This document defines diabetes mellitus and describes its two main types, type 1 and type 2. It discusses the impact of diabetes on health, including that it is a leading cause of death, end-stage renal failure, blindness, and amputations in the US. Complications of diabetes discussed include cardiovascular disease, retinopathy, nephropathy, and hypoglycemia or hyperglycemia. Treatment involves managing blood glucose levels and risks through medication, diet, exercise and screening to prevent or treat complications.
This document summarizes information about endocrine disorders, with a focus on diabetes mellitus. It describes the different types of diabetes, including type 1, type 2, gestational diabetes, and maturity-onset diabetes of the young. The clinical features, acute and chronic complications, diagnosis, and management of diabetes are discussed in detail. Treatment involves lifestyle changes, oral medications, insulin administration, and glycemic control monitoring. Dental considerations for diabetic patients are also reviewed.
This document provides definitions and classifications of diabetes mellitus. It discusses the pathogenesis of type 1 and type 2 diabetes, focusing on genetic and environmental factors. Complications of diabetes are described, including acute metabolic issues like DKA and chronic issues like atherosclerosis, nephropathy, neuropathy and retinopathy. Diagnosis methods such as blood glucose testing and oral glucose tolerance tests are outlined. Gestational diabetes is also briefly discussed.
The document discusses diabetic ketoacidosis, providing an overview of its pathophysiology, classification, diagnosis, and treatment. Diabetic ketoacidosis results from a lack of insulin and leads to hyperglycemia, ketonemia, and metabolic acidosis if not treated. Treatment involves fluid resuscitation, electrolyte replacement, insulin therapy to reduce blood glucose levels and resolve acidosis, and careful monitoring to prevent complications such as cerebral edema.
The document discusses diabetic ketoacidosis, providing an overview of its pathophysiology, classification, diagnosis, and treatment. Diabetic ketoacidosis results from a lack of insulin and leads to hyperglycemia, ketonemia, and metabolic acidosis if not treated. Treatment involves fluid resuscitation, electrolyte replacement, insulin therapy to reduce blood glucose levels and resolve acidosis, and careful monitoring to prevent complications such as cerebral edema.
Lecture 7. diabetic mellitus & pancreatic tumourAyub Abdi
1. Diabetes mellitus is a metabolic disorder characterized by hyperglycemia that affects over 29 million people in the US and 422 million worldwide.
2. There are several types of diabetes including type 1 caused by autoimmune destruction of beta cells, type 2 caused by insulin resistance and relative insulin deficiency, and gestational diabetes during pregnancy.
3. Chronic complications of diabetes include damage to blood vessels leading to heart disease, stroke, and kidney failure as well as nerve damage causing neuropathy. Rare forms include monogenic diabetes and pancreatic tumors such as insulinomas.
Diabetes Mellitus is a chronic disease that can result in terminal consequences which will be discussed in this presentation. Due to its commonality, it is vital for everyone to have sufficient information about it. This slideshow takes you through the different types and characteristics of DM. The signs, symptoms, risk factors as well as its pathophysiology are covered. A standardized protocol for diagnosis and treatment is highlighted too.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
Lesson plan of teaching and learning.pptxRashidahabib1
This document provides information on diabetes mellitus (DM), including its various types, pathophysiology, clinical manifestations, management, and nursing considerations. It discusses the classification of DM into types 1 and 2, gestational DM, and other types associated with other conditions. The roles of insulin, insulin resistance, and pancreatic beta cell function are explained for each type. Common symptoms, medical treatments including insulin therapy and oral medications, and nursing assessments, diagnoses, goals, and interventions are also summarized.
This document summarizes information about endocrine disorders, with a focus on diabetes mellitus. It describes the different types of diabetes, including type 1, type 2, gestational diabetes, and maturity-onset diabetes of the young. The clinical features, acute and chronic complications, diagnosis, and management of diabetes are discussed in detail. Treatment involves lifestyle changes, oral medications, insulin administration, and glycemic control monitoring. Dental considerations for diabetic patients are also reviewed.
This document provides definitions and classifications of diabetes mellitus. It discusses the pathogenesis of type 1 and type 2 diabetes, focusing on genetic and environmental factors. Complications of diabetes are described, including acute metabolic issues like DKA and chronic issues like atherosclerosis, nephropathy, neuropathy and retinopathy. Diagnosis methods such as blood glucose testing and oral glucose tolerance tests are outlined. Gestational diabetes is also briefly discussed.
The document discusses diabetic ketoacidosis, providing an overview of its pathophysiology, classification, diagnosis, and treatment. Diabetic ketoacidosis results from a lack of insulin and leads to hyperglycemia, ketonemia, and metabolic acidosis if not treated. Treatment involves fluid resuscitation, electrolyte replacement, insulin therapy to reduce blood glucose levels and resolve acidosis, and careful monitoring to prevent complications such as cerebral edema.
