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Diabetes Mellitus (DM)

What you always wanted to know about DM
by

Joan Walker

on 6 February 2013

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Transcript of Diabetes Mellitus (DM)

Types of Diabetes Type 1
Type 2
Gestational Unit 1 - Promoting Wellness in Adults with Altered Endocrine Function Nervous System

How might DM affect neuro?

How might thyroid disease affect
the neuro status? Immune System Humoral innate immunity in DM:

Autoimmune thyroiditis: HOW DOES ENDOCRINE AFFECT NEURO & IMMUNE SYSTEMS? Type 1 Diabetes Type 1 DM are usually children, but can occur at ANY age, including adults in 60s and 70s PANCREATIC HORMONES IN THE ILSETS OF LANGERHANS TYPE 2 DM GESTATIONAL DIABETES Which is worse for
the patient:

TOO LOW blood glucose
or
TOO HIGH? How do we diagnose diabetes?

Daniels & Nicoll Box 57-1 How do we know if it's Type 1 or Type 2?


People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
People over age 45
People with a family history of diabetes
People who are overweight
People who do not exercise regularly
People with low HDL cholesterol or high triglycerides, high blood pressure
Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)
Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth Who is at Greater Risk for Type 2 Diabetes? Unit 1 - Promoting Wellness in Adults with Altered Endocrine Function UNIT 1 - PROMOTING WELLNESS IN ADULTS WITH ALTERED ENDOCRINE FUNCTION HOW DOES ENDOCRINE AFFECT
IMMUNE AND NERVOUS SYSTEMS Unit 1 - Promoting Wellness in Adults
with Altered Endocrine Function How Endocrine Affects
Immune and Nervous Systems NUTRITION

MNT

ADA DIET

CONSISTENT CARBOHYDRATES


DUDEK: CHAPTER ON DM
DANIELS & NICOLL Does exercise increase or decrease
the blood glucose?



Contraindications:
GLUCOSE >250 MG/DL &
HAVE KETONES IN URINE Exercise MARKERS OF IMMUNE DESTRUCTION: ANTIBODIES:
Islet cell (ICA), Insulin (IAA), Glutamic acid decarboylase (GAD65), and tyrosine phosphates (IA-2 and IA2-Beta) How do we recognize hypoglycemia: Hypoglycemia causes?
Too much?
Too little?
Excess? Hypoglycemia treatment: How do we manage
hyperglycemia?
For Type 1?
For Type 2? Double check dose with?
ID S/S of hypo-hyper- glycemia
Know onset, peak, duration
Provide food at proper times When giving insulin, what are some important parameters to go by? Control blood glucose in what type DM?
ALL USED IN CONJUNCTION WITH? Oral Hypoglycemics/Oral Antidiabetics

Action: PROMOTE INSULIN RELEASE FROM PANCREAS
Med/Food interactions? ALCOHOL? DISULFIRAM-LIKE REACTION: INTENSE N/V, FLUSHING, PALPATIONS, CRAMPS, HA, HYPOGLYCEMIA
Lopid? Sulfonylureas

Action: SAME AS SULFONYLUREAS—PROMOTES INSULIN RELEASE FROM PANCREAS

Med/Food interactions? gemfibrozil=LOPID INHIBITION OF METABOLSIM OF THE MEGLITINIDE Meglitinides Prototype? ONLY 1: METFORMIN (GLUCOPHAGE)
Action: REDUCE PROD OF GLUCSE BY LIVER
INCREASES MUSCLES’ GLUCOSE UPTAKE &USE
Side effects MOST IMPORTANT: LACTIC ACIDOSIS (HYPERVENTILATION, MYALGIA, SLUGGISH) –CAN BE FATAL—CAN BE TREATED WITH HD

Interactions: ETOH – INCREASE RISK OF LACTIC ACIDOSIS Biguanides
Action: Slows carb absorption & digestion Alpha Glucosidase Inhibitors



THIAZOLIDINEDIONES (glitzones) Prototype (AVANDIA)
Others ( ACTOS)
Action:IMPROVES SENSATIVITY TO INSULIN BY ACTING AS AN AGONIST AT RECEPTOR SITES
Assess for fluid retention, CHF, hepatic function, LDL elevations
Interactions: Lopid
=inhibition of Avandia Thiazolidinediones (glitazones)
Action: Slows carb absorption & digestion Alpha Glucosidase Inhibitors Amylin Analog (may be used w/Type 1)
Incretin Mimetic
Dipiptidyl peptidase-4 Inhibitor (Januvia) OTHERS INEFFECTIVE WITH TYPE 1

USE CAUTIOUSLY W/ HEPATIC AND/OR RENAL DYSFUNCTION

USED IN CONJUCTION WITH DIET/EXERCISE

MAY BE USED IN COMBINATION W/OTHERS ALL ORAL
ANTIDIABETICS HOW DO WE MANAGE DKA? What are
the worst case
scenarios for
hyperglycemia? WHAT ARE THE S/S OF DKA? S/S OF DKA: Management of HHNS Macrovascular &
Microvascular
Complications
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