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Diabetes MellitusThere are two types of diabetes: type 1 and type 2. Type 1, also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, is a condition where the islets of Langerhans in the pancreas do not produce needed insulin. Insulin is necessary for food to be metabolized. Antibodies have been found in the majority of clients with type 1 diabetes. These antibodies are proteins in the blood that are part of the client’s immune system. It is believed that type 1 diabetes is in part genetically transmitted from parent to child. At stressful times in life, such as when infection is present, pregnancy or environmental toxins might trigger abnormal antibody responses that result in this autoimmune response. When this happens, the client’s body stops producing insulin. Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age; however, it can occur in older individuals. These individuals are referred to as latent autoimmune diabetes in adults (LADA). Diabetes occurs in about 6% of Caucasians, 10% of African Americans, 20–50% of Native Americans, and 15% of Hispanics. Type 2 diabetes was referred to as non–insulin-dependent, adult-onset diabetes mellitus (ADDM). However, in recent years, more and more children have been diagnosed with ADDM. This trend can be attributed to obesity and sedentary lifestyle. In ADDM, the cells of the body, particularly fat and muscle cells, become resistant to insulin. This leads to increased insulin production with increased insulin resistance. Tests have also shown that this increased insulin resistance leads to a steady decline in beta cell production further worsening glucose control. This problem along with gluconeogenesis, a process in which the liver continues to produce glucose, leads to further hyperglycemia, metabolic acidosis, and deterioration of the client’s health. Signs and symptoms associated with diabetes mellitus include
Diagnosis of diabetes mellitus is made by checking blood glucose levels. Several diagnostic tests that can be performed to determine the presence and extent of diabetes are as follows:
Management of the client with diabetes mellitus includes the following:
HyperglycemiaWhen there is lack of the hormone insulin, the glucose can’t move from the outside of the cell to the inside of the cell where it can be used. It is very important that the nurse be aware of the signs of hyperglycemia to teach the client and family. Signs and symptoms of hyperglycemia are as follows:
HypoglycemiaWhen there is a lack of glucose, cell starvation occurs. This results in hypoxemia and cell death. Signs and symptoms of hypoglycemia are as follows:
Managing Hyperglycemia and HypoglycemiaManagement of hypoglycemia includes giving glucose. Glucagon, a 50% glucose solution, is an injectable form of glucose given in emergency. Cake icing, orange juice, or a similar carbohydrate can be administered if the client is still conscious. The best bedtime snack is milk and a protein source, such as peanut butter and crackers. Fluid and electrolyte regulation is also a part of the treatment of both hyperglycemia and hypoglycemia. Unchecked hyperglycemia leads to microangiopathic and macroangiopathic changes. These lead to retinopathies, nephropathy, renal failure, cardiovascular changes, and peripheral vascular problems. Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide DiaBeta )?Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Monitor blood glucose closely, and look for signs of hypoglycemia.
What is a desirable Premeal blood glucose for a patient with diabetes?Sometimes, more insulin than needed is taken and this will cause hypoglycemia. To minimize this risk, many providers will recommend that individuals treated with insulin target a pre-meal blood sugar (plasma glucose) of 90-130 mg/dl and post meal blood sugar (plasma glucose) of less than 180 mg/dl.
When a client is experiencing diabetic ketoacidosis the insulin that would be administered is?Only short-acting insulin is used for correction of hyperglycemia. Subcutaneous absorption of insulin is reduced in DKA because of dehydration; therefore, using intravenous routes is preferable. SC use of the fast-acting insulin analog (lispro) has been tried in pediatric DKA (0.15 U/kg q2h).
Which one of the following methods techniques will the nurse use when giving insulin to a thin person?Thin individuals or children can use short needles or may need to pinch the skin and inject at a 45° angle to avoid an intramuscular injection, especially in the thigh area. Routine aspiration (i.e., drawing back on the injected syringe to check for blood) is not necessary (13).
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