Metabolism

Module 4

(diabetes)

Objectives

Describe the function of the pancreas and

relationship with the development of diabetes.
Differentiate among the various categories of
diabetes mellitus, including their etiologies.
Describe the etiology of Type I diabetes, how it is
diagnosed and who is at risk for developing the
disease.
Describe the etiology of Type II diabetes, how it is
diagnosed and who is at risk for developing the
disease.
Identify the clinical manifestations of diabetes
Type I or II
Identify the diagnostic and clinical significance of

Objectives

Describe the relationship between diet, exercise,

and medication (insulin or oral hypoglycemic
agents) for people with diabetes.
Describe the major macrovascular,
microvascular, and neuropathic complications of
diabetes and the self-care behaviors important in
their prevention.
Describe management strategies for a client with
diabetes to use during sick days.
Define Diabetic Ketoacidosis.
Apply the principles of infection control in the
care of patients with diabetes.
Identify teaching needs for patients with

Hyperglycemia and
Hypoglycemia
See handout for
symptoms

Education is
essential

Diabetic Ketoacidosis
DKA

Uncontrolled hyperglycemia

Metabolic acidosis

Increased production of ketones

Infection is the most common precursor to DKA

Symptoms

Treatment Goals

#1 Goal:

Medications to
treat Diabetes

If nutrition and weight loss do not work to correct

the blood sugar then medications will be added

Antidiabetic Drugs

Insulin Secretagogues Second-Generation

Sulfonylurea

Biguanides

Meglitinide Analogs

Thiazolidinediones

DPP-4 Inhibitors

Insulin

Insulin Secretagogues
Second-Generation
Sulfonylurea

Examples
Glipizide

(Glucotrol) 5-10mg Q12Hr

Glucotrol XL 5-20mg Daily
Glimepiride (Amaryl) 1-4mg Daily for maintenance

Meglitinide Analogs

Examples
Repaglinide

(Prandin) 0.5-4mg Daily

Nateglinide (Starlix) 60-120mg Daily before meals

Biguanides

Examples
Metformin

(Glucophage) 850mg BID, breakfast and

dinner
Glucophage XL 500-2000mg Daily, before breakfast

Thiazolidinediones

Examples
Pioglitazone

(Actos) 15mg or 30mg Daily

Rosiglitazone (Avandia) 4mg Daily or 2mg BID

DPP-4 Inhibitors

Examples
Sitagliptin

(Januvia) 100mg Daily

Saxagliptin (Onglyza) 2.5mg or 5mg Daily

Insulin

Must be given SQ or IV so it bypasses the GI tract

Goal is to duplicate the normal release pattern
from the pancreas
Want to mimic the basal amount and the prandial
levels
Basal insulin will make up about 40-50% of the
daily need with the remainder divided into premeal doses
NPH and Long-acting insulins cover the basal
needs
Rapid or Short acting insulins cover the prandial
needs

Injectable Insulin
Insuli Onset Peak
n
Rapid
Acting
Short
Acting

15-20
mins
30 mins

Durati
on

30 mins-3
hrs
2-5 hrs

3-5 hrs

4-12 hrs

16-24 hrs

5-8 hrs

Exp concentrated

Intermediat 1- 1.5 hrs

e Acting

Exp Levemir

Exp mixes 70/30 50/50

Long Acting

2-4 hrs

None

24 hrs

Rapid Acting

Short Acting

Intermediate Acting

Long Acting

Insulin dosing

Single Daily injection

Multiple-component

Insulin Dosing
Intensified regimens

Sub Q injections

1435 Charts 67-4

and 67-5

Sliding scale
http://diabetesinstitute.pitt.edu/files/Re
gHumulinISS.pdf

Factors Influencing
Insulin Absorption

Acute
Effects from
Diabetes
The risk for
death in diabetic

clients is twice that of persons

without the disease

Acute complications

Chronic effects
Macrovascular

Chronic Effects
Microvascular

Chronic effects
Microvascular

Chronic
Effects from Diabetes

Peripheral Neuropathy

Diabetic Foot Care

Self-Management

Education begins with diagnosis and continues

throughout the disease
Patients need to be assessed for learning needs,
readiness, and limitations
Daily management of nutrition and medications
Case Management and multiple resources
needed
Constant evaluation

Sick Days

Take anti-diabetic agents as usual

Test blood BG every 3-4 hours

Report BG levels greater than 300mg/dL

Insulin-requiring patients may need supplemental

doses of insulin every 3-4 hours
Substitute meals for soft food if regular meals not
tolerated 6-8 times a day
Take in liquids if vomiting, diarrhea or fever every
-1 hour (NOT sugarless drinks)
Report nausea, vomiting and diarrhea
Diabetics may need hospitalization if enable to
retain fluids(to avoid DKA and possible coma)

Exercise Therapy

Regular exercise is an essential part of

a diabetic treatment plan
Benefits of exercise
Assessment before initiating an
exercise program
Guidelines for exercise

Coping with Diabetes

Special Issues for

Diabetic patients

Surgery

Hospitalization

Hypo/hyperglycemia

Diet changes
NPO whether to give insulin
Clear Liquids
Tube feeding
Hygiene issues

Health
Promotion

Nursing Diagnosis