Define

Diabetes Mellitus

A disease in which the body is unable to properly use and store glucose. Glucose backs up in the bloodstream causing the blood glucose level to rise too high

Diabetes Mellitus is a chronic multi system disease related to:

A chronic multi system disease related to:

* Abnormal insulin production

 * Impaired insulin utilization

 * Or both

 * End stage renal disease

 * Adult blindness

 * Non-traumatic lower limb amputations

 * Heart disease

 * Stroke – 2 - 4 X’s higher chance -

Genetic predisposition

Environmental factors (viruses and toxins)

Family History? (Risk to offspring of diabetic fathers is 5-6%)

Most often occurring in children and young adults

Daily Insulin required for life.

List the Clinical Manifestations for Type 1 Diabetes Mellitus   

⃝

 * Polyuria (frequent urination)

 * Polydipsia (excessive thirst)

  * Polyphagia (excessive hunger)

Weight loss –

    - It burns fat stores -

Weakness

Fatigue

-          Happens very rapidly -

⃝    Type II Diabetes Mellitus     ⃝

Define Type 2 DM

A metabolic disorder resulting from the body’s inability to make enough, or properly use, insulin.

Type 2 DM is not the most common form of the disease

True or False

False

It is the most common form of the disease.

List the Risk Factors for Diabetes Type II     ⃝

 * Age Greater Than 45 years

 * Positive family history

 * Ethnicity

 * Obesity specifically abdominal/visceral adiposity

 * Low HDL-C (<40, >240) or High Triglycerides (> 60 < 200)

 * History abnormal FBS or OGTT

 * History of GDM or baby greater than 9 lbs

 * Presence of diabetes related complications

 * Hypertension

 * Existing CAD

      -  End Stage Kidney failure, correlates with diabetes.

 * Nonspecific symptoms

* May have classic symptoms of Type 1 DM

 * Fatigue

 * Recurrent infections

 * Recurrent vaginal yeast or monilia infections

 * Prolonged wound healing

 * Visual changes

Criteria for Diagnosis of Diabetes     ⃝

* A1C >+ 6.5% (Needs to be <=) OR

* FPG >= 126 mg/dl Fasting is no caloric intake for at least hrs. OR

* Symptoms of hyperglycemia and a casual plasma glucose >= 200mg/dl OR

* 2 hour plasma glucose >= 200mg/dl during an OGTT

Oral Glucose Tolerance Test (OGTT)

Client eats diet high in carbohydrates for days before test while maintaining normal physical activity

* Discontinue drugs that will interfere with the test

* NPO 10-22 hours prior to the test

* A fasting blood sample and urine sample are drawn

* The client is then given a specified amount of glucose orally 75G

* Blood and urine samples are taken after the glucose is ingested every 30 min. for 2 hours

* During the test the client will remain at rest and not be able to smoke eat or drink

* Report any signs of hypoglycemia

Urine Studies     ⃝

Describe Urine testing

* Urine Testing for Glucose

* Urine Testing for Ketone Bodies

* Tests for Renal Function

   * For the presence of protein as albumin (albuminuria) to detect the early onset of nephropathy

   * 24 hour urine test for creatinine clearance to evaluate renal function if albumin is present

What are the strengths of the

Glycosylated Hemoglobin test

or the A1C test

 * Demonstrates amount of glucose attached to Hgb molecules over their lifetime

 * Measures glycemic levels over the previous 90-120 days (3-4 months)

 * A1C goal <7% non-pregnant adults with diabetes

 * Used to diagnosis monitor success of treatment and make changes in modalities     

Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes

 * People with pre diabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)

 * Persons at increased risk for type diabetes

 * A1C 5.7% to 6.4% OR

 * Impaired Fasting Glucose OR

 * Defined as a fasting plasma glucose of

 * 100 to 125 mg/dl after an overnight fast

 * Impaired Glucose Tolerance OR 2hr. post 75g glucose challenge >= 140 to 199 mg/dl

How might Type 2 DM be delayed or even prevented

 * Modest weight loss

 * Regular exercise

 * Monitor for development DM every 1-2 years

 * Assess for other CVD risk factors (tobacco use, hypertension, dyslipidemia)

 * Drug therapy with metformin, acarbose, orlistat, and rosiglitazone has also been shown to decrease incident of diabetes

⃝    Self-monitoring Blood Glucose

What are some of the instuctions given to those who will be performing self monitoring of blood glucose

 * Alternate sites of blood collection available but not as accurate as fingertips!!!

 * No deep punctures use side of finger pad not center no alcohol needed but hand washing required

 * No sharing of meters to prevent infection blood borne pathogens can be on meter

⃝    Self-monitoring Blood Glucose

Why is client education crucial for those who will be performing self monitoring of blood glucose

To prevent inaccurate readings

⃝    Self-monitoring Blood Glucose

Who is self monitoring of blood glucose recomended

 * Recommended for all insulin treated clients

Diabetes Food Pyramid      ⃝

Why is the Diabetes food pyramid different from teh USDA Food Guide Pyramid

Diabetes Food Pyramid      ⃝

What is the caloric intake if a client were to eat the minimum amount in each food group.

The maximum amount.

 * If eat min. amount in each food group = 1600 calories

 * If eat max amount will be about 2800

   ⃝    Exercise

 What are the potential benefits of exercise

 * Improved overall sense well being

 * Reduced CV risk factors

 * Lowers Plasma lipids

 * Lowers B P

 * Increases Cardiac performance

 * Lowers Platelet hyperaggregability

 * Increases Insulin sensitivity

 * Weight management

   ⃝    Exercise

 What constitutes physical activity

 * 30 minutes of aerobic exercise 5 or more times per week is recommended. Best to exercise after meals when BG levels are rising

 * Regular moderate exercise may be the single most important treatment for the prevention and treatment of Type II diabetes

 * Perform resistance exercises targeting all major muscle groups three or more times per week if not contraindicated

Exercise Tips     ⃝

What are some tips for those with DM when they Execise

 * Measure your blood glucose levels before after and during activity if longer than 30 minutes Check BG before bed and during the night

 * Exercise is not appropriate if BG is >250, may cause BG to further elevate especially if ketones are present

 * Wear medic alert at all times

 * Don’t do strenuous activity

 * Be alert for S&S of hypoglycemia during and for several hours after exercise (up to 48 hours)

 * Carry rapidly absorbed CHO (Glucose tablets, sweet tarts juice) to treat “lows” immediately

 * Take extra fluids before after and during exercise to prevent dehydration

Insulin     ⃝

What is insulin

 * A hormone produced by the beta cells and therefore, a protein. Carbohydrates are absorbed from the intestines into the bloodstream after a meal

Insulin     ⃝

What is the result for some one who developes a deficincy of insulin

They must have it replaced via injections or pumps

Mealtime Insulin (Bolus)

What is meal time insulin used for

 * Used to control post meal blood glucose levels

 * Rapid acting insulin - closely mimics natural insulin secretion in response to meals