MIDTERMS MED SURG

• Pancreas


  Islets of Langerhans (containing beta cells, which produce insulin. While alpha cells secrete glucagon)

  
• Alpha cells


  Glucagon – increase glucose levels (it function with gluconeogenesis)

  
• When blood sugar is low

  Glucagon will be released by alpha cells and it will raise glucose levels

  
• Beta cells


  Insulin - decrease glucose levels by: Transcellular membrane transport of glucose, Inhibits breakdown of fats & CHON

  
• Beta cells require


  • Na+ for transport of CHON
  • K+ for production
• Delta cells


  Somatostatin – inhibits action of growth hormone
• Diabetes Mellitus


  A chronic metabolic disease characterized by hyperglycemia due to disorder of carbohydrate, fat and protein metabolism

  
• Once you have diabetes, you have it for life
• Predisposing Factors for Diabetes

  • Heredity
  • Obesity
  • Stress
  • Viral infection
  • Autoimmune Disorders
  • Multigravida Women with large babies
• Types of Diabetes Mellitus

  • Type I
  • Type II
  • Gestational Diabetes
  • Diabetes associated with other conditions or syndromes
• Type I (IDDM) Insulin Dependent Diabetes Mellitus

  • Juvenile – onset, Brittle DM, Unstable DM
  • Onset is less than 30 years
  • Common in children or in non-obese adults
  • NO insulin production (there is destruction on pancreas, therefore there's no insulin production at all)
  • Prone for DKA (Diabetic Ketone Acidosis, because there is absolute deficiency of insulin, the body will burn protein and fat reserves)

  
• Type II (NIDDM) Non-Insulin Dependent Diabetes Mellitus

  • Maturity – onset, Stable DM, Ketosis – resistant DM
  • Onset is 40 years
  • Common in obese adults
  • Inadequate insulin production or cells do not respond to insulin
  • Prone for HHNKS (Hyperosmolar Hyperglycemic Nonketotic Syndrome – high BP) mataas ang bp pero hindi necessarily mataas ang ketone bodies because there is still circulating insulin

  
• Type II diabetics can also develop DKA, but it is rare. They will only develop it when there is severe stress
• Management for Type I and Type II Diabetes

  • Diet
  • Exercise
  • Insulin lifetime (for Type I)
  • OHA (Oral Hypoglycaemic Agents), Insulin in STRESSFUL situation (for Type II)

  
• Pathophysiology of Diabetes


  1. Food intake and absorption of nutrients

  2. Pancreas secretes chemicals including insulin from beta cells

  3. Insulin binds to receptors to decrease glucose in the body

  4. Pancreas malfunction or receptor issues lead to glucose staying in the blood and resulting in diabetes

  
• Hyperglycemia: 3P's


  • Polyuria
  • Polydipsia
  • Polyphagia
• Ketones act as CNS depressants and may decrease brain pH leading to coma
• Effects of Diabetes on Protein Metabolism

  • Increased blood viscosity
  • Sluggish circulation
  • Proliferation of microorganisms

  
• Infections due to Diabetes

  • Periodontal
  • UTI
  • Vasculitis
  • Cellulitis
  • Vaginitis
  • Furuncles
  • Carbuncles
  • Retarded Wound Healing
• Thoroughly inspect your feet daily and keep them clean and dry
• Complications of Diabetes


  • Macroangiopathy (Brain - Cerebrovascular accident, Heart - Myocardial infarction, Peripheral arteries - Peripheral vascular disease)
  • Microangiopathy (Kidneys - Renal failure due to nephropathy, Eyes - Cataract due to retinopathy)
  • Neuropathy (Spinal Cord/ ANS, Peripheral neuropathy - Involves damage to the PNS, Affect movement, sensation, and bodily functions, Paralysis, Gastroparesis, Neurogenic bladder, Decreased Libido, impotence)
• Diagnostic Tests for Diabetes

