DIABETES MELLITUS

it is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. an Endocrine disease characterized by imbalance supply and demand of insulin in the body.

is a serious illness that can lead to kidney failure, blindness, and death if left untreated.

There are three major types of diabetes: Type 1 diabetes

is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. Cause of this is the destruction of beta cells in the pancreas

Type 2 diabetes
is far more common than type 1. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin.

Gestational diabetes

 is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease. It is usually go away if the baby was already born

Symptoms are:
Blurry vision Excessive thirst Fatigue Frequent urination Hunger Weight loss

Symptoms of type 1 diabetes:

Fatigue Increased thirst Increased urination Nausea Vomiting

Symptoms of type 2 diabetes:

Blurred vision Fatigue Increased appetite Increased thirst Increased urination

Here are some example of diagnostic test and exam : URINE ANALYSIS
used to look for glucose and ketones from the break down of fat.

Fasting blood glucose level

fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight).

Random plasma glucose test also called a casual plasma glucose test measures blood glucose without regard to when the person being tested last ate. Hemoglobin A1c blood test measures the average blood glucose level during the past two to three months. It is
used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes.

TREATMENT
changes in diet, oral medications, daily injections of insulin

Medication: Sulfonylurea drugs

these medications stimulate your pancreas to produce and release more insulin. For them to be effective, your pancreas must produce some insulin on its own.

Second-generation sulfonylureas
glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl)

Meglitinides
these medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but youre not as likely to develop low blood sugar. Meglitinides work quickly, and the results fade rapidly

Biguanides
it works by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells.

Alpha-glucosidase inhibitors

 these drugs block the action of enzymes in your digestive tract that break down carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If taken in high doses, they may also cause reversible liver damage.

Thiazolidinediones
these drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose

Side effects of thiazolidinediones

rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver damage.

NURSING INTERVENTIONS
Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin.

Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of technique by taking step by step approach.

 Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized insulin regimen

Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia. Explain the importance of exercise in maintaining or reducing weight.

Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia. Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair distribution, pulses and deep tendon reflexes

Maintain skin integrity by protecting feet from breakdown . Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow.

Prevention
Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes. Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

INSULIN
Hormone, produced in the islets of Langerhans of the pancreas, that regulates the metabolism of carbohydrates, fats, and starches in the body. Insulin enables the cells of the body to take up glucose, the simple sugar that cells burn for energy

Insulin was first extracted from the pancreatic tissue of dogs in 1921 Human insulin, the first human protein to be synthesized, was made in 1965

insulin is a protein, and like other proteins, it is partially digested if administered orally.

TYPES OF INSULIN RAPID ACTING INSULIN Lispro (humalog) - peak hour 1hr Aspart (novolog) 40-50 mins peak hr SHORT_ ACTING INSULIN Regular insulin (humulin R, novolin R ) only insulin given in IV Semi lente 2-4hrs peak INTERMEDIATE_ ACTING INSULIN NPH (neutral, protamin, hagedon)- novolin N, humulin N Lente insulin 6-12hrs

LONG -ACTING INSULIN Humulin U Ultralente 12-18hrs (peak) VERY LONG AVTING INSULIN Glargin Lantus peakless, 24 hrs of duration