Disease of the metabolic & endocrine system

Deficit in insulin secretion or creation of insulin

type 1 = cells don't respond to insulin

type 2 = pancreas stops producing insulin

food absorbed in the GI tract

&

liver forms glucose from ingested food substances

Hispanics

African Americans

Native Americans

new blindness

also the leading cause of non-traumatic amputations

control BG levels

prevent acute/chronic complications

Insulin Dependent

usually juvenile onset

only 5-10% of DM patients are type 1

thin / recent weight loss

genetic, immunologic, or environmental cause

**antibodies to islet cells & insulin**

Tx: insulin

Non-Insulin Dependent

90-95% of DM patients are type 2

onset > 30yrs old

80% are obese

genetic, environmental, & obesity causes

no antibodies to islet cells & insulin

**insulin resistant

Tx: weight loss & diet, oral antidiabetic meds, & insulin

**DKA is rare unless they had DM for a long time & didn't know it.

HHNS (hyperglycemic hyperosmolar nonketotic syndrome)

what diseases are assoicated to DM?

secondary to DM

Pancreatic Disease

Hormonal abnormalities

drugs (corticosteriods, estrogen)

occurs in 2-5% off all pregnancies in 2nd or 3rd trimester

onset usually > 30yrs

usually obese

hormone, genetic, obesity causes

no antibodies

glucose intolerance

Tx: diet, insulin, NO po meds

30-40% develop type 2 DM within 10yrs

screened b/w 24-28 wks

Borderline DM, latent DM, subclinical DM, or asymptomatic DM

onset usually >30yrs

usually obese

no antibodies

BG levels fall b/w normal & diagnostic for DM

Oral glucose tolerance test (GTT) b/w 140-200 mg/dL

Impaired fasting BG b/w 110-126 mg/dL

29% develop DM

Tx: diet modifications, weight loss if obese

3 P's = polyuria, polydipsia, polyphagia (not always this one)

recent dramatic weight loss or gain

fatigue, weakness

Sudden visual changes

Tingling/numbness in hands & feet

Dry skin

Slow healing sores

Recurrent infections

NV - abdominal pain

Acetone breath - sweet & fruity - "juicy fruit smell"

dehydration

Kussmal's resp

Sexual Dysfunction - what brings most men to Dr!

Primary Family History

Obesity

Race/ethnicity

Age

HTN

HDL < 35mg/dl

triglyceride level >250mg/dl

History of gestational DM or Baby >9lbs

S/S of DM

+

Random BG >200mg/dl

or

Fasting BG >126mg/dl

or

2hr post prandial BG >200mg/dl

BG numbers above have to be on >2 occassions on different days

BG increases with age

(40+years old = age related hyperglycemia)

Causes:

poor diet

physical inactivity

decreased lean body mass (muscle)

altered insulin secretion

insulin resistance

How do you manage Geriontologic DM?

Name 5 things

Nutrition

exercise

monitor BG

pharmacologic treatment

education

Normalize insulin activity

Normalize BG levels

Prevent vascular & neuropathic complications

proper diet

weight control

meet energy needs

prevent wide BG fluctuations

decrease serum lipid levels

the number of the insulin receptors increase allowing glucose to bind better.

Could cause them to not have to take any DM meds and control DM by diet & exercise only!

Let them personalize it.

Let them choose what they want to eat but offer suggestions to make the plan better for their DM needs.

ex:  Instead of pork bacon, try turkey bacon.

What percentage of CHO, fat, & protein are needed for a ADA diet?

50-60% CHO

<30% fat

10-15% protein

lowers total cholesterol

lowers LDLs

Improves BG levels

bread/starch

veggie

milk

meat

fruit

fat

this slows the absorption and lowers glycemic response.

So does raw foods compared to chopped, cooked, or pureed foods.

Whole fruit compared to fruit juice!

Hypoglycemia

because they want to get drunk, they don't eat.

the basics:

how to admin insulin

exercise & simple diet

teach them what will kill them first

yes

exercise lowers BG and could cause Hypoglycemia

you don't snack a type 2 if they are trying to lose weight unless they show s/s of hypoglycemia

6 = average of 120

anything >7 = high BG of >150

Lispro (Humalog)

Glulisine (Apidra)

Aspart (Novalog)

onset = 10-15mins

peak = 1-2hrs

duration = 3hrs

shoRt acting

onset = 30min-1hr

peak = 2-3 hrs

duration = 4-6hrs

isophane/NPH

(Humulin N, Novolin N)

onset = 3-4hrs

peak = 4-12hrs

duration = 20-30hrs

U = Long (end of alphabet)

ultralente (Humulin U)

onset = 6-8hrs

peak = 12-16 hrs

duration = 20-30hrs

detemir (Levemir)

glargine (Lantis)

how is Lantis like the pancreas?

onset = 1 hr

peak = continuous

duration = 24hrs

local allergic reaction

systemic allergic reaction

lipodystrophy

resistance

morning hyperglycemia

syringe

insulin pen

jet injector

insulin pump

implantable & inhalant insulin

transplant of pacreas or islet cells

stimulate pancreas to release insulin

lowers glucose production by the liver

facilitates insulin's action on peripheral sites

delays glucose absorption in gut

HYPOGLYCEMIA

GI disturbance (NVD - hey pepto bismal)

Liver (altered function)

Lactic Acidosis (same as metabolic acidosis)

Hyperglycemia

good for 1 month on shelf

good for 1 year in frig

What scares you the most?

Give choices on what they want to learn first but still teach what you need to teach that day.

show control & positive attitude

what is Hypoglycemia?

cause & S/S

abnormally low BG (<50-60)

caused by too much insulin,

too little food,

excessive physcial activity

S/S = sweat, tremor, tachycardia, palpitations

inability to concentrate, HA, Lightheaded, Slurred speech, emotional changes, irritability, diplopia, drowsy

10-15g of fast acting CHO

3-4 glucose tabs

4-6oz fruit juice/soda

**4-6 oz Milk is the best choice**

recheck BG after 15mins

>70-75 = give snack (protein & starch)

<70-75 = repeat CHO

unconscious pt = 1g Glucagon SQ or IM

pt should regain conscious within 20 mins, give snack. Notify Md

unconscious pt in ED = 20-50ml D50W IV