This document discusses diabetes mellitus and its various types. It defines diabetes as a metabolic disorder characterized by hyperglycemia due to lack of insulin or cellular resistance to insulin. There are four main types of diabetes: type 1 usually diagnosed in childhood and requiring daily insulin injections; type 2 which is most common and often associated with obesity; gestational diabetes occurring during pregnancy; and pre-diabetes involving above average blood glucose. Symptoms, diagnostic tests, treatment options involving medications and insulin, and management are described for the different types of diabetes.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
Diabetes mellitus (DM)
Introduction Sign and symptoms
complications
Types Etiology
Risk factors
Comparison between type 1 & type 2 DM
Causes of gestational DM
Q. Is there any impact of gestational DM on children?
Insulin Mechanism of action
Clinical features
List of oral hypoglycemic drugs available in BD
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
Diabetes mellitus (DM)
Introduction Sign and symptoms
complications
Types Etiology
Risk factors
Comparison between type 1 & type 2 DM
Causes of gestational DM
Q. Is there any impact of gestational DM on children?
Insulin Mechanism of action
Clinical features
List of oral hypoglycemic drugs available in BD
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
Definition : Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from impaired insulin secretion, insulin action [ insulin resistance ] or both .
The chronic hyperglycemia in DM is associated with long term damage dysfunction and failure of various organs
Is based on etiology not on type of treatment or age of the patient.
Type I(Beta cell destruction-absolute insulin deficiency)
Immune mediated Idiopathic
Type II
predominant insulin resistant with relative insulin deficiency
predominant secretory defect with insulin resistance
Nursing Management · Monitor blood sugar and use a sliding scale to treat high levels of glucose · Educate patient about diabetes · Examine feet .
Diagnosis involves measuring blood glucose levels. Ongoing specialized assessment and evaluation for complications are essential for diabetes management.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Diabetes Mellitus
Definition: metabolic disorder characterized by
hyperglycemia due to an absolute or relative
lack of insulin or to a cellular resistance to
insulin
Major classifications
• 1. Type 1 Diabetes
• 2. Type 2 Diabetes
3. There are 4 major types of diabetes:
– 1) Type 1 Diabetes
• usually diagnosed in childhood
• affected by hereditary
• sometimes there are no symptoms
• Imperative to inject insulin daily
because the body makes little or no
insulin
• frequently called the ‘insulin-
needed’ group
• Patients with type 1 diabetes need
insulin daily to survive
Types of diabetes
4. Types of diabetes (cont.…)
2)Type 2 Diabetes
• most common
• usually occurs in adulthood
but diagnosis is increasing
in the younger generation
• affects many children
• Body is incapable of
responding to insulin
• Rates rising due to
increased obesity and
failure to exercise and eat
healthy
5. –3) Gestational Diabetes
• blood sugar levels are high
during pregnancy in women
• Women who give birth to
children over 9 lbs.
• high risk of type 2 diabetes
and cardiovascular disease
Types of diabetes
6. –4) Pre-diabetes
• At least 79 million people are
diagnosed with pre-diabetes each
year
• above average blood glucose levels,
not high enough to be classified
under type 1 or type 2 diabetes
• long-term damage to body,
including heart and circulatory
system
• Starts with unhealthy eating habits
& inadequate exercise
Types of diabetes (cont.…)
7. Diabetes Mellitus
Impact on health
1. Sixth leading cause of death due to cardiovascular
effects resulting in atherosclerosis, coronary artery
disease, and stroke
2. Leading cause of end stage renal failure
3. Major cause of blindness
4. Most frequent cause of non-traumatic amputations
8. Diabetes Mellitus
5.Diabetes affects estimated 15.7 million people
(10.3 million are diagnosed; 5.4 million are
undiagnosed)
6.Increasing prevalence of Type 2 Diabetes in older
adults and minority groups (African American,
American Indian and Hispanic populations)
9. Diabetes Mellitus
Diabetes Type 1
Definition
1. Metabolic condition in which the beta cells of pancreas
no longer produce insulin; characterized by
hyperglycemia, breakdown of body fats and protein
and development of ketosis
2. Accounts for 5 – 10 % of cases of diabetes; most often
occurs in childhood or adolescence
3. Formerly called Juvenile-onset diabetes or insulin-
dependent diabetes (IDDM)
10. Diabetes Mellitus
Pathophysiology
1. Autoimmune reaction in which the beta cells that produce
insulin are destroyed
2. Alpha cells produce excess glucagons causing hyperglycemia
Risk Factors
1. Genetic predisposition for increased susceptibility; HLA
linkage
2. Environmental triggers stimulate an autoimmune response
a. Viral infections (mumps, rubella, coxsackievirus B4)
b. Chemical toxins
11.
