1. Mosby items and derived items © 2006 by Mosby, Inc. Slide 1 Chapter 20 Diabetes Mellitus

2. Mosby items and derived items © 2006 by Mosby, Inc. Slide 2 Chapter 20 Lesson 20.1

3. Mosby items and derived items © 2006 by Mosby, Inc. Slide 3 Key Concept Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.

4. Mosby items and derived items © 2006 by Mosby, Inc. Slide 4 About Diabetes Seventeen million Americans have diabetes (6.2% of the population). Diabetes is the sixth leading cause of death from disease in the U.S. People with diabetes either do not produce insulin or cannot effectively use it. Diabetes is characterized by hyperglycemia.

5. Mosby items and derived items © 2006 by Mosby, Inc. Slide 5 Word Origins Diabetes from Greek “to pass through” Mellitus from Latin for “honey” Insulin from Latin for “island” Islets of Langerhans—clusters of pancreatic cells named for discoverer

6. Mosby items and derived items © 2006 by Mosby, Inc. Slide 6 Type 1 Diabetes Mellitus Accounts for 5% to 10% of cases Previously called insulin-dependent or juvenile-onset diabetes Severe, unstable form Caused by autoimmune destruction of pancreatic cells Can occur at any age Requires exogenous insulin

7. Mosby items and derived items © 2006 by Mosby, Inc. Slide 7 Type 2 Diabetes Mellitus Accounts for 90% to 95% of cases Previously called adult-onset or non-insulin-dependent diabetes Initial onset usually after age 40 Now being diagnosed in children Strong genetic link Prevalent in older, obese people Caused by insulin resistance or defect Usually treated with diet, exercise

8. Mosby items and derived items © 2006 by Mosby, Inc. Slide 8 Risk Factors for Type 2 Diabetes Mellitus Family history of diabetes Age 45 years or older Overweight Not physically active Race/ethnicity (African American, Hispanic American, Native American, Asian American, Pacific Islander) History of gestational diabetes Woman who has delivered infant weighing more than 9 pounds Identified impaired glucose tolerance

9. Mosby items and derived items © 2006 by Mosby, Inc. Slide 9 Gestational Diabetes Temporary form of disease occurring in pregnancy Presents complications for mother and fetus/infant Must be carefully monitored and controlled

10. Mosby items and derived items © 2006 by Mosby, Inc. Slide 10 Other Types of Diabetes (Secondary) Causes  Genetic defect  Pancreatic conditions or disease  Endocrinopathies—imbalance with other hormones in the body  Drug/toxin- or chemical-induced

11. Mosby items and derived items © 2006 by Mosby, Inc. Slide 11 Impaired Glucose Tolerance (IGT) Above normal fasting blood glucose but not high enough to be diabetes A risk factor for type 2 diabetes Underlying conditions often present

12. Mosby items and derived items © 2006 by Mosby, Inc. Slide 12 Symptoms of Diabetes Initial signs  Increased thirst  Increased urination  Increased hunger  Unusual weight loss (type 1)  Unusual weight gain (type 2) (Cont'd…)

13. Mosby items and derived items © 2006 by Mosby, Inc. Slide 13 Symptoms of Diabetes (…Cont’d) Laboratory Test Results  Glycosuria (sugar in urine)  Hyperglycemia (elevated blood sugar)  Abnormal glucose tolerance tests Progressive Results  Water, electrolyte imbalance  Ketoacidosis  Coma

14. Mosby items and derived items © 2006 by Mosby, Inc. Slide 14 Chapter 20 Lesson 20.2

15. Mosby items and derived items © 2006 by Mosby, Inc. Slide 15 Key Concept Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.

16. Mosby items and derived items © 2006 by Mosby, Inc. Slide 16 Metabolic Patterns Diabetes is especially related to metabolism of carbohydrate and fat. It is important to control blood glucose within normal levels of 70 to 110 mg/dl. If diabetes is uncontrolled and insulin is lacking:  Glucose cannot enter the cells and builds up in the blood.  Fat tissue breaks down.  Protein breaks down, causing weight loss and nitrogen loss.