The document discusses diabetic ketoacidosis, providing an overview of its pathophysiology, classification, diagnosis, and treatment. Diabetic ketoacidosis results from a lack of insulin and leads to hyperglycemia, ketonemia, and metabolic acidosis if not treated. Treatment involves fluid resuscitation, electrolyte replacement, insulin therapy to reduce blood glucose levels and resolve acidosis, and careful monitoring to prevent complications such as cerebral edema.
Lecture 7. diabetic mellitus & pancreatic tumourAyub Abdi
1. Diabetes mellitus is a metabolic disorder characterized by hyperglycemia that affects over 29 million people in the US and 422 million worldwide.
2. There are several types of diabetes including type 1 caused by autoimmune destruction of beta cells, type 2 caused by insulin resistance and relative insulin deficiency, and gestational diabetes during pregnancy.
3. Chronic complications of diabetes include damage to blood vessels leading to heart disease, stroke, and kidney failure as well as nerve damage causing neuropathy. Rare forms include monogenic diabetes and pancreatic tumors such as insulinomas.
Diabetes Mellitus is a chronic disease that can result in terminal consequences which will be discussed in this presentation. Due to its commonality, it is vital for everyone to have sufficient information about it. This slideshow takes you through the different types and characteristics of DM. The signs, symptoms, risk factors as well as its pathophysiology are covered. A standardized protocol for diagnosis and treatment is highlighted too.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
Lesson plan of teaching and learning.pptxRashidahabib1
This document provides information on diabetes mellitus (DM), including its various types, pathophysiology, clinical manifestations, management, and nursing considerations. It discusses the classification of DM into types 1 and 2, gestational DM, and other types associated with other conditions. The roles of insulin, insulin resistance, and pancreatic beta cell function are explained for each type. Common symptoms, medical treatments including insulin therapy and oral medications, and nursing assessments, diagnoses, goals, and interventions are also summarized.
This document provides information on diabetes mellitus (DM), including its definition, epidemiology, pathophysiology, diagnosis, management, and the differences between type 1 and type 2 DM. Some key points:
- DM is characterized by hyperglycemia resulting from defects in insulin secretion/action and is a major cause of illness and death worldwide. It is predicted to increase significantly by 2030.
- The pathophysiology involves abnormalities in carbohydrate, fat, and protein metabolism due to deficient insulin action. Chronic hyperglycemia can cause damage to various organs.
- Diagnosis is based on symptoms, random blood glucose levels, HbA1c levels, and glucose tolerance tests.
- Management involves diet,
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
This document provides information on diabetes mellitus (DM), including the different types of DM, complications of DM, diagnostic tests, treatment, and management. It begins by defining DM as a chronic condition characterized by hyperglycemia. It describes the three main types of DM - type 1 DM which results from an autoimmune destruction of the pancreas, type 2 DM which involves insulin resistance and relative lack of insulin production, and gestational DM which develops during pregnancy. It also outlines the acute complications of DM including hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic syndrome. Long term complications from macrovascular and microvascular changes are also discussed.
Diabetes Mellitus is a disease characterized by high blood sugar levels. There are several types of diabetes including type 1, type 2, gestational diabetes, and other rare forms. Type 1 diabetes occurs when the immune system destroys pancreatic beta cells, preventing insulin production. Type 2 diabetes involves insulin resistance and sometimes relative insulin deficiency, impairing glucose regulation. Gestational diabetes develops in some pregnant women due to changing hormone levels. Prediabetes refers to elevated blood sugar not high enough for a diabetes diagnosis. Risk factors include family history, obesity, age, and ethnicity.
Diabetes is a chronic disorder caused by insufficient insulin or insulin resistance. It can be asymptomatic and lead to complications if not properly managed. There are two main types - Type 1 is an autoimmune disorder destroying pancreatic beta cells, while Type 2 is caused by insulin resistance and often related to obesity. Chronic hyperglycemia can cause complications through non-enzymatic glycation and sorbitol accumulation, leading to damage in small and large blood vessels causing issues like heart disease, stroke, neuropathy, kidney disease and retinopathy. Proper management through lifestyle changes, medication and monitoring can prevent complications of diabetes.
This document discusses the regulation of blood sugar levels and diabetes mellitus. It explains that blood glucose is tightly regulated by factors that control glucose entry into and depletion from the bloodstream. In fasting state, glycogenolysis and gluconeogenesis maintain blood glucose levels. After eating, insulin helps regulate levels by promoting glucose uptake and storage. Diabetes occurs when this regulation breaks down, and is classified into type 1 (insulin deficiency) and type 2 (insulin resistance). The document outlines symptoms, treatments, and oral manifestations of diabetes.