12. Diabetes Mellitus
Manifestations
1. Process of beta cell destruction occurs slowly;
hyperglycemia occurs when 80 – 90% is destroyed;
often trigger stressor event (e. g. illness)
13. Diabetes Mellitus
2.Hyperglycemia leads to
a. Polyuria (hyperglycemia acts as osmotic diuretic)
b. Glycosuria (renal threshold for glucose: 180 mg/dL)
c. Polydipsia (thirst from dehydration from polyuria)
d. Polyphagia (hunger and eats more since cell cannot
utilize glucose)
e. Weight loss (body breaking down fat and protein to
restore energy source
f. Malaise and fatigue (from decrease in energy)
g. Blurred vision (swelling of lenses from osmotic
effects)
14. • High blood levels of glucose
• Blurry vision
• Fatigue
• Thirst
• Painful urination
• Frequent urination
• Sores that do not heal
• Nausea
• Vomiting
• Weight loss
• Hunger
• **In some cases…there are no
symptoms at all!!
• **Diabetes type 1 and type 2 symptoms
are closely similar, although, type 1 is
often worse in severity
Symptoms of diabetes
15.
16.
17. Diabetes Mellitus
• Diagnosis
– Patient is symptomatic plus
• Casual plasma glucose (non-fasting) is 200 mg/dl OR
• Fasting plasma glucose of 126 mg/dl or higher OR
• Two hour plasma glucose level of 200 mg/dl or greater
during an oral glucose tolerance test
18. Two tests doctors use to diagnose
diabetes and pre-diabetes:
– 1) FPG (Fasting Plasma Glucose Test)
• Patient must fast for eight hours
• Doctor draws blood
• Doctor will mix blood with other liquids
to determine the amount of sugar or
glucose in the blood
• This is measured in mg/dl
• Blood glucose range for pre-diabetics
will be in the 100-125 mg/dl range.
• Type 2 diabetes will have blood sugar
results in the range of 126 mg/dl and
above
• These levels can increase the risk of
heart disease and stroke
–2) OGTT (Oral Glucose Tolerance
Test)
• Doctor measures how well your
body reacts to average dose of
sugar
• Patient will be drawn blood two
hours before and after he/she
drinks pre-mixed beverage with
the sugar
• Blood glucose levels are
measured to see how the body
reacted
• Blood glucose range for pre-
diabetics will be between 140-199
mg/dl.
• For those with type 2 diabetes,
the range will start at 200 mg/dl
and continue to peak
TESTING FOR DIABETES
19. Diabetes Mellitus
Diagnostic tests
a. Blood glucose greater than 250 mg/dL
b. Blood pH less than 7.3
c. Blood bicarbonate less than 15 mEq/L
d. Ketones present in blood
e. Ketones and glucose present in urine
f. Electrolyte abnormalities (Na, K, Cl)
G. serum osmolality < 350 mosm/kg (normal 280-300)
20. Diabetes Mellitus
Treatment
a. Requires immediate medical attention and usually
admission to hospital
B .Frequent measurement of blood glucose and treat
according to glucose levels with regular insulin (mild
ketosis, subcutaneous route; severe ketosis with
intravenous insulin administration)
c. Restore fluid balance: initially 0.9% saline at 500 –
1000 mL/hr.; regulate fluids according to client
status; when blood glucose is 250 mg/dL add
dextrose to intravenous solutions
21. Diabetes Mellitus
Diabetes Type 2
A. Definition: condition of fasting
hyperglycemia occurring despite availability
of body’s own insulin
B. Was known as non-insulin dependent
diabetes or adult onset diabetes
– Both are misnomers, it can be found in children
and type II DM may require insulin
22. Diabetes Mellitus
Pathophysiology
• 1. Sufficient insulin production to prevent
DKA; but insufficient to lower blood glucose
through uptake of glucose by muscle and fat
cells
• 2. Cellular resistance to insulin increased by
obesity, inactivity, illness, age, some
medications
23.
24.
25.
