1EndocrineDiabetes Mellitus American Epidemic Big problem d/t lack of good diet and exercise. Do NOT have to be overweight/obese to have DM. Disease Process Concept map in book!! A chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both Affect 25.8 million people 7th leading cause of death!! Dont usually die from DM itself, but from the complications of it (kidney failure, heart disease, stroke, etc) Leading cause of: Adult blindness End stage kidney disease Nontraumatic lower limb amputations Major contributing factors: Impaired circulation d/t increase sugar, it damages the vascular system Heart disease Stroke Hypertension Etiology/Patho Combination of causative factors: Genetic Autoimmune Environmental Absent/insufficient insulin and/or poor utilization of insulin Normal insulin metabolism Produced by b-cells in islets of Langerhans Released continuously into bloodstream in small increments with alrger amounts released after food Stabilizes glucose level in range of 70-120 fasting OR after meals (post prandial) (70-110 at JMCGH) Normal insulin secretion chart in book Spikes after you eat and back down and lowest before meals (this is why we check sugar BEFORE meals.) Classes of Diabetes Type I Lack of insulin production Used to be called juvenile onset Type I is now diagnosed in older people now, typically find it around adolescence (rapid periods of growth) Accounts for only about 5% of DM diagnsosis Type II Used to be called adult onset Problem of usage of insulin (resistance, etc.) From the get go, this means poor diet and sedentary lifestyle 90-95% of DM diagnosis Gestational Higher chance of developing Type II DM later on in life Back to normal w/i 6 weeks High risk screened at first visit Increased risk of section baby is usually larger d/t being pumped full of sugar before ever born Other specific types d/t various causes Can be induced by viral infection Autoimmune response Certain medicines Resolved when underlying condition is fixed Prediabetes Individuals at high risk for type 2 diabetes Impair glucose intolerance 2 hour oral glucose tolerance test (OGTT): 140 199 mg/dL Impaired fasting glucose (IFG) Fasting glucose level: 100-125 mg/dL Asymptomatic usually but damage is already occurring Clinical manifestations Type I Classics Polyuria Polydipsia Polyphagia Weight loss Body trying to get energy to cells and burns fat/muscle Weakness Fatigue Clinical manifestations Type II Non-specifics Classics of type I may manifest Fatigue Recurrent infection Recurrent vaginal yeast or canididal infection Prolonged wound healing Client comes in, 62 yo bank worker, states just tired; says weakness/numbness in right foot (began a month ago); sensory exam reveals diminished sensations of light touch, proprioception, and vibration in both feet; increased thirt and frequent nighttime urination; denies other weakness, numbness, or changes in vision; has erythematous scaling rash in both inguinal areas and in axillae; states rash has been there on and off for several years and is worse in the warm weather Vital signs and weight first BP 162/98, HR 92, RR 20 Gained 18 lbs w/ high fat diet over last year History & Physical info above Older people already have increased thirst d/t increased risk of dehydration as well as increased nighttime urination d/t drinking so much and bladder muscles being weak Scaling rash in areas d/t moisture, skin/skin May not have went to dr d/t being busy or didnt see it as a serious risk Want to check BG level & A1C A1C gives a look at what sugar has been running over last 3 months Before doing accucheck, need to know when last time someone ate or drank anything Coffee doesnt really affect sugar BG 253 HBG A1C 9.1% Want UA to check for ketones, proteins, etc. Glucose in urine but no protein Want to look at rash and ID if its yeast; usually diagnosed simply by visualization Wet prep of rash: candida albicans (yeast) May want ECG d/t hypertension ECG: evidence of early ventricular hypertrophy Risk Factors: High-fat diet; age; lifestyle, sedentary job, AA, fatigue, thirst, urination, weight gain, hypertension, rash, neuropathy Clinical Manifestations: Kind of lumped-in with risk factors. Diagnosed with Type II DM Teaching: Diet & exercise No bad carbs; teach good vs bad Less processed foods better off she is. Fruits/Veggies cooking process does something to dietary values Need fat in diet for brain fuction, but its the type of fat that gets us dont need fatty foods like bacon, pork parts; need unsat fats; SAT FAT IS BAD FAT; fatty fishes but have to watch mercury Protein high protein is not needed; lean protein is what is needed chicken, fish, turkey, etclean pork and beef is okay tend to be more expensive and dryer Refer to websites like ADA website, mypyramid.gov, etc. Should be walking for exercise 30 minutes/day for 5-7 days per week Eventually want her to start doing strength training build up to it. Medication compliance Metformin Mechanism of action: enhances insulin sensitivity (insulin pusher); pushes BG into cells, but works with our insulin in the body! Teaching: test blood sugar levels as needed or prescribed by MD; may want to teach s/sx of hypoglycemia usually not an issue, but may be; dont drink alcohol & take with food Taking w/ alcohol may lead to lactic acidosis: nausea, weakness, muscle pain, etc. May have interactions w/ diagnostic tests (dyes) and metformin Seek medical attention if having difficulty breathing!!