Topic 1 Diabetes Parts 1,2,3 and Thyroid Diseases

• Diabetes Mellitus is an alteration in glucose metabolism with altered mechanisms in type 1 and type 2 DM.
• Glucose is a crucial component in the body, playing various roles such as providing energy, aiding in the formation of red blood cells, and maintaining nerve function.
• Too much glucose can lead to hyperglycemia, which can cause symptoms like polyuria, polydipsia, polyphagia, and weight loss.
• Insulin production plays a crucial role in glucose metabolism.
• Diabetes Mellitus is a major cause of death in this country and is a leading cause of cardiovascular disease, peripheral neuropathy, and renal disease.
• The risk of developing diabetes is higher in certain populations such as Native Americans & Alaska Natives, Blacks, Hispanics, Asians & Pacific Islanders.
• Clinical manifestations of diabetes include hyperglycemia, polyuria, polydipsia, polyphagia, and weight loss.
• Type 1 Diabetes is an autoimmune process that results in the progressive destruction of the pancreatic B-cells and requires the supply of exogenous insulin.
• Type 2 Diabetes is characterized by hyperglycemia due to insulin deficiency, decrease insulin activity, insulin poorly utilized, and insulin resistance.
• Normal fasting serum glucose is less than 100 mg/dL; and normal random serum glucose is 125 mg/dL or less.
• Hemoglobin A1C level should be 6.5% or higher if less than 7%, then considered good control.
• Fasting serum glucose level should be higher than 126 mg/dL.
• Classic symptoms of hyperglycemia include random serum glucose level of 200 mg/dL or higher.
• Two-hour serum glucose level during OGTT should be 200 mg/dL (with glucose load of 75 g).
• Cholesterol & Triglycerides, BUN & creatinine, electrolytes, and urinalysis should be tested to anticipate diabetes.
• Goal of diabetes management is to maintain normal glucose levels.
• Interprofessional care goals include managing A1C, BP, cholesterol, and insulin management.
• Medications and blood glucose monitoring are crucial aspects of diabetes management.
• Nutrition plays a significant role in diabetes management, including carbohydrate counting, food exchanges, and glycemic index.
• Type 1 DM meals need consistent times (and snacks) synchronized with action times of insulin.
• Type 2 DM meals need to achieve glucose, lipid, BP goals, and wt loss.
• Exercise is an integral part of diabetes management.
• Insulin is a crucial aspect of diabetes management, with various methods of administration/delivery available.
• Interprofessional Care: Provider Insulin Plans include Basal-Bolus plan, Mealtime insulin: rapid or short-acting insulin, and Immediate insulin.
• Taking Nursing Action: Mealtime insulin is a small bolus with as little as 1 unit of rapid or short-acting insulin before the meal.
• The dose of mealtime insulin is based on the glucometer reading and can vary from client to client.
• Taking Nursing Action:Mealtime insulin example: The client, who weighs 54 kg, has a prescription for basal and bolus insulin at breakfast and bedtime: NPH 18 units SC at breakfast, lispro units SC per bolus scale with meals and bedtime, NPH 9 units SC at bedtime.
• Blood glucose intervention: Less than 70, Rule of 15; 71-199, No intervention; 200-249, 2 units of insulin lispro; 250-299, 4 units of insulin lispro; 300-349, 6 units of insulin lispro; 350-399, 8 units of insulin lispro; 400-449, 10 units of insulin lispro.
• Taking action: Other drugs and teaching: Be aware of the effect of other medications on glucose levels, Birth-control pills increase glucose levels, Steroids increase glucose levels, ETOH decreases glucose levels in diabetic client.
• Somogyi effect and Dawn phenomenon are two terms related to blood glucose levels.
• Interprofessional Care: Oral & Noninsulin Injectable Agents used in type 2 DM work differently depending on classification and may be used in combination, combination tablets, or with insulin.
• Interprofessional Care: Nutrition Therapy aims to manage carbohydrate intake at 45% of daily intake, limit fat and cholesterol, protein 15%-20%, limit high fructose corn syrup & sugar sweetened beverages, limit ETOH consumption.
• Taking Action: Nutrition Therapy involves teaching the client to eat according to prescribed meal plan, not to skip meals, appropriate food portions, and snacks (mid-afternoon and bedtime) to minimize fluctuations of blood glucose levels.
• Exercise increases insulin sensitivity and has a direct effect on lowering blood sugar levels.
• Blood Glucose Monitoring can be conducted using portable meters or continuous glucose meters (CGM) and provides daily monitoring and fluctuations.
• Transplant may be an option for someone with type 1 DM if in end stage renal disease & will have a coinciding kidney transplant, or meet other criteria, still experimental-islet cell transplants.
• Nursing Management: Assessment for Hyperglycemia includes the classic 3 Ps, blurred vision, vomiting, fatigue, fruity breath, dry mouth, warm, moist skin, altered reflexes, restlessness, wound healing, infections, numbness, tingling, weight gain/loss, muscle wasting, confusion, stupor, coma.
• Nursing Management: Problems & Plan includes clinical problems such as altered blood glucose level, deficient knowledge, risk for injury, impaired endocrine function, neurologic problem, and planning/goals which include self-care behaviors and life-style adjustments, glucose management, and reducing risk for complications with no emergencies.
• The nurse's statement, "The laboratory test result is positive for type 2 diabetes," is the best choice as it provides a definitive diagnosis of type 2 diabetes.
• The nurse's statement, "You will develop type 2 diabetes within 5 years," is not the best choice as it is not based on the individual's current health status.