26. Diabetes Mellitus
Diagnostic tests to monitor diabetes management
1. Fasting Blood Glucose (normal: 70 – 110 mg/dL)
2. Glycosylated hemoglobin (c) (Hemoglobin A1C)
• a. Considered elevated if values above 7%
• b. Blood test analyzes excess glucose attached to
hemoglobin. Since rbc lives about 120 days gives an
average of the blood glucose over previous 2 to 3
months
– Not a fasting test, can be drawn any time of the day
– % of glycated (glucose attached) hemoglobin measures how
much glucose has been in the bloodstream for the past 3
months
27. Diabetes Mellitus
3.Urine glucose and ketone levels (part of
routine urinalysis)
– a.Glucose in urine indicates hyperglycemia (renal
threshold is usually 180 mg/dL)
– b. Presence of ketones indicates fat breakdown, indicator
of DKA; ketones may be present if person not eating
4. Urine albumin (part of routine urinalysis)
• a. If albumin present, indicates need for workup
for nephropathy
• b. Typical order is creatinine clearance testing
28. Diabetes Mellitus
5.Cholesterol and Triglyceride levels
a.Recommendations
1.LDL < 100 mg/dl
2.HDL > 45 mg/dL
3.Triglycerides < 150 mg/dL
b. Monitor risk for atherosclerosis and
cardiovascular complications
Serum electrolytes in clients withDKA or HHNS
29. Diabetes Mellitus
Medications
A. Insulin
1. Sources: standard practice is use of human insulin prepared
by alteration of pork insulin or recombinant DNA therapy
2. Clients who need insulin as therapy:
a. All type 1 diabetics since their bodies essentially no longer
produce insulin
b. Some Type 2 diabetics, if oral medications are not adequate
for control (both oral medications and insulin may be
needed)
c. Diabetics enduring stressor situations such as surgery,
corticosteroid therapy, infections, treatment for DKA, HHNS
d. Women with gestational diabetes who are not adequately
controlled with diet
e. Some clients receiving high caloric feedings including tube
feedings or parenteral nutrition
30. Diabetes Mellitus
• Injection sites
– Abdominal areas is the most preferred because
of rapid absorption
– Do not aspirate insulin injections
– Administration covered in the lab
33. BEFORE
BREAKFAST
BEFORE
LUNCH
BEFORE
DINNER
AT
BEDTIME
NPH dose 12 units 6 units
Regular insulin dose if
fingerstick
glucose is (mg/dl)
[mmol/L]:
70-100 [3.9-5.5] 4 units 4 units
101-150 [5.6-8.3] 5 units 5 units
151-200 [8.4-11.1] 6 units 6 units
201-250 [11.2-13.9] 7 units 7 units
251-300 [14.0-16.7] 8 units 1 unit 8 units 1 unit
>300 [>16.7] 9 units 2 units 9 units 2 units
34. Diabetes Mellitus
Oral Hypoglycemic Agents
1.Used to treat Diabetes Type 2
2.Client must also maintain prescribed diet and
exercise program; monitor blood glucose
levels
3.Not used with pregnant or lactating women
4.Several different oral hypoglycemic agents and
insulin may be prescribed for the client
5.Specific drug interactions may affect the blood
glucose levels
6. Must have some functioning beta cells
35. Diabetes Mellitus
Classifications and action
a.Sulfonylureas
• 1. Action: Stimulates pancreatic cells to
secrete more insulin and increases sensitivity
of peripheral tissues to insulin
• 2. Used: to treat non-obese Type 2 diabetics
• 3. Example: Glipizide (Glucotrol),
Chlorpropamide (Diabinese), Tolazamide
(Tolinase)
36. Diabetes Mellitus
b. Meglitinides
• 1. Action: stimulates pancreatic cells to secret
more insulin
• 2. Taken just before meals, rapid onset, limited
duration of action
• 3. Major adverse effects is hypoglycemia
• 4. Used in non-obese diabetics
• 5. Example: Repaglinide (Prandin), Nateglinide
(Starlix)
37. Diabetes Mellitus
c. Biguanides
• 1. Action: decreases overproduction of
glucose by liver and makes insulin more
effective in peripheral tissues
• 2. Used in obese diabetics
• 3. Does not stimulate insulin release
• 4. Metabolized by the kidney, do not use
with renal patients
• 5. Example: Metformin (Glucophage
38. Diabetes Mellitus
d.Alpha-glucoside Inhibitors
• 1. Action: Slow carbohydrate digestion and
delay rate of glucose absorption
• 2. Take with first bite of the meal or 15 min.
