DIABETES MELLITUS SHORT NOTES
DIABETES MELLITUS SHORT NOTES
- It is a chronic disorder of impaired carbohydrate, protein and lipid metabolism caused by deficiency of insulin.
PRIMARY DIABETES MELLITUS
It is divided into two types
A) TYPE-1 DIABETES MELLITUS OR INSULIN DEPENDENT DIABETES MELLITUS
- Occur due to deficient of secretion of insulin
- Destruction of pancreas by infection such as streptococcus bacteria and coxsackie virus
- Auto-antibodies may destroy beta cells of pancreas
- Develop in people below 20 years of age
- when it develop at infancy & childhood it is called juvenile DM
- It is not associated with insulin
B) NON-INSULIN DEPENDENT DIABETES MELLITUS OR TYPE-2 DIABETES MELLITUS
- Relative lack of insulin or resistance to the action of insulin
- It is more common type (more than 90%)
- Diabetic keto acidosis not occur in type 2 because presence of insulin prevents breakdown of fat
- Old age(more than 40 year of age)
- Stress and heredity
SECONDARY DIABETES MELLITUS
- Results from other disorders like damage of pancreas after frequent episodes of pancreatitis or drugs such as corticosteroids
SIGNS AND SYMPTOMS
- Cardinal signs are polyuria, polyphagia, polydipsia
- weight loss, asthenia, blurred vision, slow wound healing, paresthesia, glucosuria, hyperglycemia
HOW TO DIAGNOSE
- Glucose tolerence test
- HBA1C (Normal range:4-6%)
- Day to day consistency in timing and amount of food intake helps control the blood glucose level
- To take low sugar and fat diet in small amount frequently
- It lowers the blood glucose level encourages weight loss, reduce cardiovascular risks, improve circulation, decrease cholesterol level and insulin resistance.
- If the blood glucose level is higher than 250 mg/dL and urinary ketones are present, the client is instructed not to exercise until the blood glucose level is closer to normal and urinary ketones are present.
- Instruct the client with diabetes mellitus to monitor the blood glucose level before, during and after exercising.
- CAD, Hypertension, CVA
- Diet management
- Oral hypoglycemic medication
1)Rapid acting : 3-5 hrs
2)Short acting : 5-7hrs
3)Intermediate acting : 24 hrs
4)Long acting : 36 hrs
- Use 27 to 29 gauge needle for insulin injection
- Rotate injection site 1.5 inch apart in every injection to prevent lipodystrophy
- Regular insulin can mix with any type of insulin and can be administered IV also can be use into emergency treatment of Diabetic ketoacidosis.
- When mixing insulin, draw up the regular insulin first from vial
- Insulin itself does not cross the placenta or enter breast milk
- Insulin should be stored in cold place and avoid freezing and direct exposure to sun light
- Most suitable site for insulin injection is abdomen around umbilicus, posterior surface of arm, anterior surface of thigh and hips.
- Insulin is mainly used in Type-1 DM
COMPLICATION OF INSULIN THERAPY
- local allergic reaction like redness, swelling, tenderness and induration
- Occur from reduced sensitivity to insulin and usually develops between 5 and 8 am (Prebreakfast hyperglycemia occur), it may be caused by nocturnal release of growth hormone
- Treatment include administering an evening dose (or increasing the amount of a current dose) of intermediate acting insulin at about 10 pm
- Normal or elevated blood glucose levels are present at bedtime, hypoglycemia occurs at about 2 to 3 am, which causes an increase in the production of counterregulatory hormones.
- By about 7 am, in response to the counter regulatory hormones, the blood glucose rebounds significantly to the hyperglycemic range
- Treatment includes decreasing the evening(Pre-dinner or bedtime)dose of intermediate-acting insulin or increasing the bedtime snack.