Diabetes Mellitus Type II

Pathophysiology
Risk Factors
1. Pre-diabetes
  1. Impaired glucose tolerance (IGT)
    1. 2h OGTT: 7.8-11.1 mmol/L (ADA, 2004)
  2. Impaired fasting glucose (IFG)
    1. FPG 5.6-6.9 mmol/L (ADA, 2004)
2. Genetics
3. Obesity
4. Aging
5. Metabolic Syndrome (Grundy et al., 2004)
  1. Dyslipidemia
  2. Abdominal obesity
Diagnosis
CLINICAL MANIFESTATIONS
MANAGEMENT
1. PHARMACOLOGICAL
  1. Insulin
    1. Preparations
      1. rapid-acting: peak 1.5-2.5h
      2. short-acting (regular): peak 2-4h
      3. Intermediate (NPH - cloudy): peak 6-8h
      4. Long-acting: no peak
    2. Admin
      1. self-admin
      2. subcutaneous
        abdomen, buttocks, thigh, deltoid
        rotate injection sites
      3. intravenous
  2. Oral Anti-hyperglycemic Agents
    1. α-glucosidase inhibitors
      1. mech: slow carb digestion
    2. DPP-4 inhibitors
      1. mech: slow incretin hormone inactivation
    3. Biguinides (i.e. metformin)
      1. FIRST-LINE OHA TREATMENT! (Nathan et al., 2009; Inzucchi et al., 2012)
    4. Thiazolidinediones
      1. mech: decrease insulin resistance
    5. sulphonylureas
    6. metglitinides
      1. mech: increase insulin production by β cells
2. STRESS MANAGEMENT (Surwit et al., 2002)
  1. Muscle Relaxation
  2. Cognitive Behavioural
    1. Recognizing stressors
    2. Guided imagery
3. EXERCISE
  1. 150 min/week moderate intensity
  2. Mechs
    1. ↓ blood glucose
    2. ↑ insulin sensitivity
    3. weight loss
4. NUTRITION
  1. Diet Teaching
    1. Personalized diet planning (Inzucchi et al., 2012)
    2. Fat <7% of daily intake
    3. Carbs < 10% of daily intake from sucrose
    4. Protein: 15-20% of daily intake
Nursing Considerations
1. Nursing Process
  1. 1. Assessment
    1. Learning needs, motivation and the ability to learn
    2. Physical history
      1. BMI, height, weight, vital signs
      2. Current medication
      3. Past surgical procedure
      4. History of infection
    3. Lifestyle
      1. Stress
      2. Exercise
  2. 2. Plan
    1. Determine goals and expected outcome with the patient
      1. Setting priorities
      2. Learning objectives
      3. Selecting teaching methods
  3. 3. Implementation
    1. Home care
      1. Importance of medication adherence
      2. Travel
        Adequate medication
        Diabetic medical bracelet
    2. Health promotion
      1. Patient education
        Diet
        Define the disease
        Purposeful factiities that can control the disease
        Self monitoring blood glucose
        Important resources
  4. 4. Evaluation
    1. Patient understanding
      1. Up-to-date immunizations

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Diabetes Mellitus Type II

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