DIABETES MELLITUS SHORT NOTES

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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.

CLASSIFICATION

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

CAUSES

  • Destruction of pancreas by infection such as streptococcus bacteria and coxsackie virus
  • Auto-antibodies may destroy beta cells of pancreas
  • Hereditary
  • 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

Causes

  • Obesity
  • 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%)

DIET

  • 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

EXERCISE

  • 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.
READ MORE  INCREASED INTRACRANIAL PRESSURE SHORT NOTES

COMPLICATION

  • Retinopathy
  • Neuropathy
  • Nephropathy
  • CAD, Hypertension, CVA
  • Gangrene

TREATMENT

  • Diet management
  • Exercise
  • Oral hypoglycemic medication
  • Insulin

 INSULIN

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
  • Lipodystrophy
  • Lipohypertrophy

DAWN PHENOMENON

  • 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

SOMOGYI PHENOMENON

  • 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.
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