Diabetes is a chronic disease characterized by high blood sugar levels due to insufficient insulin production or impaired insulin utilization. It can be caused by genetic, autoimmune, viral, or environmental factors and its prevalence is increasing worldwide. Without enough insulin, glucose stays in the blood instead of being used for energy, leading to complications over time such as damage to blood vessels, nerves, eyes, and kidneys. Diabetic ketoacidosis is a life-threatening complication of diabetes caused by lack of insulin and an accumulation of ketones in the blood, with symptoms including nausea, vomiting, rapid breathing, and confusion. Proper management of diabetes can help prevent acute complications and reduce the risk of long-term damage.
Diabetes mellitus by Dr. Bhavishath ShettyBhavishathS
The document discusses diabetes mellitus (DM), a metabolic disorder characterized by high blood glucose levels. DM results from defects in insulin production, insulin action, or both. Long-term effects of DM include damage to various organs and specific complications such as retinopathy, nephropathy, neuropathy, and increased risk of cardiovascular disease. The main types of DM are type 1, type 2, and gestational diabetes. The document also discusses various metabolic derangements associated with DM, symptoms of DM, diagnostic tests such as glycosylated hemoglobin, and complications of DM like angiopathy.
This document summarizes the clinical manifestations and complications of diabetes mellitus. It discusses the symptoms of type 1 and type 2 diabetes, including polyuria, polydipsia, weight loss, and ketoacidosis in type 1 patients. Acute complications covered are diabetic ketoacidosis, hyperglycemic hyperosmolar state, lactic acidosis, and hypoglycemia. Chronic complications are also briefly mentioned. The pathophysiology, clinical features, diagnosis, and management of diabetic ketoacidosis are described in detail.
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.
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. The four main types of diabetes are described as type 1, type 2, gestational diabetes, and pre-diabetes. Type 1 diabetes is usually diagnosed in childhood and requires daily insulin injections. Type 2 diabetes is the most common type and is often associated with obesity. Gestational diabetes occurs during pregnancy and increases risk of future diabetes. Pre-diabetes involves above normal blood sugar levels that can lead to long-term health damage if not addressed.
This document discusses diabetes mellitus and hypoglycemia. It defines diabetes as a clinical syndrome of hyperglycemia caused by insulin deficiency. There are two main types of diabetes - type 1 caused by autoimmune destruction of beta cells resulting in absolute insulin deficiency, and type 2 which is genetic and associated with obesity and insulin resistance. Without treatment, complications from hyperglycemia can include glycosuria, impaired immune function, hyperosmolarity, and glycosylation of proteins leading to long term damage. The pathophysiology revolves around metabolic alterations from insulin deficiency like hyperglycemia, ketoacidosis, and lipid abnormalities.
Hyperg crisittnoon conference hall of coronary circulation of the matters of coronary circulation and my reaction is the matters for men and women with out of India as well as the matters to help someone else and my reaction is the best of the world cup today and today
This document provides information on diabetes mellitus (DM), including:
- DM results from defects in insulin production/action leading to hyperglycemia.
- The prevalence of DM in Nepal is approximately 3.6% overall, higher in urban vs. rural areas.
- The main types of DM are type 1, type 2, and gestational diabetes.
- Risk factors, symptoms, diagnostic criteria, treatment methods including diet, exercise, medications, education and potential acute/chronic complications are outlined.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
This document presents information on complications, management, and treatment of diabetes mellitus. It defines diabetes as a group of metabolic diseases involving high blood glucose levels due to inadequate insulin production or cells not responding to insulin. It discusses the types and classifications of diabetes, epidemiology, clinical manifestations, acute and chronic complications, and current pharmacological and non-pharmacological treatment approaches including insulin, oral hypoglycemic agents, lifestyle changes, and education. The goal of diabetes management is to eliminate hyperglycemia symptoms, reduce complications, and allow patients to live as normal a lifestyle as possible.
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.
Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. The main types are type 1 diabetes, which accounts for 10% of cases and results from autoimmune destruction of beta cells, and type 2 diabetes, which accounts for 80% of cases and involves insulin resistance and impaired insulin secretion. Diagnosis is confirmed by random plasma glucose over 200 mg/dL or an oral glucose tolerance test. Complications include acute issues like ketoacidosis and hypoglycemia, and chronic complications involving the cardiovascular, renal, neurological, and ophthalmic systems.
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both .
Causes:-
Life style
Genetics factor
Obesity
Diet time variation
Etiological Classification of Diabetes:
Type :-1 Diabetes (insulin dependent)
Type :-2 Diabetes (non insulin dependent)
Gestational diabetes
DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance.
DEFINITION OF GESTATIONAL DIABETES :
Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due to reduced sensitivity of insulin receptors.
