DIABETES MELLITUS SHORT NOTES

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)

• 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.

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.