Class notes
NURS 304 Diabetes Lecture Notes
- Course
- Nurs 304
- Institution
- Maryville University Of St. Louis
This is a comprehensive and detailed note on; Diabetes for Nurs 304. *An Essential Study Resource!!
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DiabeteDiabetes: s: group of metabolic diseases characterized by hyperglycemia (elevated levels of glucose in blood). Results from defects in insulin secretion, insulin
action, or both. Ethnic and racial minorities are disproportionally affected.
Function Insulin:: transports and metabolizes glucose for energy, stimulates storage of glucose in the liver and muscle as glycogen, signals the liver to stop
Functionss of Insulin
the release of glucose, enhances storage of fat in adipose tissue, accelerates transport of amino acids into cells, inhibits the breakdown of stored glucose,
protein, and fat.
Type 1: An autoimmune dysfunction (t-cells) involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. Insulin-
dependent diabetes. More susceptible to other autoimmune disorders. 5-10% of patients with diabetes.
Etiology:: Insulin-producing beta cells in pancreas are destroyed by a combination of genetic, immunologic, and environmental factors (e.g., virus). Results in
Etiology
decreased insulin production (makes cells unable to use glucose), unchecked glucose production by the liver and fasting hyperglycemia. Requires insulin
because little or no insulin is produced. 5-10% of patients with diabetes. Ketosis prone when insulin absent: DKA.
Assessment: Sudden onset, usually s, (recent wt loss d/t fat converted for cellular energy), little or no endogenous insulin to
preserve life, intracellular dehydration, Polydipsia (excessive thirst), polyuria (excessive urination), Polyphagia (excessive hunger), fatigue, weakness, general
feeling of malaise, & recent infection.
Complilications: DKA: lack of insulin leads to rapid fat/protein/muscle breakdown- free fatty acids trigger ketone production. Glucose >250, ketonuria,
Comp
ketonemia, metabolic acidosis (HCO <18, pH <7.3), Kussmaul respirations (hyperventilation), weakness, abdominal pain, n/v, lethargy, confusion. Blurred
vison:: increased glucose in eye fluid, thicken fluid. Electrolyte imbalances: dilutional hyponatremia, depletion of potassium (K+). Hyp
vison oglycemia:: insulin
Hypoglycemia
oglycemia
reactions, stress, inadequate food, infection, & illness. S/S: sweating, hunger, tremors, HA, irritability, confusion.
Type 2: Insulin resistance and impaired insulin secretion d/t decreased tissue sensitivity to insulin. Affects 90-95% of adults with diabetes. Slow, progressive
glucose intolerance. No chance of DKA (ketones are not produced d/t no breakdown of fat)
Etiology: onset at or over age 30, o (esp. children), gestational DM, PCOS, African American, Native American, Hispanic, HTN, CAD (low HDL,
High LDL, High triglycerides), & physical inactivity.
Assessment: mild fatigue, irritability, polyuria, polydipsia, poor skin heeling, vaginal infections, blurred vision, & obesity.
Complications: If uncontrolled: HHS (hyperosmolar Hyperglycemic Syndrome)
Latent A utoimmune Diabetes of Adults (LADA): Subtype of diabetes in which progression of autoimmune beta cell destruction in pancreas is slower than in
Autoimmune
types 1 and 2. Not insulin dependent in the initial 6 months of onset but can occur after. Share the same feature as type 1 and 2.
Risk factors for Diabetes iin n Gen
General
eral
eral:: low HDL <35 and high triglycerides >250, gestational diabetes, HTN, family history, obesity, impaired fasting glucose or
impaired glucose tolerance, race: African American, Hispanic Americans, native Americans, Asian Americans, pacific islanders.
Diagnos
Diagnostictic: symptoms, fasting plasma glucose >126 ( ), Two-hour post load glucose >200 during oral test, Hemoglobin A1C >6.5% (48).
A1C or tolerance test is more effective than urine testing d/t the
increase renal threshold for glucose.
Diabetes 6.5% or 126 or above 200 or above
above
Pre-Diabetes 5.7-6.4% 100-125 140-199
Normal Below 99 or below 140 or below
5.7%
Manageme
Management: nt: Nutritional management, exercise, monitoring, pharmacologic therapy, &
education
Nutrition Goal
Goals:s: control total caloric intake to maintain normal/reasonable body weight, control
blood glucose levels, & normalization of lipids and blood pressure to prevent heart disease.
Nurses role
role:: be knowledgeable about dietary management, communicate with dietician or
other management specialists, reinforce patient understanding, support dietary and lifestyle
changes.
Mea
Meall planning: review patients eating habits and lifestyle patterns (keep a food diary). Consider food preferences, lifestyle, usual eating time, and ethnic
background. Review history and need for weight loss/gain or maintenance. Caloric requirements and calorie distribution throughout the day; exchange lists-
simplify. 50-60%- emphasize while grains in moderation to avoid increase postprandial blood glucose. : 20-30% (limit saturated fats to 10% of total
calories, cholesterol intake <300mg/day). : 10-20% (whole grains and lagoons=non-animal protein) : 28g daily. **use my plate food guides**
Glycemic Inde
Index:x: how much blood glucose increase with a given amount of food. Patient can create own glycemic index by monitoring blood glucose levels
after eating- gives them control over manipulating their food choices. ReduceReduce:: combining starchy foods with protein and fat (slows absorption and glycemic
response). Raw or whole foods tend to have a lower response than cooked, chopped, or pureed foods. Eat whole fruits rather than juices (decreases
response d/t fiber- slows absorption). Adding foods with sugars may produce a lower response if eaten with foods that are more slowly absorbed.
Alc
Alcohol:
ohol: doesn’t require insulin for absorption and absorbs before other nutrients. Moderation is recommended. n
s. I a (esp. if using insulin) d/t impairment of glucose production (gluconeogenesis). Hard to
differentiate hypoglycemia from being drunk.
Exercise: increases uptake of glucose by muscles, improves insulin utilization, increases lean muscle mass (increase resting metabolic rate). Lowers blood
sugar, helps with weight loss & stress, lowers cardiovascular risks. Exercise 3 times a week without 2 consecutive days without exercise. Perform resistance
training twice a week for type 2. Exercise at same time of day (preferably when blood glucose levels are at their peak) and for the same duration. Use proper
footwear and other protective equipment. Avoid trauma to lower extremities (esp. if have neuropathy). Inspect feet daily. Avoid extreme heat or cold and
time of poor metabolic control. Stretch for 10-15 mins before exercising.
Exercise Pre
Precau
cau
cautions:
tions: Insulin normally decreases with exercise; pts on exogenous insulin should eat a 15g carbohydrate snack before moderate exercise to
prevent hypoglycemia. Potential postexercise hypoglycemia- monitor glucose levels more often and eat a snack at the end of sessions. e
b . If >250mg and
ketones in urine, pt should not exercise until negative for ketones and lower glucose levels.
Self
Self--Monito
Monitoring
ring
ring:: SMBG: . A1C: measure of glucose levels over 3 months, Diagnose or monitor effectiveness of therapy (healthcare workers only). :
check when glycosuria (glucose in urine), persi tent elevation in blood glucose (>240 twice), illness, pregnancy, gestational diabetes.
- Make sure p y. Also talk to the patient
about how much each test cost and which one they want. How often a pt check glucose levels is dependent on their treatment & is individualized
Pharmacological
Pharmacological:: Insulin Onset Pea
Peakk Duration Indications
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