Diabetes Mellitus II

Diabetes Mellitus II

1. ETIOLOGY

   • ↑ INSULIN RESISTANCE
   • ↓ INSULIN PRODUCTION
   • ↑ HEPATIC GLUCOSE PRODUCTION
   • CHANGE IN ADIIPOKINE LEVELS
     • ↑ Resistin
     • ↓ Adiponectin
     • ↑ Leptin Resistance
       • ↓ Satiety
   • METABOLIC SYNDROME X

2. RISK FACTORS

   • DYSLIPIDEMIA

3. MANIFESTATIONS

   • ACUTE COMPLICATIIONS
     • Insulin Deficiency
       • ↑ Hepatic Glucose Output
         • Hyperglyecemia
           • Glucosuria
             • Osmotic Diuresis
               • Polyuria
                 • Dehydration (HHS)
                   • ↓ Blood Volume
                     • Peripheral Circulatory Failure
                       • Renal Failure
                         • Death
                       • Low Cerebral Blood Flow
                   • Polydipsia
                   • Cellular Shrinking
                     • Nervous System Malfunction
       • ↓ Glucose Cell Uptake
         • Intracellular Glucose Deficiency
           • Polyphagia
       • ↓ Triglyceride Synthesis
         • ↑ Blood Fatty Acids
           • Alternative Energy Source
             • Ketosis
               • Metabolic Acidosis (DKA)
                 • Diabetic Coma
               • ↑ Ventilation
       • ↑ Lipolysis
       • ↓ Amino Acid Cell Uptake
         • ↑ Blood Amino Acids
           • ↑ Gluconeogensis
       • ↑ Protein Degredation
         • Muscle Wasting
           • Weight Loss
   • SYMPTOMATIC
     • Frequent/Recurring Infections
   • ASYMPTOMATIC (Most Common)
   • CHRONIC COMPLICATIONS
     • Feet/Lower Extremities
       • Amputation
     • Neuropathy
     • Microvasculature
       • Skin (Infection, Ulcers, Dry Gangrene)
       • Kidneys (Failure)
       • Eyes (Retinopathy)
     • Macrovasculature
       • Coronary Artery Disease
         • Stroke
       • Hypertension
     • ↑ Fracture RIsk
     • Weight Gain

4. NURSING MANAGEMENT

   • ASSESSMENTS
   • PLANNING
     • Active Client Participation
     • Maintain Normal Blood Glucose + ↓ Hypo/Hyperglycemic Emergencies
     • ↓ Onset/Progression of Chronic Complications
     • Adjust Lifestyle
   • INTERVENTIONS
     • Health Promotion
       • Identify Risks
       • Routine Screening
     • Acute Intervention
       • ↑ Management, Insulin, Fluids (noncarbohydrates)
         • ↓ Rise in Blood Glucose by Counterregulatory Hormone Responses
           • ↓ Hypoglycemia/Stress
     • Ambulatory/Home Care
       • Client Teachings
         • Enable Client Participation/Independence
           • Insulin/OHAs
             • Safe Administration Techniques
             • Interactions/SE
             • TIme/Frequency
           • Personal Hygeine
             • Daily Brushing/Flossing
             • Foot Care
           • Diet/Exercise
           • Monitoring
             • Blood Glucose
             • Injuries/Lesions
             • Signs/Symptoms
             • Health Examinations
           • Disease Process
             • Insulin-Glucose Relationship
   • EVALUATIONS
     • Client Knowledge of Disease and Treatments
     • Self-Care Measures
     • Balanced Blood Glucose by Lifestyle/Treatment Adjustments
     • No Injuries from Hypoglycemia (ex. ↓ Sensation/Circulation esp. in Feet)

5. DIAGNOSIS

   • SCREENING/MONITORING
     • Fasting Plasma Glucose (FPG) ≥ 7.0 mmol/L
     • Casual Plasma Glucose ≥ 11.1 mmol/L + Diabetes Symptoms
     • A1C ≥ 6.5%
     • 2 Hr Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L with 75 g of Glucose

6. TREATMENTS

   • EXERCISE
     • Start Small & Progressively ↑ Intensity
     • 150 Mins/Week of Moderate to Intense Aerobic Exercise
     • Avoid Hypoglycemia
       • Exercise 1 Hr After a Meal
       • 15g Carbohydate Snack Before Exercising (blood glucose < 5.5 mmol/L)
         • Evaluate After 15-30 Mins (blood glucose < 5.5 mmol/L; discontinue exercise)
       • Small Carbohydrate Snacks Every 30 Mins During Exercise
         • Juice
         • Glucose Tablets
         • Apples
         • Hard Candies
         • 4-6 Crackers
   • NUTRITION
     • Eat 3 Meals a Day at Regular Times no More than 6 hrs Apart
     • Choose Foods with Low Glycemic Index
     • ↑ Fibre
     • ↓ Fat
     • Alcohol
       • High in Calories
       • No Nutritional Value
       • ↑ Hypoglycemia Risk in Combination with Insulin
       • ↑ Lactic Acidosis Risk in Combination with Metformin
       • Limit to 1 Glass a Day (consume with food)
     • ↓ Calories
     • Herbs
       • ↓ Glucose Lowering Effects of Meds (ex. St. John's Wort)
       • ↑ Glucose Lowering Effects of Meds (ex. bay, basil, bee pollen, garlic, ginger, milk thistle, sage)
     • Dietitian Recommendations & Canada's Food Guide
   • MEDICATIONS (when glucose can't be controlled only by exercise and diet)
     • Oral Hypglycemic Agents (OHAs)
     • INSULIN (when OHA's aren't sufficient)
       • Hypoglycemia (Insulin overdose)
       • Allergies
         • Local (ex. itching, redness, burning sensations)
         • Systemic (ex. urticaria, anaphylatic shock)
       • Dawn Phenomenon (rebound hyperglycemia in the morning)
       • Somogyi Effect (hypoglycemia causes counter regulatory hormones that releases glucose)
       • Poor Control of DMII with Insulin Alone Compared to OHAs
   • RESEARCH & DEVELOPMENT
     • Inhaled/Topical Insulin Powders
     • Enteric Coated Natural/Synthetic Insulin
     • Stem Cell/Pancreatic Islet Implants
     • Endogenous Cell Reprogramming
     • Artificial Pancreas

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