CAUSES :
The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include:
Genetics
Exposure to viruses and other environmental factors
Endocrine disorders such as acromegaly , Cushing's syndrome
Endocrine disorders e.g. Pancreatitis .
Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons .
Micro vascular complications (zeroplateas , neutrophils , eosinophil's )
Macro vascular complications (CHF , stroke , peripheral vascular disease)
SYMPTOMS :
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
Increased thirst
Frequent urination
Bed-wetting in children who previously didn't wet the bed during the night
Extreme hunger
Unintended weight loss
Irritability and other mood changes
Fatigue and weakness
Blurred vision
PHARMACOLOGICAL TREATMENT :
Insulin:
People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection.
Metformin :
Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should.
Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin.
B) NON- PHARMACOLOGICAL TREATMENT :
CONTROL THE SYMPTOMS .
EXERCISES
MONITORING THE SUGAR LEVELS
HEALTHY FOODS .
This document provides an overview of endocrinology with a focus on diabetes mellitus and thyroid disorders for second year anesthesia students. It defines diabetes mellitus and classifies it into two main types. Type 1 diabetes is characterized by an absolute insulin deficiency due to autoimmune destruction of beta cells, while type 2 diabetes involves insulin resistance and a relative insulin deficiency. The document discusses the pathogenesis, clinical features, diagnosis, treatment and complications of both types of diabetes mellitus. It also outlines the goals of diabetes management and various pharmacologic therapies.
This document provides information on diabetes mellitus (DM), including its definition, epidemiology, pathophysiology, diagnosis, management, and the differences between type 1 and type 2 DM. Some key points:
- DM is characterized by hyperglycemia resulting from defects in insulin secretion/action and is a major cause of illness and death worldwide. It is predicted to increase significantly by 2030.
- The pathophysiology involves abnormalities in carbohydrate, fat, and protein metabolism due to deficient insulin action. Chronic hyperglycemia can cause damage to various organs.
- Diagnosis is based on symptoms, random blood glucose levels, HbA1c levels, and glucose tolerance tests.
- Management involves diet,
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
This document provides information on diabetes mellitus (DM), including the different types of DM, complications of DM, diagnostic tests, treatment, and management. It begins by defining DM as a chronic condition characterized by hyperglycemia. It describes the three main types of DM - type 1 DM which results from an autoimmune destruction of the pancreas, type 2 DM which involves insulin resistance and relative lack of insulin production, and gestational DM which develops during pregnancy. It also outlines the acute complications of DM including hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic syndrome. Long term complications from macrovascular and microvascular changes are also discussed.
Diabetes Mellitus is a disease characterized by high blood sugar levels. There are several types of diabetes including type 1, type 2, gestational diabetes, and other rare forms. Type 1 diabetes occurs when the immune system destroys pancreatic beta cells, preventing insulin production. Type 2 diabetes involves insulin resistance and sometimes relative insulin deficiency, impairing glucose regulation. Gestational diabetes develops in some pregnant women due to changing hormone levels. Prediabetes refers to elevated blood sugar not high enough for a diabetes diagnosis. Risk factors include family history, obesity, age, and ethnicity.
Diabetes is a chronic disorder caused by insufficient insulin or insulin resistance. It can be asymptomatic and lead to complications if not properly managed. There are two main types - Type 1 is an autoimmune disorder destroying pancreatic beta cells, while Type 2 is caused by insulin resistance and often related to obesity. Chronic hyperglycemia can cause complications through non-enzymatic glycation and sorbitol accumulation, leading to damage in small and large blood vessels causing issues like heart disease, stroke, neuropathy, kidney disease and retinopathy. Proper management through lifestyle changes, medication and monitoring can prevent complications of diabetes.
This document discusses the regulation of blood sugar levels and diabetes mellitus. It explains that blood glucose is tightly regulated by factors that control glucose entry into and depletion from the bloodstream. In fasting state, glycogenolysis and gluconeogenesis maintain blood glucose levels. After eating, insulin helps regulate levels by promoting glucose uptake and storage. Diabetes occurs when this regulation breaks down, and is classified into type 1 (insulin deficiency) and type 2 (insulin resistance). The document outlines symptoms, treatments, and oral manifestations of diabetes.
Diabetes is a chronic disease characterized by high blood sugar levels due to insufficient insulin production or impaired insulin utilization. It can be caused by genetic, autoimmune, viral, or environmental factors and its prevalence is increasing worldwide. Without enough insulin, glucose stays in the blood instead of being used for energy, leading to complications over time such as damage to blood vessels, nerves, eyes, and kidneys. Diabetic ketoacidosis is a life-threatening complication of diabetes caused by lack of insulin and an accumulation of ketones in the blood, with symptoms including nausea, vomiting, rapid breathing, and confusion. Proper management of diabetes can help prevent acute complications and reduce the risk of long-term damage.
