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Diabetes Mellitus: Risks Factors
Diabetes Mellitus: Risks Factors
Risks factors
Family history of diabetes (ie, parents or siblings with diabetes)
Obesity (ie, ≥20% over desired body weight or BMI ≥27 kg/m2)
Race/ethnicity (eg, African Americans, Hispanic Americans,
Native Americans, Asian Americans, Pacific Islanders)
Age ≥45 years
Previously identified impaired fasting glucose or impaired glucose
tolerance
Hypertension (≥140/90 mm Hg)
HDL cholesterol level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride
level ≥250 mg/dL (2.8 mmol/L)
.History of gestational diabetes or delivery of babies over 9 lbs
Classification of Diabetes
1
■ 90% of DM; ↓sensitivity to insulin (insulin resistance) and ↓secretion
of
insulin; may be controlled by diet, exercise, and hypoglycemics; may
need
insulin when stressed; Type 2 DM is associated with obesity, genetics,
inactivity, gestational diabetes. Usually presents at _45yr old
NURSING ALERT Ketone bodies are acids that disturb the
acid–base balance of the body when they accumulate in excessive
amounts. The resulting DKA may cause signs and symptoms such
as abdominal pain, nausea, vomiting, hyperventilation, a fruity
breath odor, and, if left untreated, altered level of consciousness,
coma, and death. Initiation of insulin treatment, along with fluid
and electrolytes as needed, is essential to treat hyperglycemia
Type 1
2
Alterations in Blood Glucose Associated with DM
1- Hyperglycemia Hypoglycemia
Occurs secondary to stress, omission of medication, excess food
intake;develops over days S&S: Polyuria; thirst; dry, hot, red
skin; blurred vision; confusion;↑P; ↓BP; S&S of dehydration
2- Hyperglycemic Hyperosmolar
■ Long-term complications:
3
■ Regular exercise to control weight and ↓insulin resistance
■ ↓Calorie diet (50-60% carbohydrates, 20% protein, 20-30% fat) based
on
glycemic food index; ↑soluble fiber →slow glucose absorption
■ Insulin and/or oral hypoglycemics
■ Pancreatic or Islets of Langerhans transplants
■ Treatment of DKA and HHNS: IVF, rapid acting insulin, eventual Na
and K†replacement
■ Treatment of hypoglycemia: 10-15g of simple sugar followed by
complex carbohydrate and protein if conscious; glucagon injection or
50% dextrose IV if unconscious.
INSULIN LIPODYSTROPHY
Lip dystrophy refers to a localized reaction, in the form of either
Nursing Measures
■ Monitor S&S
■ Provide foot care:
4
■ Inspect daily for lesions
■ Wash/dry between toes daily, wear socks and well-fitting shoes, avoid
heat/cold
■ Encourage weight control efforts and need for continued medical
supervision (certified diabetic educator, dietician
■ Provide emotional support
■ Teach self-monitoring of blood glucose (SMBG) and urine testing for
ketones if hyperglycemic
■ Teach S&S and management of hyperglycemia, hypoglycemia, and
med administration
Explain need for medical alert ID ■