13472616
Description
Mind Map by Marizzy Aliabilon, updated more than 1 year ago
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Created by Marizzy Aliabilon
over 6 years ago
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|
Type 2 Diabetes Mellitus
- PATHOGENESIS
- Type 2 diabetes is a consequence
of pathophysiologic changes that
make diabetics vulnerable to
subsequent disruption of normal
glucose homeostasis.
- Insulin resistance is
often the primary
metabolic
abnormality in Type
II Diabetes
- Etiological
Factors
- Increased Food
Consumption
- Sedentary
Lifestyle
- Genetics
- OBESITY
- Less glucose
utilization in liver
- Fat and muscles
do not utilize
glucose as well
- Decreased
sensitivity to
insulin
- INSULIN
RESISTANCE
- Increased insulin
demand and
release
- HYPERGLYCEMIA
- Due to the lack of
glucose absorption by
cells, the liver releases
glucose into the
bloodstream in attempt
to supply organs that
need glucose (cell
starvation).
- Due to the lack of
glucose absorption by
cells, the liver releases
glucose into the
bloodstream in attempt
to supply organs that
need glucose (cell
starvation).
- HYPERGLYCEMIA
- Excess glucose is not
absorbed by cells of organs
even when there is
resistance; receptors do
not work properly. Thus,
increasing blood sugar in
the blood stream
- ABNORMAL
- <-- Glucose is unable to enter cells despite the
presence of insulin
- ABNORMAL
- Increased insulin
demand and
release
- INSULIN
RESISTANCE
- CELL
STARVATION
- Increased
Gluconeogenesis
- Increased
Glycogenolysis
- Increased
Glycogenolysis
- a or death if
left untreated.
- Increased
Gluconeogenesis
- Decreased
sensitivity to
insulin
- KIDNEYS
- HEART
- EYES
- BRAIN
- Increased build-up of plaque in
arteries keep blood from flowing to
the brain
- STROKE
- High blood
pressure is a
leading risk
factor for stroke
- Brief loss of
consciousness
- Dizziness
- Sudden, inability to
move part of the body
- HEADACHE
- High blood
pressure is a
leading risk
factor for stroke
- HEADACHES
- STROKE
- COMA
- If cells are unable to get
energy from glucose, the
body will try to convert fats
and proteins into sugar. The
liver forms ketone bodies
for energy, but in high
enough levels, ketoacidosis
will occur. This can lead to
coma or death if left
untreated.
- If cells are unable to get
energy from glucose, the
body will try to convert fats
and proteins into sugar. The
liver forms ketone bodies
for energy, but in high
enough levels, ketoacidosis
will occur. This can lead to
coma or death if left
untreated.
- Increased build-up of plaque in
arteries keep blood from flowing to
the brain
- High blood glucose and high blood
pressure damages blood vessels in
eyes
- RETINOPATHY
- Blurred Vision
- Blurred Vision
- RETINOPATHY
- BRAIN
- Studies report a positive correlation
between hypertension and insulin
resistance
- HYPERTENSION
- Chest Pain
- Myocardial infarction
- Myocardial infarction
- Chest Pain
- HYPERTENSION
- PANCREAS
- Abnormalities in
insulin secretion
- Abnormalities in
insulin secretion
- EYES
- Increased
Urination
- Loss of
Electrolytes
- Frequent Urination
- Hyponatremia
(Low Na+)
- Hypokalemia
(Low K+)
- Hypochloremia
(Low Cl-)
- KIDNEYS
- KIDNEYS
- Hypochloremia
(Low Cl-)
- Hypokalemia
(Low K+)
- Hyponatremia
(Low Na+)
- DEHYDRATION
- Hyperosmolarity
- Cell Shrinkage
- Slow Blood Flow
- Slow Blood Flow
- Cell Shrinkage
- Brittle Nails
- BRAIN
- EYES
- HEART
- ANGINA
- KIDNEYS
- BLOOD VESSELS
- FEET
- Blue-tinged skin
- EXTREMITIES
- Burn
- EXTREMITIES
- EXTREMITIES
- Stabbing pain
- Burning pain
- NERVE
DAMAGE
- Problems with positional awareness
- Fainting
- Weakness
- Fainting
- Excessive sweating
- Trouble digesting food
- Stomach spasm
- Constipation
- Stomach spasm
- Problems with positional awareness
- Burn
- EXTREMITIES
- Blue-tinged skin
- FEET
- BLOOD VESSELS
- Pain on arms,
shoulder, back
and chest
- Excessive Sweating
- Shortness of breath
- KIDNEYS
- Myocardial Infarction
- STOMACH
- Polyphagia
- Always hungry
- Increased
food-intake (if
uncontrolled)
- PARADOX: Increased
food-intake does not
equate to weight
gain. In fact, diabetics
will experience
weight-loss due to
the decreased usage
of glucose.
- PARADOX: Increased
food-intake does not
equate to weight
gain. In fact, diabetics
will experience
weight-loss due to
the decreased usage
of glucose.
