Type 2 diabetes Mellitus

Pathophysiology

Occurs due to an inadequate endogenous insulin and the body's inability to use insulin properly.

occurs in juveniles, young adults and middle age.

Beta cells respond inadequately to hyperglycemia resulting in chronically elevated blood glucose.

continuous high glucose level in the blood desensitizes the beta cells

beta cells becomes progressively less responsive to the elevated glucose.

Specific receptor sites become insensitive to insulin that is “insulin resistance”, preventing glucose from entering the cells.

Medications

Dieting or nutritional management

exercise

medication

insulin therapy

metformin (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet).

Interventions

self-management training for safe exercise

Carbohydrate counting is particularly useful for people who use intensive insulin therapy or pumps.

Patient teaching should include sample menus that include as many favorite foods as possible.

educate and support pateint to learn to manage the dietary guidelines.

Have a complete medical examination before initiating a new exercise program.

Because circulating insulin may be inadequate to ensure glucose uptake, avoid exercise when your serum glucose is elevated and ketosis is present.

Exercise with caution if your serum glucose is greater than 300 mg/dL and no ketosis is present.

Pertinent assessment findings

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Type of diabetes

• Hypoglycemics: name, dosage, when last dose was taken

• Food and fluid intake for the past 3 days

• Relevant laboratory values: blood glucose, blood pH, bicarbonate levels, electrolytes, and serum and urine osmolality

Health History

Reason for Seeking Care.

Present Health/History of Present Illness.

Past Health History.

Family History.

Review of Systems.

Functional Assessment

Physical Examination

Pateint education

Learn the names of your prescribed drugs, dosages, schedule, and (if on insulin) technique for injections.

Take some form of carbohydrate if you have symptoms of hypoglycemia: nervousness, palpitations, hunger.

Monitoring your blood glucose helps you to see how well your diabetes is being controlled.

We will teach you how to check your blood glucose, how to interpret the findings, and what actions, if any, to take.

Nutrition is an important part of managing your diabetes. The dietitian will discuss dietary guidelines with you.