Diabetes mellitus by Dr. Bhavishath ShettyBhavishathS
The document discusses diabetes mellitus (DM), a metabolic disorder characterized by high blood glucose levels. DM results from defects in insulin production, insulin action, or both. Long-term effects of DM include damage to various organs and specific complications such as retinopathy, nephropathy, neuropathy, and increased risk of cardiovascular disease. The main types of DM are type 1, type 2, and gestational diabetes. The document also discusses various metabolic derangements associated with DM, symptoms of DM, diagnostic tests such as glycosylated hemoglobin, and complications of DM like angiopathy.
This document summarizes the clinical manifestations and complications of diabetes mellitus. It discusses the symptoms of type 1 and type 2 diabetes, including polyuria, polydipsia, weight loss, and ketoacidosis in type 1 patients. Acute complications covered are diabetic ketoacidosis, hyperglycemic hyperosmolar state, lactic acidosis, and hypoglycemia. Chronic complications are also briefly mentioned. The pathophysiology, clinical features, diagnosis, and management of diabetic ketoacidosis are described in detail.
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.
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. The four main types of diabetes are described as type 1, type 2, gestational diabetes, and pre-diabetes. Type 1 diabetes is usually diagnosed in childhood and requires daily insulin injections. Type 2 diabetes is the most common type and is often associated with obesity. Gestational diabetes occurs during pregnancy and increases risk of future diabetes. Pre-diabetes involves above normal blood sugar levels that can lead to long-term health damage if not addressed.
This document discusses diabetes mellitus and hypoglycemia. It defines diabetes as a clinical syndrome of hyperglycemia caused by insulin deficiency. There are two main types of diabetes - type 1 caused by autoimmune destruction of beta cells resulting in absolute insulin deficiency, and type 2 which is genetic and associated with obesity and insulin resistance. Without treatment, complications from hyperglycemia can include glycosuria, impaired immune function, hyperosmolarity, and glycosylation of proteins leading to long term damage. The pathophysiology revolves around metabolic alterations from insulin deficiency like hyperglycemia, ketoacidosis, and lipid abnormalities.
Hyperg crisittnoon conference hall of coronary circulation of the matters of coronary circulation and my reaction is the matters for men and women with out of India as well as the matters to help someone else and my reaction is the best of the world cup today and today
This document provides information on diabetes mellitus (DM), including:
- DM results from defects in insulin production/action leading to hyperglycemia.
- The prevalence of DM in Nepal is approximately 3.6% overall, higher in urban vs. rural areas.
- The main types of DM are type 1, type 2, and gestational diabetes.
- Risk factors, symptoms, diagnostic criteria, treatment methods including diet, exercise, medications, education and potential acute/chronic complications are outlined.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
This document presents information on complications, management, and treatment of diabetes mellitus. It defines diabetes as a group of metabolic diseases involving high blood glucose levels due to inadequate insulin production or cells not responding to insulin. It discusses the types and classifications of diabetes, epidemiology, clinical manifestations, acute and chronic complications, and current pharmacological and non-pharmacological treatment approaches including insulin, oral hypoglycemic agents, lifestyle changes, and education. The goal of diabetes management is to eliminate hyperglycemia symptoms, reduce complications, and allow patients to live as normal a lifestyle as possible.
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.
Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. The main types are type 1 diabetes, which accounts for 10% of cases and results from autoimmune destruction of beta cells, and type 2 diabetes, which accounts for 80% of cases and involves insulin resistance and impaired insulin secretion. Diagnosis is confirmed by random plasma glucose over 200 mg/dL or an oral glucose tolerance test. Complications include acute issues like ketoacidosis and hypoglycemia, and chronic complications involving the cardiovascular, renal, neurological, and ophthalmic systems.
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both .
Causes:-
Life style
Genetics factor
Obesity
Diet time variation
Etiological Classification of Diabetes:
Type :-1 Diabetes (insulin dependent)
Type :-2 Diabetes (non insulin dependent)
Gestational diabetes
DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance.
DEFINITION OF GESTATIONAL DIABETES :
Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due to reduced sensitivity of insulin receptors.
CAUSES :
The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include:
Genetics
Exposure to viruses and other environmental factors
Endocrine disorders such as acromegaly , Cushing's syndrome
Endocrine disorders e.g. Pancreatitis .
Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons .
Micro vascular complications (zeroplateas , neutrophils , eosinophil's )
Macro vascular complications (CHF , stroke , peripheral vascular disease)
SYMPTOMS :
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
Increased thirst
Frequent urination
Bed-wetting in children who previously didn't wet the bed during the night
Extreme hunger
Unintended weight loss
Irritability and other mood changes
Fatigue and weakness
Blurred vision
PHARMACOLOGICAL TREATMENT :
Insulin:
People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection.
