Diabetes
Glycemic Control
Weight Management
Exercise
Ways to prevent Diabetic Complications
Higher risk for dementia
Neuron damage
Brain atrophy
Cognitive Dysfunction in Diabetic patients
Onset 0.5 hours
Peaks 2-4 hours
Duration 5-12 hours
Regular Insulin
Fasting blood glucose levels 70-130mg/dL
Controlled blood glucose
Main glucocorticoid
Produced by Adrenal Cortex
Affects our response to stress, emotional stability, immune function, sodium and water balance, carbohydrate, protein, and fat metabolism
Cortisol
1st degree relative with diabetes
Hypertensive (>140/90)
Triglyceride level >250mg/dL
Hemoglobin A1C> 5.7%
Elevated BMI
Sedentary lifestyle
History of vascular disease
Exposure to Agent Orange
Risk Factors of Diabetes
Precipitated by infection
Uncontrolled hyperglycemia
Metabolic acidosis
Increased production of ketones
Kussmauls respirations
Polyuria, polydipsia, sunken eyes
Fatal in 10% of cases
Diabetic Ketoacidosis
Half cup of fruit juice
8 ounces of skim milk
Re-test in 15 minutes
Measurement of average blood glucose over course of 120 days
Hemoglobin A1C
Vasopressin
Promotes water reabsorption
ADH
Juvenile Onset
Pancreatic beta cell destruction
Insulin Dependent
Stems from viral infection or autoimmunity
Type 1 Diabetes
Pathological change in the kidneys
Reduces kidney function, leads to kidney failure
10-15 year history of diabetes
Poor glucose control
Declining GFR
Diabetic Nephropathy
Onset 1-4 hours
Peaks 4-12 hours
Duration 10-24+ hours
NPH Insulin
Glucose levels less than 180mg/dL
Normal post-prandial blood glucose
Secretes digestive enzymes
Secretes glucagon
Secretes insulin
Secrete somatostatin
Pancreas
Cool, clammy skin
Sweaty
Anxious, irritable, confusion
Weak
Double or blurred vision
Tachycardia, palpitations
Negative for Ketones
Hypoglycemia
Mismatch of nutrient absorption and insulin action
Gastroparesis
Store in refrigerator
Store at room temp for 28 days
Do not expose to temp 36F or above 86F
Avoid excessive shaking
Avoid exposure to sunlight
Discard after 28 days
Care of Insulin
Present in urine
Indication is that insulin levels are not adequate
Patient should not exercise if these are present
Ketones
Mineralocorticoid
Produced by Adrenal Cortex
Helps control fluid and electrolyte balance
Promotes sodium and water reabsorption
Promotes potassium excretion
Regulated by the renin-angiotensin-aldosterone system (RAAS)
Aldosterone
Warm, dry
Patient is dehydrated
Fruity breath
Kussmauls Respirations
Acidosis
Can go from alert to stuporous
Positive for Ketones
Hyperglycemia
Anti-rejection therapy
Increased risk for infection, cancer, and atherosclerosis
Risk for Hyperglycemia
Pancreas Transplant
Decreases intestinal glucose absorption
Increase insulin sensitivity
Do not drink alcohol
Need to stop before certain imaging tests (contrast dyes) and wait 48 hours before starting again (prevents kidney damage and lactic acidosis)
Side effects: GI issues
Metformin
Measures specific hormones
Empty bladder, discard, note the time
Ask about preservatives (caustic)
Ask about temperature
24 hour Urine Collection
Process to restore homeostasis
Example: Glucose levels rise so, insulin is secreted. Insulin decreases blood glucose levels.
Negative Feedback Mechanism