Patients with Diabetic Disorders

Salient Features Pre-Diabetic or Asymptomatic Diabetes - Occasional Hyperglycemia Obesity - Persons that are risk for DM

Management 1.Promotion and Prevention a. Teach patient about disease and effects b. Life Modification a. Diet (alcohol) Based on RDA b. Activity Promote consumption energy / increasing expenditure WEIGHT LOSS 2. Surveillance and Monitoring At least annual checkup of glucose: - OGTT - FBS Risk Individuals or Asymptomatic DM a. Family History of DM b. History of Large baby delivery c. History of GD d. Elderly e. >45 years old Bigger chances of beta cell/ pancreatic damage Insulin down regulation f. History of Viral infection (Gastroenteris & Epstein Barr virus/ Rota virus) g. History of Autoimmunity h. OBESITY - Nursing Advice: Surveillance of Blood Glucose Annually at least 2 separate events: 1. Impaired Glucose Tolerance 2. Impaired Fasting Glucose - Urine test (*Benedicts is not a good diagnostic criteria)

Diabetic Phase 1. Type 1: Insulin Dependent - ABOSLUTE/LACK of INSULIN due to the following factors a. immune damage b. no pancreas (congenital) c. no beta cell (congenital) d. viral damage e. trauma f. history of pancreatitis g. surgical removal Identify the common signs symptoms: 1. Polyuria 2. Polydypsia 3. Weight Loss (DM type 1) or Obese (DM type 2) 4. Polyphagia Confirm the Diagnosis of DM 1. Check the hyperglycemia a. OGTT b. Fasting Blood Glucose (*8 hours NPO) c. 70g/Load Glucose Test for 2 hours >126mg/dl for FBS ( 2 separate events) > 220mg/dl for Load test (2 hours) 2. Identify the Diabetes (DM Type 1 or Type 2) a. C-peptide test if + (DM type 2) - There is a presence of Insulin production b. C-peptide test if (DM type 1) - No insulin synthesis or production 3. Teaching management for DM a. DM Type 1: a. Compliance to Insulin Administration b. Universal Precaution with Body Fluids c. Monitoring of Blood Glucose (KIT) d. Management for acute Hypoglycemic Events - Overdosing

2. Type 2

- Wrong Timing administration Nursing: a. Confirm the Hypoglycemia (Blood Glucose) - <80mg/dl b. Signs and Symptoms: Adrenergic Events - Tachycardia, Hypertesion, Pawis (muscarinic activation of norepinephrine) c. Management: HOME: Hard Candy/Orange Juice (Simple sugars only) HOSPITAL: Glucagon/D5W d. Accident precaution E. Diet and Activity DM type 2: 1. Monitoring of Blood Glucose 2. Lifestyle modification (DIET & ACTIVITY) PROMOTE WEIGHT LOSS Increases insulin signaling (Insulin resistance reduce) OBESITY ADIPOSE TNF alpha FFA competition on the binding sites of the Insulin Receptor. (INSILIN RESISTANCE) 3. Oral Hypoglycemic Drugs 4. Insulin management (*mutated beta cell with abnormal insulin production structure of insulin)

Complications (*10 years) 1. Macro-vascular Effects a. Buergers Disease b. Acute Coronary Syndrome(MI) c. Poor wound Healing 2. Micro-vascular Effects a. Retinopathy b. Neuropathy c. Nephropathy d. Stoke