Metformin :
Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should.
Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin.
B) NON- PHARMACOLOGICAL TREATMENT :
CONTROL THE SYMPTOMS .
EXERCISES
MONITORING THE SUGAR LEVELS
HEALTHY FOODS .
This document provides an overview of endocrinology with a focus on diabetes mellitus and thyroid disorders for second year anesthesia students. It defines diabetes mellitus and classifies it into two main types. Type 1 diabetes is characterized by an absolute insulin deficiency due to autoimmune destruction of beta cells, while type 2 diabetes involves insulin resistance and a relative insulin deficiency. The document discusses the pathogenesis, clinical features, diagnosis, treatment and complications of both types of diabetes mellitus. It also outlines the goals of diabetes management and various pharmacologic therapies.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Tests for analysis of different pharmaceutical.pptx
nursingcareofptwithdiabetes1 (1).ppt
1. 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
2. Diabetes Mellitus
Impact on health of American
population
• 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
3. 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)
• 7. Estimated 11 % of older U. S. population
(65 – 74) have diabetes
4. 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)
5. 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
7. 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)
8. 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
9. Diabetes Mellitus
Diabetic Ketoacidosis (DKA)
1. Results from breakdown of fat and overproduction
of ketones by the liver and loss of bicarbonate
2. Occurs when Diabetes Type 1 is undiagnosed or
known diabetic has increased energy needs, when
under physical or emotional stress or fails to take
insulin
1. Mortality as high as 14%
3. Pathophysiology
• a. Hypersomolarity (hyperglycemia, dehydration)
• b.Metabolic acidosis (accumulation of ketones)
• c. Fluid and electrolyte imbalance (from osmotic
diuresis)
10. 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)
11. Diabetes Mellitus
• DKA
– Signs and symptoms
• Kussmals respirations
– Blow off carbon dioxide to reverse acidosis
• Fruity breath
• Nausea/ abdominal pain
• Dehydration
• Lethargy
• Coma
• Polydipsia, polyuria, polyphagia
12. 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
13. Diabetes Mellitus
• DKA
– d.Correct electrolyte imbalance: client often is
initially hyperkalemic
• As patient is rehydrated and potassium in pushed back
into the cell they become hypokalemic
• Monitor K levels
– e. Monitor cardiac rhythm since hypokalemia puts
client at risk for dysrrhythmias
– f. Treat underlying condition precipitating DKA
– G. Acidosis is corrected with fluid and insulin
therapy and rarely needs bicarb
14. 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
15. 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
16. Diabetes Mellitus
Risk Factors
• 1. History of diabetes in parents or siblings; no
HLA
• 2. Obesity (especially of upper body)
• 3. Physical inactivity
• 4. Race/ethnicity: African American, Hispanic, or
American Indian origin
• 5. Women: history of gestational diabetes,
polycystic ovary syndrome, delivered baby with birth
weight > 9 pounds
• 6. Clients with hypertension; HDL cholesterol < 35
mg/dL, and/or triglyceride level > 250 mg/dl.
17. Diabetes Mellitus
• Syndrome X or Metabolic Syndrome
– Chronic, low grade inflammatory process
– Gives rise to diabetes type 2, ischemic heart
disease, left ventricular hypertrophy
– Group of disorders with insulin resistance as the
main feature
– Includes
• Obesity especially around the waist and abdomen
• Low levels of physical activity
• High blood pressure
• Increased blood cholesterol (high LDL, low HDL, high
triglycerides
18. Diabetes Mellitus
Manifestations
1. Client usually unaware of diabetes
• a. Discovers diabetes when seeking health care for
another concern
• b. Most cases aren’t diagnosed for 5-6 years after
the development of the disease
• c. Usually does not experience weight loss
19. Diabetes Mellitus
2.Possible symptoms or concerns
• a. Hyperglycemia (not as severe as with
Type 1)
• b. Polyuria
• c. Polydipsia
• d. Blurred vision
• e. Fatigue
• f. Paresthesias (numbness in extremities)
• g. Skin Infections
20. Diabetes Mellitus
Hypersomolar Hyperglycemic Nonketotic
Syndrome (HHNS)
1. Potential complication of Diabetes Type 2
2. Life threatening medical emergency, high
mortality rate, as high as 50%
3. Enough insulin is secreted to prevent
ketosis, but not enough to prevent
hyperglycemia
4. High blood sugar causes an extreme
diuresis with severe electrolyte and fluid
loss
21. • Characterized by
– Plasma osmolarity 340 mOsm/l or greater-
normal 280-300
– Blood glucose severely elevated, 800-1000
– Altered level of consciousness
22. Diabetes Mellitus
4. Precipitating factors
• a. Infection (most common)
– pneumonia
• b. Therapeutic agent or procedure
