Diabetes Assignment

1. Type 2 diabetes mellitus is the result of the pancreas being unable to produce adequate amounts of insulin and the resistance of cells to insulin. This results in glucose remaining in the blood and not being taken up by the cells leading to hyperglycemia. Because of insulin’s role in the stimulation of the synthesis of protein and the storage of fatty acids in adipose tissue, inadequate amounts of insulin also reduces nutrients that are essential for fuel and storage being accessed by tissues. Beta cells of the pancreas do not function correctly leading to inadequate amounts of insulin being produced. (P. 549) [ (Wolters Kluwer Health, 2012) ] [ (Khardori, 2012) ] 2. The major risk factors for the development of DM II include: 1) being overweight by a margin of at least 120% of ideal body weight; 2) being older than 45 (however, this is changing); 3) being of Hispanic, African American, Native American, Pacific Islander or Asian American heritage; 4) Having a first-degree relative who has a history of DM II; 5) Having hypertension or having low HDL cholesterol or high triglycerides; 6) Having a previous history of impaired fasting glucose or impaired glucose tolerance; 7) having previous had gestational diabetes or having given birth to a baby weighing over 9 pounds; 8) having polycystic ovarian syndrome. [ (Khardori, 2012) ]

3. The difference between a glucose tolerance test, fasting blood glucose and HgbA1C test are as follows: A glucose tolerance test is done with the patient eating normally for several days prior to the test, but fasting for 8-12 hours before the test. A blood sample is taken to establish a baseline. The patient then drinks glucose (usually 75 mL) in a liquid as quickly as possible. Blood tests are done every 30 minutes for up to 3 hours. [ (Dugdale, 2012) ] A fasting blood glucose test is done after not having eaten for 8 hours and then a blood test is done to determine the amount of glucose in the blood. [ (Healthwise Staff, 2011) ] An HgbA1C test is a glycohemoglobin test that measures the amount of glucose that has adhered to RBCs. It measures the estimated average of blood glucose levels for approximately the past 2-3 months. [ (Healthwise Staff, 2011) ] 4. Major complications that are associated with DM II are:

A. Neuropathy which is caused by the damage to the capillaries in the periphery. This is caused by excess glucose in the blood. Tingling and burning of the extremities, especially the lower extremities are a common symptom. Constipation, erectile dysfunction, nausea, vomiting and diarrhea are all effects of this nerve damage. [ (Mayo Clinic Staff, 2012) ] B. Nephropathy is also caused by nerve damage, this time in the kidneys. It can lead to the need for dialysis or kidney transplant due to the destruction of the nerves. [ (Mayo Clinic Staff, 2012) ] C. Retinopathy which can lead to blindness, glaucoma or cataracts is also caused by nerve damage, this time in the eye. [ (Mayo Clinic Staff, 2012) ] D. Infections of the foot that can lead to amputation are caused by nerve damage. [ (Mayo Clinic Staff, 2012) ] E. Alzheimer’s Disease which can be caused from blood flow to the brain being blocked or strokes, inflammation in the brain due to too much insulin or brain cells being deprived of glucose due to lack of insulin. [ (Mayo Clinic Staff, 2012) ] 5. Three areas for patient’s educational needs regarding diabetes are:

A. Adherence to meal planning. This is important because it helps maintain blood glucose levels at a therapeutic level, helps maintain a healthy weight, and helps in the prevention of cardiovascular disease. Making sure to include protein, carbohydrates, vegetables and fruits, and dairy in the correct proportion is the best way to attain these goals. (P. 76) [ (Omnigraphics, 2008) ]

B. Maintaining a physically active lifestyle. Being physically active helps in maintaining an optimum weight, blood glucose is lowered because activity helps insulin work more efficiently, it helps maintain energy, and helps cardiovascular system perform better. (P. 77, Omnigraphics, 2008)

C. Being compliant with diabetes medication. Medication, whether it is insulin or oral medication, helps the body to maintain insulin levels and lower glucose levels in the blood. Oral diabetic medications enable the body that still produces insulin to release what it makes or makes the cells less resistant to the insulin that is produced. Exogenous insulin is required when the pancreas no longer produces insulin. Either way, in order to keep hyperglycemia under control, medication should be taken every day at the scheduled times. 6. Psychosocial needs of patients newly diagnosed with DM are:

A. Support in managing their illness day-to-day. Patients may seem overwhelmed with the meal planning and medication management of their disease that is required on a daily basis. It can seem unmanageable when one thinks of how meticulous one must be in monitoring and managing blood glucose levels. [ (Thoolen, Ridder, Bensing, Gorter, & Rutten, 2006) ]

B. Overcoming depression linked to diagnosis. Patients who are newly diagnosed with diabetes can become depressed when considering how their lifestyle must change. Losing weight, changing diet habits, and becoming more physically active can seem like a tremendous amount of obstacles to overcome. [ (Thoolen, Ridder, Bensing, Gorter, & Rutten, 2006) ]

C. Anxiety regarding the ability of the patient to make the changes deemed necessary to manage blood glucose levels. The fact that the patient will likely be on medication for the rest of their lives, and that the way they eat may have to be completely overhauled can lead to a significant amount of anxiety. Patients may feel crushed under the weight of the reality of their situation. Their body doesn’t work the way that it should and all organ systems are affected. This can cause a burden that causes anxiety as to how to change their lifestyle and still enjoy life. [ (Thoolen, Ridder, Bensing, Gorter, & Rutten, 2006) ] 7. As a nurse working with patients who are noncompliant in their management of their diabetes, I will use compassion and understanding. I will remember that we are all in charge of our own health and that no one can be forced to do what they do not want to do.

I will provide the care that is called for in each situation. I will also try to continue to educate the patient in the consequences of not following the experts’ recommendations. Each person has a reason for what they do and do not do. I will try to find that reason and see if, together with the patient, we can come up with a solution that is beneficial to the patient and enables them to become compliant. 8. Diabetic ketoacidosis is the result of hyperglycemia, metabolic acidosis and an increase in the ketone concentration circulating in the body. Ketoacidosis happens because insulin is either not effective or is insufficient while other hormone levels are raised, such as cortisol, glucagon, growth hormone and catecholamines. Signs and symptoms include polyuria, polydipsia, nausea and vomiting, fruity-smelling breath, shortness of breath, confusion, abdominal pain, and anorexia. [ (Umpierrez, Murphy, & Kitabchi, 2002) ] [ (Mayo Clinic Staff, 2010) ] Non-ketotic hyperosmolar hyperglycemia is seen as hyperglycemia, dehydration, and loss of consciousness.

When a person has hyperglycemia & doesn’t have enough intake of fluids, the kidneys can’t excrete the overaccumulation of glucose. This causes extreme hyperglycemia and hyperosmolarity. Hyperosmolarity is caused by high concentrations of glucose, sodium and other electrolytes that usually cause the movement of water in the blood. Because of hyperosmolarity, water is taken from other organs, the brain included. Hyperosmolarity causes a positive feedback loop that increases the level of glucose in the blood and dehydration. Signs and symptoms include coma, confusion, fever, convulsions, lethargy, polydipsia, early polyuria, nausea, weight loss and weakness. [ (Topiwala, 2012) ] The main difference between DKA & HHS is that HHS does not have ketoacidosis.

9. Dr. Michael Somogyi hypothesized in the 1930s that early morning hyperglycemia is caused by late evening hypoglycemia. Occurring most often in Type I diabetes, although it is very rare, it is caused by the missing of snacks or meals, taking insulin at the wrong time or when unnecessary. The Dawn Phenomenon is caused by hormones being released at night that cause the liver to produce glucose. Hyperglycemia in the morning is caused when there is insufficient insulin to counter the glucose. [ (Manzella, 2007) ] To tell the difference between the Somogyi Effect and the Dawn Phenomenon, glucose readings should be taken around 1 or 2 in the morning. If the reading is within therapeutic ranges then it is the Dawn Phenomenon, if it is low than it is the Somogyi Effect. (Manzella, 2007)

Bibliography

Dugdale, I. D. (2012, June 6). Glucose Tolerance Test. Retrieved from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm
Healthwise Staff. (2011, July 5). Blood Glucose. Retrieved from WebMD: http://www.diabetes.webmd.com/blood-glucose Khardori, R. (2012, October 8). Type 2 Diabetes Mellitus. Retrieved from Medscape Reference Drugs, Diseases & Procedures: www.emedicine.medscape.com/article/117853-overview Wolters Kluwer Health. (2012). Endocrine Disorders. In W. K. Health, Medical-Surgical Nursing made Incredibly Easy! (pp. 517-570). Ambler: Lippincott, Williams & Wilkins.