Endocrine System KNH 411

Diabetes Mellitus 7% of population; 1/3 undiagnosed $132 billion in health care Sixth leading cause of death Complications of diabetes (DM) Will start showing signs of diabetes

Type 1 DM Pathophys/clinical manifestations Inability of cells to use glucose for energy Hyperglycemia and cells starve Polyuria Polydipsia Polyphagia

Type 1 DM Pathophys/clinical manifestations Lipolysis Fatty acids transformed to ketones pH falls Ketosuria Metabolic acidosis/ ketoacidosis High ketones

Type 1 DM Pathophys/clinical manifestations Hypovolemia Potassium, sodium, magnesium, phosphorus lost Decreased Hg, Hct, protein, WBC, creatinine, serum osmolality Weight loss Hypovolemic shock Deep, labored breathing

© 2007 Thomson - Wadsworth

Type 1 DM Measures of Glycemic Control Glycated Hemoglobin (A1C) Higher glucose Avg. concentration previous 2-4 mo. Not recommended for dg of DM Measured at least 2X per year Inappropriate for pt. with anemias

Type 1 DM Measures of Glycemic Control SMBG Drop of blood via finger prick 3 or more times daily Assists in adjustment for eating and medication patterns Identifies food, exercise, other patterns that affect glycemic control

Type 1 DM Measures of Glycemic Control Fructosoamine Glycemic control over 1-3 wk. period Not reliable with renal or liver disease Urine testing for glucose Renal threshold - glucose > 250 Urine testing for ketones Should be tested when glucose > 300

Type 1 DM Treatment risk factors Daily exogenous insulin Nutrition therapy Exercise

Type 1 DM Treatment - Types of Insulin Meant to mimic normal physiological action of insulin Classified based on onset of action, peak time, duration of action Dosage typically based on body weight, adjusted based on blood glucose levels

Type 1 DM Treatment - Insulin Regimens Fixed/conventional/standard Flexible/intensive Continuous infusion (CSII)

Type 1 DM Treatment - Insulin Regimens Fixed/conventional/standard Constant dose of basal insulin With short or rapid (bolus) insulin “Mixed dose” or split mixed dose Must synchronize insulin with food intake

Type 1 DM Treatment - Insulin Regimens Flexible Multiple daily injections Bolus insulin before meals Basal insulin once or twice daily More flexibility

Type 1 DM Treatment - Insulin Regimens Continuous infusion Basal rapid or short Boluses are given before meals

Type 1 DM Nutrition Therapy Should be individualized! Based on: Self care treatment plan Learning ability Current lifestyle

Type 1 DM Nutrition Therapy CHO Alcohol kcal considered additional Meal planning Individualized

Type 1 DM Nutrition therapy Carbohydrate counting Consistent amount of CHO at meals and snacks Count starches, fruits, milk/yogurt, sweets Count amount of food containing 15 g CHO or Total grams of CHO 3 skill levels

Type 1 DM Nutrition therapy Exchange System Exchange Lists for Meal Planning Substitution of different foods with each of 3 groups Each food on particular list can be substituted with food on same list

Type 1 DM Short-term illness Supplemental insulin Replacement fluids Electrolytes Glucose SMBG Urine testing Prevent progression Less than 24 hrs.

Type 2 DM 90-95% of diagnosed cases Adults, elderly, persons of color Increased risk traits

Type 2 DM Pathophysiology Insulin resistance Pancreas increases production Pancreas stops producing insulin Insulin deficiency Glucose intolerance DM develops in obese Hyperglycemia develops

Type 2 DM Metabolic syndrome Central obesity Insulin resistance Dyslipidemia Hypertension

Type 2 DM Clinical Manifestations Insidious Criteria for testing based on risk factors including PCOS Disease may progress

Type 2 DM Treatment Glycemic control depends on: Nutrition therapy Hepatic glucose production Glucose uptake by periphery Absorption of glucose from food Nutrition therapy Physical activity Medications

Type 2 DM Nutrition Therapy Plan based on metabolic priorities Lifestyle and behavior modification Weight management Monitor total CHO < 20% pro. Dietary fat goals for CVD 14 grams fiber/1000 kcal