• c. Acute or chronic illness
– MI
– Stroke
– Pancreatitis
– pregnancy
5. Slow onset 1 – 14 days
23. Diabetes Mellitus
Pathophysiology
• a. Hyperglycemia leads to increased urine output
and dehydration
• b. Kidneys retain glucose; glucose and sodium rise
• c. Severe hyperosmolar state develops leading to
brain cell shrinkage
Manifestations
• a. Altered level of consciousness (lethargy to
coma)
• b. Neurological deficits: hyperthermia, motor and
sensory impairment, seizures
• c. Dehydration: dry skin and mucous membranes,
extreme thirst, tachycardia, polyuria, hypotension
24. Diabetes Mellitus
Treatment
• a. Usually admitted to intensive care unit of
hospital for care since client is in life-threatening
condition: unresponsive, may be on ventilator, has
nasogastric suction
• b. Correct fluid and electrolyte imbalances giving
isotonic or colloid solutions and correct potassium
deficits
• c. Lower glucose with regular insulin until glucose
level drops to 250 mg/dL
• Monitor for renal failure
• d. Treat underlying condition
25. Diabetes Mellitus
Complications of Diabetes
A. Alterations in blood sugars: hyperglycemia and
hypoglycemia
B. Macrocirculation (large blood vessels)
• 1. Atherosclerosis occurs more frequently, earlier in
diabetics
• 2. Involves coronary, peripheral, and cerebral arteries
C. Microcirculation (small blood vessels)
• 1. Affects basement membrane of small blood vessels
and capillaries
• 2. Involves tissues affecting eyes and kidneys
D. Prevention of complications
• 1. Managing diabetes
• 2. Lowering risk factors for conditions
• 3. Routine screening for complications
• 4. Implementing early treatment
26. Diabetes Mellitus
Complications of Diabetes: Alterations in blood sugars
A. Hyperglycemia: high blood sugar
• 1.DKA (mainly associated with Diabetes Type 1)
• 2.HHS (mainly associated with Diabetes Type 2)
• 3.Dawn phenomenon: rise in blood sugar between 4 am and 8
am, not associated with hypoglycemia
– Glucose released from the liver in the early AM secondary to
growth hormones
– Altering the time and dose of the insulin (NPH or Ultralente) by 2-3
units stabilizes the blood sugar
27. Diabetes Mellitus
• 4. Somogyi effect: combination of
hypoglycemia during night with a
rebound morning hyperglycemia that
may lead to insulin resistance for 12 to
48 hours
28. Diabetes Mellitus
B. Hypoglycemia (insulin reaction,
insulin shock, “the lows”): low blood
sugar
• 1.Mismatch between insulin dose,
carbohydrate availability and exercise
• 2.May be affected by intake of alcohol,
certain medications
29. Diabetes Mellitus
Specific manifestations
• a. Cool, clammy skin
• b. Rapid heartbeat
• c. Hunger
• d. Nervousness, tremor
• e. Faintness, dizziness
• f. Unsteady gait, slurred and/or incoherent speech
• g. Vision changes
• h. Seizures, coma
• 5. Severe hypoglycemia can result in death
• 6. Clients taking medications, such as beta-adrenergic
blockers may not experience manifestations associated
with autonomic nervous system
• 7. Hypoglycemia unawareness: clients with Diabetes
Type 1 for 4 or 5 years or more may develop severe
hypoglycemia without symptoms which can delay
treatment
30. Diabetes Mellitus
Treatment for mild hypoglycemia
• a. Immediate treatment: client should take 15 gm of
rapid-acting sugar (half cup of fruit juice; 8 oz of
skim milk, 3 glucose tablets, 3 life savers
• b. 15/15 rule: wait 15 minutes and monitor blood
glucose; if still low, client should eat another 15 gm
of sugar
• c. Continue until blood glucose level has returned
to normal
• d. Client should contact medical care provider if
hypoglycemia occurs more that 2 or 3 times per
week
31. Diabetes Mellitus
Treatment for severe hypoglycemia is often
hospitalization
a. Client is unresponsive, has seizures, or has altered
behavior; blood glucose level is less than 50 mg/dL
b. If client is conscious and alert, administer 15 gm of
sugar
c. If client is not alert, administer
• 1. 25 %– 50% solution of glucose intravenously,
followed by infusion of 5% dextrose in water
• 2. Glucagon 1 mg by subcutaneous, intramuscular,
or intravenous route; follow with oral or intravenous
carbohydrate
d. Monitor client response physically and also blood
glucose level
32. Diabetes Mellitus
Complications Affecting Cardiovascular System,
Vision, and Kidney Function
A.Coronary Artery Disease
• 1. Major risk of myocardial infarction in Type 2
diabetics
– Increased chance of having a silent MI and delaying medical
treatment
• 2. Most common cause of death for diabetics (40 –
60%)
• 3. Diabetics more likely to develop Congestive
Heart Failure
34. Diabetes Mellitus
• C. Stroke:
– Type 2 diabetics are 2 – 6 times more
likely to have stroke as well as Transient
Ischemic Attacks (TIA) or mini stroke
35. Diabetes Mellitus
D. Peripheral Vascular Disease
• 1. Increased risk for Types 1 and 2
diabetics
• 2. Development of arterial occlusion
and thrombosis resulting in gangrene
• 3. Gangrene from diabetes most
common cause of non-traumatic lower
limb amputation
37. Diabetes Mellitus
