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Diabetes Mellitus, Type 2 Diabetes Mellitus (DM) # #, References:, Harding…
Diabetes Mellitus
Type 1 Diabetes Mellitus (DM)
occur when the pancreas is unable to produce and secrete an adequate amount of insulin needed for the body.
most common childhood disorder.
Etiology and Pathophysiology
It is an autoimmune disorder.
body develops antibodies against insulin/ pancreatic β cells that make insulin.
this result in less insulin in the body.
Genetic link
when person with human leukocyte antigens (HLAs) get exposure to virus increases risk for type 1 diabetes.
sign and symptoms
polyuria (frequent urination)
polydipsia (excessivre thirst)
weight loss
Fatigue
Blurred vision
Diabetic Ketoacidosis
polyphagia (excessive hunger)
Diagnostic studies
Hemoglobin A1c>6.1%
Fating blood glucose >126mg/dl
2-hour oral glucose tolerance test ≥200 mg/dL
random serum glucose of 200 mg/dL or greater with classic hyperglycemia symptom (Harding, 2020).
Insulin
People with type 1 Diabetes requires exogenous insulin to survive.
Rapid- acting insulin
Lispro (Humanlog),asp (Novolog), glusine (Apidra).
onset is10-30 min depending on which insulin is administered.
administer before meal
Duration time is 3 to 5 hrs (Harding, 2020).
Short-acting insulin
Regular ( himulin R, Novolin R).
Administer 30-60 min before meal.
Regular insulin is available in 2 concentration
U- 500 and U-100 (Harding, 2020).
Intermediate acting
NPH insulin
not administer before meal
administer between meals and at night (Harding, 2020).
onset is 1.5 hrs to 4 hrs
Duration is 12 to 18 hrs
Long acting insulin
glargine, detemir,
Administer once daily at the same time (Harding, 2020).).
duration is 16.24 hrs.
onset is 0.8 to 4 hrs
Treatment
Nutrition therapy
Consist of individual counselling, education
consult dietician for collaborative education with the client and the family
count grams of carbohydrate, protein and fat intake daily.
Restrict calorie intake and increase ohysical activity.
include fiber in diet to increase carbohydrate metabolism to help cholesterol levels
use of artificial sweeteners.
Limit the amount of alcohol intake maximum 1 drink for women, 2 drinks for men (Lewis, 2020).
Education for both adult and pediatric diabetic patients on for exercise.
only exercise when glucose levels are between 80 to 250mg/dl
if 1 hr has passes since eating consume a snack first
wear a comfortable shoes
always carry a identification card
check blood glucose level after 24 hrs of intensive exercise (Harding, 2020).
In a person with type 1 diabetes who has hyperglycemia and ketones, exercise can worsen these conditions (Harding, 2020).
Start gradually and increase slowly
Monitor glucose level before, during and after exercise (Harding, 2020).
24 meal plan for patient
Carbohydrate Counting
A meal technique where amt. of eaten carbohydrate can be tracked
patient education to consume within healthy range and to read the carbohydrate label's and serving sizes
Lewis explains the intake of total carbohydrate per day depends on blood glucose levels, age, weight, activity level, patient preference, and prescribed medications (2020).
Educate the patient about the insulin doses are built to the amount of carbohydrate intake (Harding, 2020).
Diabetes exchange
In this method instead of counting carbohydrate, the person is given a meal plan with specific numbers of helpings from a list of exchanges for each meal and snack (Harding, 2020).
Exchange lists are starches, fruits, milk, meats, vegetable, fats and free foods (Harding, 2020).
Easier method than carbohydrate counting.
Helps in weight management of the patient and this kind of exchange help the patient overall food intake (Harding, 2020).
Consideration for pediatric patient with DM 1
For pediatric pt. food restriction should never ne used
Child appetite should be the guide for calorie intake (Harding, 2020).
Type 2 Diabetes Mellitus (DM)
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Known as adult-onset diabetes or non–insulin-dependent diabetes mellitus (NIDDM)
Diagnostic Studies
A1C of 6.5% or higher
Fasting plasma glucose 126 mg/dl or greater.
Hyperglacemic patient plasma glucose level of 200mg/dl or greater (Harding, 2020).
white people have less rate of type 2 diabetes in comparison to other population like Asian, black, Hispanics, Native Americans
(Harding, 2020).
Etiology and pathophysiology
combination of inadequate insulin secretion and insulin resistance (Harding, 2020).
Body doesn't use insulin effectively
Absence of endogenous insulin
Decrease insulin production by pancreas
Inappropriate hepatic glucose production
Sign and symptoms
Nonspecific symptoms -Classic symptoms of type 1 may manifest
Fatigue
Recurrent infection
Recurrent vaginal yeast or candida infection
Prolonged would healing
Visual changes (Harding, 2020).
Oral Medications
Metformin
first-line treatment for type 2 diabetes
primary action of metformin is to reduce glucose production by the liver.
used to prevent type 2 diabetes in those with prediabetes
Dec, rate of hepatic glucose production
Inc. insulin sensitivity
Adverse effect
According to lewis it may cause Diarrhea, lactic acidosis. Must be held 1–2 days before IV contrast media given and for 48 hr after (2020).
Thiazolidinediones
Inc. blood glucose in muscle
Dec. endogenous glucose production (Harding, 2020).
Adverse effect
weight gain, edema. may inc, risk of heart failure, MI, stroke (Harding, 2020).
sulfonyureas
Stimulates release of insulin from pancreatic islets (Harding, 2020).
Decrease glycogenolysis and gluconeogenesis
Adverse effect
Weight gain, Low blood sugar level
Children can monitor blood glucose from school age.
References:
Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewiss Medical-surgical nursing: Assessment and management of clinical problems. St. Louis, MO: Elsevier.
