1. Endocrine System
KNH 411

2. Diabetes Mellitus 7% of population; 1/3 undiagnosed
$132 billion in health care
Sixth leading cause of death
Complications of diabetes (DM)
Majority type 2

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

4. Type 1 DM Pathophys/clinical manifestations Lipolysis
Fatty acids transformed to ketones -
pH falls
Ketosuria
Metabolic acidosis/ ketoacidosis
High level of ketones is usually reason why person goes to hospital
Extreme illness,

5. 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

7. © 2007 Thomson - Wadsworth

8. Type 1 DM Measures of Glycemic Control Glycated Hemoglobin** (A1C)**
Higher glucose- education and discussion
Avg. concentration previous 2-4 mo. Regular basis
Not recommended for dg of DM (A1C)
Measured at least 2X per year
Inappropriate for pt. with anemias/blood disorders

9. 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

10. 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

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

12. 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

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

14. 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

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

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

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

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

20. 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

21. 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

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

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

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

25. Type 2 DM Metabolic syndrome Central obesity Insulin resistance
Dyslipidemia
Hypertension

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

27. 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

28. 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