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Diabetes Mellitus: Understanding Types, Causes, Symptoms, and Management - Prof. Joann M. , Study notes of Nursing

An in-depth look into diabetes mellitus, its two main types - type i and type ii, causes, symptoms, complications, diagnostic evaluation, and therapeutic management. It covers topics such as ketoacidosis, long-term complications, nutrition, exercise, hypoglycemia, illness management, and therapeutic management of ketoacidosis.

Typology: Study notes

2009/2010

Uploaded on 12/08/2010

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Diabetes Mellitus Chapter 38
1. Chronic disorder of metabolism characterized by a partial or complete deficiency of the
hormone insulin
a. Most common metabolic disease
2. Type I- characterized by destruction of the pancreatic B cells, which produce insulin
a. Usually leads to absolute insulin deficiency
b. Autoimmune disease. Person with genetic predisposition is exposed to a precipitating
event
c. Most predominant form in pediatric age-group
3. Type II- usually arises because of insulin resistance
a. Body fails to use insulin properly
b. More likely to be influenced by stronger genetic factors
c. Changes in food consumption and exercise have increased the rate of type II diabetes in
children
4. Ketoacidosis- when glucose is unavailable for cellular metabolism, and the body chooses
alternate sources of energy (fat)
a. Fat berak down into fatty acids, and glycerol in the fat cells is converted by the liver into
ketone bodies
i. Excess is eliminated in the urine or lungs
ii. Ketone bodies in the blood are strong acids that lower pH producing
ketoacidosis
b. Respiratory system attempts to eliminate the excess carbon dioxide to raise pH
i. Kussmaul respiration
c. Cellular death results in potassium being released from the cell into the blood stream
and is excreted through the kidney
i. Total body K+ is decreased but the serum potassium level may be elevated
5. Long Term Complications
a. Microvascular- may occur as early as 2.5-3 yr after diagnosis with bad disease
management
i. Microvascular changes begin occurring after puberty
6. Clinical Manifestations
a. Hyperglycemia, weight loss, acidosis, polyphagia, polydipsia and polyuria
7. Diagnostic Evaluation (three candidate groups)
a. Children who have glycosuria, polyuria and a history of weight loss
b. Those with transient or persistent glycosuria
c. Those who display manifestations of metabolic acidosis, with or without stupor or coma
8. Diagnosis
a. An 8 hour flasting blood glucose level of 126 or more
b. A random blood glucose value of 200 or more accompanied by classic signs of diabetes
c. Oral glucose tolerance test with a finding of 200 or more in the 2 hour sample
9. Therapeutic Management
a. Insulin
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Diabetes Mellitus Chapter 38

  1. Chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin a. Most common metabolic disease
  2. Type I- characterized by destruction of the pancreatic B cells, which produce insulin a. Usually leads to absolute insulin deficiency b. Autoimmune disease. Person with genetic predisposition is exposed to a precipitating event c. Most predominant form in pediatric age-group
  3. Type II- usually arises because of insulin resistance a. Body fails to use insulin properly b. More likely to be influenced by stronger genetic factors c. Changes in food consumption and exercise have increased the rate of type II diabetes in children
  4. Ketoacidosis- when glucose is unavailable for cellular metabolism, and the body chooses alternate sources of energy (fat) a. Fat berak down into fatty acids, and glycerol in the fat cells is converted by the liver into ketone bodies i. Excess is eliminated in the urine or lungs ii. Ketone bodies in the blood are strong acids that lower pH producing ketoacidosis b. Respiratory system attempts to eliminate the excess carbon dioxide to raise pH i. Kussmaul respiration c. Cellular death results in potassium being released from the cell into the blood stream and is excreted through the kidney i. Total body K+ is decreased but the serum potassium level may be elevated
  5. Long Term Complications a. Microvascular- may occur as early as 2.5-3 yr after diagnosis with bad disease management i. Microvascular changes begin occurring after puberty
  6. Clinical Manifestations a. Hyperglycemia, weight loss, acidosis, polyphagia, polydipsia and polyuria
  7. Diagnostic Evaluation (three candidate groups) a. Children who have glycosuria, polyuria and a history of weight loss b. Those with transient or persistent glycosuria c. Those who display manifestations of metabolic acidosis, with or without stupor or coma
  8. Diagnosis a. An 8 hour flasting blood glucose level of 126 or more b. A random blood glucose value of 200 or more accompanied by classic signs of diabetes c. Oral glucose tolerance test with a finding of 200 or more in the 2 hour sample
  9. Therapeutic Management a. Insulin

i. Tailored to each child based on home blood glucose monitoring ii. Low but steady basal rate with superimposed bursts of short acting insulin that coincide with intake of nutrients (similar to pancreatic cells) b. Dosage i. Conventional-twice daily regimen consisting of a combination of rapid-acting and intermediate-acting insulin ii. Intensive- multiple injections throughout the day with once or twice daily dose of long acting insulin

  1. Monitoring a. Blood glucose levels. b. A1C i. Values should be between 6.5 and 8 c. Urine-test for ketonuria
  2. Nutrition- nutritional needs are the same as those of healthy children a. Meals and snacks must be eaten according to peak insulin action b. Calories and portions should be consistent from day to day c. Three meals per day plus snacks between meals and at bedtime
  3. Exercise- should be included as part of diabetic management a. Regular exercise aids in utilization of food and often results n a reduction of insulin requirements b. Vigorous muscular contraction increases regional blood flow and accelerates absorption i. Administer insulin in nonexercised sights
  4. Hypoglycemia-most common cause are bursts of physical activity without additional food, or delayed, omitted, or incompletely consumed meals a. s/sx- nervousness, pallor, tremulousness, palpitations, sweating, hunger, weakness, dizziness, headache, drowsiness, irritability, loss of coordination, seizures and coma i. often difficult to distinguish between hyper and hypoglycemia----always test blood glucose b. treat with 10-15 grams of simple carbohydrate i. may repeat in 10-15 minutes if sugars don’t return to normal
  5. Illness Management a. Goal is to restore euglycemia, treat urinary ketones and maintain hydration i. Ketones should be monitored every 3 hours b. Never omit insulin (dosage requirements may increase, decrease or remain unchanged
  6. Therapeutic management of Ketoacidosis a. Management i. Rapid assessment ii. Administer adequate insulin to reduce the elevated blood glucose level iii. Administer fluids to overcome dehydration iv. Replace electrolytes (especially K+) b. Fluid and Electrolyte Therapy