after
• 3. Adjunct to diet to decrease blood glucose
levels
• 4. Example: Acarbose (Precose), Miglitol
(Glyset)
39. Diabetes Mellitus
Thizaolidinediones (Glitazones)
• 1. Action: Sensitizes peripheral tissues to
insulin
• 2. Used in obese diabetics
• 3. Inhibits glucose production
• 4. Improves sensitivity to insulin in muscle,
and fat tissue
• 5. Example: Rosiglitazone (Avandia),
Pioglitazone (Actos)
40. Diabetes Mellitus
• Patients with Type 2 DM who are obese have
insulin resistance, they produce enough
insulin
– Should use Glucophage, Actos or Avandia
– Enhances insulin secretion in tissue, but does not
increase amount of insulin secreted
41. Diabetes Mellitus
• Patients with Type 2 DM who are thin do not
produce enough insulin, they are not insulin
resistant
– Need sulfonylurea agents like Diabinese,
Tolinase, Glucotrol, Diabeta
42. Diabetes Mellitus
Role of Diet in Diabetic Management
A. Goals for diabetic therapy include
1.Maintain as near-normal blood glucose levels
as possible with balance of food with
medications
2.Obtain optimal serum lipid levels
3.Provide adequate calories to attain or
maintain reasonable weight
43. Diabetes Mellitus
B.Diet Composition
1. Carbohydrates: 60 – 70% of daily diet
– Carbohydrates convert quickly to sugars
• Advice patient to consume a similar amount of carbs at each
meal
• Medications can work on a consistent glucose response from
foods
2. Protein: 15 – 20% of daily diet
3. Fats: No more than 10% of total calories from
saturated fats
44. Diabetes Mellitus
4. Fiber: 20 to 35 grams/day; promotes intestinal
motility and gives feeling of fullness
5. Sodium: recommended intake 1000 mg per 1000
kcal
6. Sweeteners approved by FDA instead of refined
sugars
7. Limited use of alcohol: potential hypoglycemic
effect of insulin and oral hypoglycemics
45. Diabetes Mellitus
Diet
– Look for more dietary information online at
http://www.diabetes.org/nutrition-and-
receipes/nutrition/overview.jsp
46. Diabetes Mellitus
Nursing Care
A. Assessment, planning, implementation with client
according to type and stage of diabetes
B. Prevention, assessment and treatment of complications
through client self-management and keeping
appointments for medical care
C. Client and family teaching for diabetes management
D. Health promotion includes education of healthy life style,
lowering risks for developing diabetes for all clients.
E. Blood glucose screening at 3 year intervals starting at age
45 for persons in high risk groups
47. Diabetes Mellitus
Common Nursing Diagnoses and Specific Teaching
Interventions
A. Risk for impaired skin integrity: Proper foot care
1. Daily inspection of feet
2. Checking temperature of any water before washing feet
3. Need for lubricating cream after drying but not between toes
4. Patients should be followed by a podiatrist
5. Early reporting of any wounds or blisters
B. Risk for infection
1. Frequent hand washing
2. Early recognition of signs of infection and seeking treatment
3. Meticulous skin care
4. Regular dental examinations and consistent oral hygiene care
48. Diabetes Mellitus
C. Risk for injury: Prevention of accidents, falls and
burns
D.Sexual dysfunction
1. Effects of high blood sugar on sexual functioning,
2. Resources for treatment of impotence, sexual
dysfunction
E. Ineffective coping
1. Assisting clients with problem-solving strategies
for specific concerns
49. Diabetes Mellitus
2. Providing information about diabetic
resources, community education programs,
and support groups
3.Utilizing any client contact as opportunity to
review coping status and reinforce proper
diabetes management and complication
prevention
50. • Prevention all starts with a better lifestyle
• Eating healthier
• Being active
• Taking medicine as directed
• Taking care of your body
• Check feet to make sure there is no nerve damage or interruption of blood
flow
• Take care of teeth
• Control blood pressure and high
• No smoking!
• Check in with your doctor at least once a month
• Have your blood sugar checked along with weight, blood pressure, and
feelings
• Check blood sugar levels daily by using home monitoring device
How to prevent/control diabetes