Develops when there is an absolute deficiency in insulin and an increase in the insulin counterregulatory hormones -> ketogenesis is stimulated
Hyperosmolar Hyperglycemic State (HHS)
- Occurs in Type 2 DM
- Acute, life-threatening condition characterized by hyperglycemia (greater than 600 mg/dL), hyperosmolarity (340 mOsm/L), and absence of ketosis
- Can lead to coma or death
DKA risk factors
- Lack of sufficient insulin
- Reduced or missed insulin dose
- Any condition that increases carbohydrate metabolism (physical or emtional stress, illness, infection, surgery, or trauma)
HHS risk factors
- Inadequate fluid intake (dehydration)
- Decreased kidney function
- Medical conditions: MI, CVA, sepsis
- Certain meds: glucocorticoids, diuretics, phenytoin (Dilantin), propranolol (Inderal), and calcium channel blockers
- Infection or stress
Nursing Interventions for DKA/HHS
- Provide rapid isotonic fluid (0.9% sodium chloride) replacement
- Follow with a hypotonic fluid (0.45% NaCl) to continue replacing losses to total body fluid
- When glucose levels approach 250 mg/dL, add glucose to the IV fluids to minimize risk of cerebral edema and to prevent hypoglycemia
- Administer regular insulin 0.1 unit/kg as an IV bolus and then follow with a cont, IV infusion at 0.1 unit/kg/hr
- Monitor serum potassium levels
- Give sodium bicarbonate by slow IV for severe acidosis (pH < 7.0)
Pt Education for DM Complications
- Wear medical alert bracelet
- Drink at least 3 L of water/day to prevent dehydration
- Monitor glucose every 4 hr when ill and continue to take insulin
Foot Care
- Inspect feet & wash daily (watch for hot temp)
- Pat feet dry, esp. between toes and avoid lotion between toes
- Avoid open-toe shoes/sandals, no barefeet
- Avoid prolonged sitting, standing, or crossing legs
- Recommend podiatrist for cutting nails
- Wear shoes that fit properly
- Trim toenails straight across and file edges
Nutritional Guidelines
- Eat at regular intervals, do NOT skip meals
- Count grams of carbs consumed
- Include fiber to increase carb metabolism and to control cholesterol levels
- Use artificial sweeteners
- Dietary fats should be low in saturated fat and cholesterol
Alcohol for DM pts
- Not encouraged
- Men should drink no more than 2 drinks, and women no more than 1 drink per day
- 1.5 oz of alcohol = 2 fat exchanges
- Drink with meals
Acute complication: Hypoglycemia (treatment)
- Give 15 g of rapid-acting sugar (1/2 fruit juice/soda, 2 tsp of sugar or honey), wait 15 mins, check blood glucose
- If still low, give another 15g of carbohydrate