  • Random Blood Sugar (RBS)
  • Fasting Blood Sugar (FBS)
  • Postprandial Blood Sugar
  • Oral Glucose Tolerance Test (OGTT)
  • Glycosylated hemoglobin (HbA1c)

  
• Random Blood Sugar (RBS)


  Blood specimen is drawn without preplanning, ≥ 200mg/dl + symptoms is suggestive of DM
• Fasting Blood Sugar (FBS)


  Blood specimen after 8 hours of fasting, Normal (70-100 mg/dl), pre-diabetes (101 but < 126mg/dl), DM – > 126 mg/dl

  
• Postprandial Blood Sugar


  Blood sample is taken 2 hrs after a high CHO meal, No DM (70-140mg/dl), prediabetes (≥140 but <200 mg/dl)

  
• Oral Glucose Tolerance Test (OGTT)

  1. Diet high in CHO is eaten for 3 days

  2. Client then fast for 8 hours. A baseline blood sample is drawn & a urine specimen is collected

  3. An oral glucose solution is given, and time of ingestion recorded

  4. Blood is drawn at 30 minutes & 1, 2, and 3 hours after the ingestion of glucose solution. Urine is collected

  
• Glycosylated hemoglobin (HbA1c)


  The amount of glucose stored by the hemoglobin is elevated above 7% in the newly diagnosed client with DM, in one who is noncompliant, or in one who is inadequately treated

  
• Management of Diabetes


  • Diet (Low caloric diet specially if obese, 20% CHON, 30% Fats, 50% CHO, Consume complex CHO and HIGH fiber diet)
  • Exercise (Regularly, Increases CHO uptake by the cells, Decreases insulin requirements, Maintains ideal body weight, serum carbohydrates & serum lipids)

  
• Insulin Preparations


  • Beef and pork insulin
  • Pure beef
  • Pure pork
  • Human insulin - purest insulin and has the lowest incidence of hypersensitivity
• Insulin Types by Onset, Peak and Duration

  • Rapid acting (clear) - Lispro (Humalog), Aspart (Novalog)
  • Short acting (clear) - Regular (Humulin R), (Novolin R), (Iletin II regular)
  • Intermediate (cloudy) - NPH, Humulin N, Lente, Humulin L
  • Long acting - Ultralente, Glargine (Lantus)

  
• Oral Hypoglycemic Agents (OHA)

  • Sulfonylureas
  • Nonsufonylureas (Biguanides, Alpha-glucosidase inhibitors, Thiazolidinediones, Meglitinides)
• Sulfonylureas


  Stimulate the beta cells to secrete more insulin, Increases the ability of insulin cell receptors to bind insulin
• Biguanides


  Help tissues use available insulin more efficiently, "insulin sensitizers"

  
• Alpha-glucosidase inhibitors


  Alpha-glucosidase is an intestinal enzyme that breaks down carbohydrates into glucose, when this enzyme is inhibited, the process of forming glucose is slowed and glucose is absorbed more slowly from the small intestine

  
• Thiazolidinediones (TZDs)


  Help tissues use available insulin more efficiently, "insulin sensitizers"

  
• Meglitinides


  Help tissues use available insulin more efficiently
• Nursing Responsibilities in Insulin Therapy

  • Route: Subcutaneous, IV insulin in emergency cases (DKA)
  • Administer insulin at room temperature
  • Store vial of insulin in current use at Room Temperature, Other vials should be refrigerated
  • Rotate the site of injection
  • Gently roll vial in between the palms to redistribute insulin particles, DO NOT Shake
  • Observe for side effects of insulin therapy
• Insulin Therapy: Insulin Pumps

  A computerized device that delivers insulin to patients automatically throughout the day, closely mimic normal pancreatic functioning, Uses only regular insulin, Insulin can be administered via the basal rate and by a bolus dose prior to each meal

  
• Insulin sensitizers


  Increase the sensitivity of insulin receptors
• Insulin sensitizers


  • No weight gain, no hypoglycemia unlike sulfonylureas