3 P’s of diabetes
polydipsia
polyuria
polyphagia
most powerful risk factor for type 2 diabetes
obesity (abdominal and visceral fat)
things that can cause secondary diabetes
Schizophrenia
Cushing’s syndrome (too much cortisol released)
Hyperthyroidism
Immuno-suppressive therapy
Parenteral nutrition (IV nutrition)
Cystic fibrosis
corticosteroids
phenytoin (dilantin)
atypical antipsychotics (clozapine)
clinical manifestations of type 2 diabetes
Nonspecific
Fatigue
Recurrent infections
Prolonged wound healing
Visual acuity changes
Painful peripheral neuropathy in the feet
administration of insulin
- best absorption - abdomen –> arm –> thigh –> buttock
- do not exercise in the area that insulin is being administered
- rotate sites
somogyi effect
- Rebound effect in which an overdose of insulin causes hypoglycemia
- Usually during hours of sleep
- Counterregulatory hormones released
- Rebound hyperglycemia and ketosis may occur
dawn phenomenon
- Characterized by hyperglycemia present on awakening in the morning
- Due to release of counterregulatory hormones in predawn hours
- Growth hormone/cortisol possible factors
- Most common when growth hormones are peaked (more common in younger populations cause of puberty and growth)
healthy eating habits for diabetes
1) eating 3 meals per day at regular times; do not go more than 6 hours without eating
2) limit sugars and sweets
3) limit high fat food
4) eat high fibre foods
5) drink water
6) add physical activity
alcohol
- High in calories, no nutritive value, detrimental effects on liver
- Can cause severe hypoglycemia
- Limits gluconeogenesis (breakdown of glycogen into glucose by the liver)
exercise
- increases insulin receptor sites
- lowers blood glucose
- weight loss
- best after meals
diabetes - physical exam
- Eyes – vitreal hemorrhages; cataracts; soft, sunken eyeballs
- Integumentary – dry, warm, inelastic skin; pigmented lesions (on legs); ulcers (especially on feet); loss of hair on toes
- Respiratory – rapid, deep respirations
- Cardiovascular – hypotension, weak, rapid pulse, peripheral pulses diminished, feet pale and cool to touch
- Gastrointestinal – dry mouth, vomiting, fruity breath
- Neurological – altered reflexes, restlessness, confusion, stupor, coma, reduced sensation or vibration in feet
- Musculoskeletal – muscle wasting