Diabetic Retinopathy
1. Definition
• a. Retinal changes related to diabetes
– Hemorrhage, swelling, decreased vision
• b.Leads to retinal ischemia and breakdown of
blood-retinal barrier
2. Leading cause of blindness ages 25 – 74
• a. Affects almost all Type 1 diabetics after 20 years
• b.Affects 60 % of Type 2 diabetics
3. Diabetics should be screened for retinopathy and
receive treatment (laser photocoagulation surgery)
to prevent vision loss
1. Should be sent immediately to ophthalmologist upon
diagnosis because may already have damage
4. Diabetics also have increased risk for cataract
development
38. Diabetes Mellitus
Diabetic Nephropathy
• 1. Definition: glomerular changes in kidneys of
diabetics leading to impaired renal function
• 2. First indicator: microalbuminuria
• 3. Diabetics without treatment go on to develop
hypertension, edema, progressive renal
insufficiency
• a. In type 1 diabetics, 10 – 15 years
• b. May occur soon after diagnosis with type 2
diabetes since many are undiagnosed for years
• 4. Most common cause of end-stage renal failure in
U.S.
• 5. Kimmelstiel-Wilson syndrome:
glomerulosclerosis associated with diabetes
39. Diabetes Mellitus
• Male erectile dysfunction
– Half of all diabetic men have erectile
dysfunction
40. Diabetes Mellitus
Collaborative Care
A.Based on research from 10-year study of Type 1
diabetics conducted by NIH focus is on keeping
blood glucose levels as close to normal by active
management interventions; complications were
reduced by 60%
B.Treatment interventions are maintained through
• 1. Medications
• 2. Dietary management
• 3. Exercise
C.Management of diabetes with pancreatic transplant,
pancreatic cell or Beta cell transplant is in
investigative stage
41. Diabetes Mellitus
Other Complications from Diabetes
• A. Increased susceptibility to infection
• 1. Predisposition is combined effect of other
complications
• 2. Normal inflammatory response is
diminished
• 3. Slower than normal healing
• B. Periodontal disease
• C. Foot ulcers and infections: predisposition
is combined effect of other complications
42. 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
)
43. 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
44. 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
6.Serum electrolytes in clients with DKA or
HHNS
45. 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
46. Diabetes Mellitus
• Injection sites
– Abdominal areas is the most preferred
because of rapid absorption
– Do not aspirate insulin injections
– Administration covered in the lab
49. Diabetes Mellitus
• When rapid acting or short acting insulin is
mixed with longer acting insulin, draw the
short acting insulin into the syringe first.
• Prevents contamination of the shorter acting
insulin with the longer acting insulin
• Draw up clear, then cloudy
• Insuling glargine (Lantus) should not be
mixed with any other insulin
51. Diabetes Mellitus
• Alternative insulin administration
– Insulin pump
• Continuous subcutaneous infusion of a basal
dose with increases at meal times
– Implanted pumps
• Implanted into the peritoneal cavity
– Inhaled insulin
• Under development
54. 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
55. 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)
56. 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)
57. 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
58. 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)
59. 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)
60. 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
61. 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
62. 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
63. 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
64. 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
65. Diabetes Mellitus
• Diet
– Look for more dietary information online at
http://www.diabetes.org/nutrition-and-
receipes/nutrition/overview.jsp
66. Diabetes Mellitus
Care of diabetic older clients
• A. 40% of all clients with diabetes are over age of
65
• B. Need to include spouse, members of family in
teaching who may assist with client meeting medical
needs
• C. Diet changes may be difficult to implement since
client has established eating habits
• D. Exercise programs may need adjustment to meet
individual’s abilities (such as physical limitations
from other chronic illnesses)
– Obesity worsens diabetes
– Minimum of 30 minutes of moderate exercise like walking or
swimming most days of the week
67. Diabetes Mellitus
• E. Individual reluctance to accept
assistance to deal with chronic illness,
assist with hygiene
• F. Limited assets for medications,
supplies, dietary
• G. Visual deficits or learning
challenges to learn insulin
administration, blood glucose
monitoring
68. 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
69. 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
70. 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
71. 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