17. Mosby items and derived items © 2006 by Mosby, Inc. Slide 17 Three Key Hormones Islets of Langerhans produce:  Insulin  Glucagon  Somatostatin

18. Mosby items and derived items © 2006 by Mosby, Inc. Slide 18 Insulin Controls blood sugar  Helps transport glucose into cells  Helps change glucose to glycogen and store it in liver, muscles  Stimulates changes of glucose to fat for storage as body fat  Inhibits breakdown of tissue fat and protein  Promotes uptake of amino acids  Influences burning of glucose for energy

19. Mosby items and derived items © 2006 by Mosby, Inc. Slide 19 Glucagon Acts in a manner opposite of insulin Breaks down stored glycogen and fat Raises blood glucose as needed to protect brain during sleep or fasting

20. Mosby items and derived items © 2006 by Mosby, Inc. Slide 20 Somatostatin A “referee” for several other hormones Inhibits secretion of insulin, glucagon, and other hormones Also produced in other parts of the body (e.g., hypothalamus)

21. Mosby items and derived items © 2006 by Mosby, Inc. Slide 21 Long-Term Complications of Diabetes Retinopathy Nephropathy Neuropathy Heart disease  Dyslipidemia—elevated triglyceride, decreased HDL cholesterol  Hypertension—a major comorbid condition

22. Mosby items and derived items © 2006 by Mosby, Inc. Slide 22 Chapter 20 Lesson 20.3

23. Mosby items and derived items © 2006 by Mosby, Inc. Slide 23 Key Concepts A consistent, sound diet is the keystone of diabetes care and control. Good self-care skills practiced daily enable a person with diabetes to remain healthy and reduce risks for complications. A personalized care plan, balancing food intake, exercise, and insulin regulation, is essential to successful diabetes management.

24. Mosby items and derived items © 2006 by Mosby, Inc. Slide 24 Criteria for Diagnosis of Diabetes Mellitus Symptoms of diabetes plus casual (any time) plasma glucose concentration greater than or equal to 200 mg/dl Fasting plasma glucose greater than or equal to 126 mg/dl Two-hour plasma glucose greater than or equal to 200 mg/dl during an oral glucose tolerance test

25. Mosby items and derived items © 2006 by Mosby, Inc. Slide 25 Management of Diabetes Early detection Glycemic control Prevention of complications Glucose tolerance test Goals of Care  Maintaining optimal nutrition  Avoiding symptoms  Preventing complications (Cont'd…)

26. Mosby items and derived items © 2006 by Mosby, Inc. Slide 26 Management of Diabetes (…Cont’d) Elements of therapy plan  Diet  Exercise  Ensuring adequate insulin activity  Controlling stress

27. Mosby items and derived items © 2006 by Mosby, Inc. Slide 27 Diet Therapy Weight reduction (type 2) Sufficient energy intake Balance of energy intake and output Balance of carbohydrate, fat, protein

28. Mosby items and derived items © 2006 by Mosby, Inc. Slide 28 Core Focus: Glycemic Control Nutrition therapy  Total energy balance  Nutrient balance  Food distribution balance Personal diet  Total kcalories of energy balance  Ratio of carbohydrate, fat, protein  Daily food distribution pattern

29. Mosby items and derived items © 2006 by Mosby, Inc. Slide 29 Energy Balance Carbohydrate  Should provide 60% of energy intake  Starch and sugar—complex and simple carbohydrates  Fiber  Sugar substitutes—nutritive and nonnutritive Protein  About 15% to 20% of total energy Fat  No more than 25% to 30% of kcalories

30. Mosby items and derived items © 2006 by Mosby, Inc. Slide 30 Food Distribution Balance Eat even amounts of food at regular intervals. Maintain even blood glucose supply. Snacks may be needed. Adjust eating according to activity level and stress. Regulate glycemic response according to physical activity/exercise.

31. Mosby items and derived items © 2006 by Mosby, Inc. Slide 31 Diet Management Develop plan to meet individual needs. Consult clinical dietician. Use the food exchange system.  Foods grouped into “exchange lists”  Foods selected to meet energy needs, balance ratio of nutrients Limit processed foods. Limit alcohol; plan carefully. Avoid hypoglycemia.

32. Mosby items and derived items © 2006 by Mosby, Inc. Slide 32 Symptoms of Hyperglycemia Extreme thirst (polydipsia) Frequent urination (polyuria) Excessive hunger (polyphagia) Dry skin Blurred vision Drowsiness Nausea

33. Mosby items and derived items © 2006 by Mosby, Inc. Slide 33 Person-Centered Self-Care Persons with diabetes need essential skills/knowledge.  Understand nature of diabetes  Nutrition—develop sound food plan  Insulin—know type, duration of action, combinations  Monitor glucose levels  Control emergencies, illness  Identification bracelet

34. Mosby items and derived items © 2006 by Mosby, Inc. Slide 34 Resources American Diabetes Association American Heart Association “Light” cookbooks