Beruflich Dokumente
Kultur Dokumente
I. Diabetes Mellitus: Overview of the Disease and Its Treatment—Production of large volumes
of glucose-rich urine; a disorder of carbohydrate metabolism; symptoms from deficiency of
insulin or from resistance to insulin’s actions; symptom of sustained hyperglycemia
polyuria, polydipsia, ketonuria, and weight loss; over time leads to hypertension, heart
disease, blindness, renal failure, neuropathy, amputations, impotence, and stroke
A. Types of Diabetes Mellitus—Two major types (type 1 and type 2) plus gestational
diabetes
1. Type 1 (previously known as insulin-dependent diabetes mellitus)—Usually
begins in childhood with abrupt symptoms; pancreatic beta cells are destroyed
2. Type 2 (previously known as non-insulin–dependent diabetes mellitus)—Most
prevalent form of DM; obesity present; little risk of ketoacidosis; symptoms
result from insulin resistance and altered secretion
B. Short-Term Complications of Diabetes—Usually with type 1, see hyperglycemia or
hypoglycemia; ketoacidosis is potentially fatal for untreated hyperglycemia
C. Long-Term Complications of Diabetes—Most problems due to disruption of blood
flow from macro- or microvascular damage; rigorous control decrease in long-term
complications
1. Macrovascular disease—Cardiovascular complications leading cause of death;
atherosclerosis develops early in DM
2. Microvascular disease—Microangiopathy common kidney damage and
blindness
3. Retinopathy—DM major cause of blindness
4. Nephropathy—Proteinuria, reduced GFR, HTN
5. Neuropathy—Nerve degeneration begins early in DM but symptoms absent
for years
6. Amputations—DM responsible for more than 50% of lower limb amputations
7. Impotence—13% males and 8% in females
8. Gastroparesis—Affects 20%–30% of DM patients
D. Diabetes and Pregnancy—Difficult to control DM during pregnancy because of
placenta-producing hormones that antagonize insulin’s actions; production of cortisol
increases threefold; hyperglycemia in mother stimulates secretion of fetal insulin;
gestational diabetes is diabetes that appears during pregnancy and then subsides
rapidly after delivery
E. Diagnosis of Diabetes
1. Fasting plasma glucose (FPG) test—Administer 8–10 hours after last meal;
normal levels are less than 110 mg/dL; if greater than 126 mg/dL, DM
indicated
2. Casual plasma glucose test—Should be less than 200 mg/dL; if patient has
symptoms, DM is diagnosed