- Increased
food-intake (if
uncontrolled)
- Always hungry
- Nausea
- Vomitting
- SMOOTH MUSCLE
DISORDERS
- SMOOTH MUSCLE
DISORDERS
- Vomitting
- Heartburn
- Acid reflux
- Acid reflux
- Stomach spasm
- Polyphagia
- STOMACH
- ANGINA
- Blurred Vision
- Blurred Vision
- HEART
- Exhaustion
- Headaches
- Muscle weakness
- INSOMNIA
- Difficulty
staying asleep
- Waking up
too early
- Daytime
tiredness
- Ongoing worries
about sleep
- Stress
- Anxiety
- Anxiety
- Stress
- Ongoing worries
about sleep
- Difficulty
staying asleep
- Headaches
- MENTAL
- Irritability
- Anger
- Easily upset
- One of the
things the
thalamus is
responsible for
is emotional
self-control. .
- The thalamus'
emotional
control will not
be regulated
with insufficient
insulin.
- The thalamus'
emotional
control will not
be regulated
with insufficient
insulin.
- One of the
things the
thalamus is
responsible for
is emotional
self-control. .
- Easily upset
- Anger
- Anxiety
- Lack of
concentration
- Mood Swings
- Memory loss
- High glucose levels,
over many years,
can damage nerves,
including those of
the brain, which can
increase the risk of
memory loss.
- DEMENTIA
- DEMENTIA
- High glucose levels,
over many years,
can damage nerves,
including those of
the brain, which can
increase the risk of
memory loss.
- Mood Swings
- Depression
- Lack of
concentration
- Irritability
- EYES
- BRAIN
- Dry Skin
- Thin Hair
- Poor skin turgour
- Hypovolemia (decreased
blood volume)
- Ischemia (inadequate
blood supply)
- Hypoxia (decreased
Oxygen content)
- Anaerobic Metabolism
- Lactic Acid Build-Up
- MUSCLE
SPASM
- Pain
- Pain
- MUSCLE
SPASM
- Lactic Acid Build-Up
- CELL NECROSIS
- Gangrene
- Impaired Tissue
Integrity
- Impaired Tissue
Integrity
- Gangrene
- CYANOSIS
- Cold feet
- Numbness
- Deformed
feet
- Blisters our wounds
without pain
- FOOT
ULCERS
- Swelling
- Discolouration
- Callused skin
surrounding
ulcer
- Swelling
- iNFECTIONS
- Fever
- Chills
- Shaking
- Shock
- Fever
- FOOT
ULCERS
- Deformed
feet
- Numbness
- Cold feet
- Anaerobic Metabolism
- Hypoxia (decreased
Oxygen content)
- Ischemia (inadequate
blood supply)
- Hyperosmolarity
- Frequent Urination
- Loss of
Electrolytes
- HEART
- LIVER
- BLOOD VESSELS
- FEET
- Nerve damage
- High blood glucose can
damage nerves to
pain, weakness and
numbness in hands
and feet
- High blood glucose can
damage nerves to
pain, weakness and
numbness in hands
and feet
- Nerve damage
- Plaque build-up
damages blood
vessels
- Insulin resistance
weakens blood
vessels as well.
- Together, these can
raise blood pressure
to dangerous levels
- VS,
- NORMAL
- NORMAL
- Insulin escorts and
allows glucose into your
cells, where it is needed
for energy. Without
insulin, glucose will
remain floating in your
bloodstream.
- HEART DISEASE
- VS,
- Together, these can
raise blood pressure
to dangerous levels
- Insulin resistance
weakens blood
vessels as well.
- FEET
- Fat and muscles
do not utilize
glucose as well
- Less glucose
utilization in liver
- OBESITY
- Increased Food
Consumption
- Due to an increase in
blood sugar, beta cells
release insulin. But with
prolonged release, beta
cells become exhausted
and eventually atrophy,
which later decreases
insulin production
- Etiological
Factors
- Insulin resistance is
often the primary
metabolic
abnormality in Type
II Diabetes
- Type 2 diabetes is a consequence
of pathophysiologic changes that
make diabetics vulnerable to
subsequent disruption of normal
glucose homeostasis.
- SIGNS AND
SYMPTOMS
- There are many signs and symptoms
that indicate diabetes. However,
symptoms for Type 2 Diabetes are
mild and unnoticeable until it's too late.
- There are many signs and symptoms
that indicate diabetes. However,
symptoms for Type 2 Diabetes are
mild and unnoticeable until it's too late.
- NURSING INTERVENTION
- Nurses, along with the health care team, ensure
that patients are educated about type 2 diabetes
and all about anti-diabetic medication. Diabetics
need to know how to have proper nutrition and
have a physically active lifestyle. Additionally,
monitoring blood glucose level is vital for each
diabetic individual.
- NUTRITION
- REDUCTION IN CALORIES
- It is important to reduce
foods that are high in fat and
sugar. The following are examples...
- Carbonated drinks
and sugary juices
- Highly processed
carbohydrates and foods
- Foods with trans
fat and high-fat
animal
- Artificial sweeteners and
high fructose corn syrup
- Carbonated drinks
and sugary juices
- It is important to reduce
foods that are high in fat and
sugar. The following are examples...
- BALANCE OF NUTRITION
- Energy input should not be
more than energy output
- Try to make.... Energy Input = Energy Output
- Try to make.... Energy Input = Energy Output
- Carbohydrates
- Fats
- Proteins
- Protein helps keep blood glucose levels stable,
promotes satiety, and beats cravings
- Eggs and Soy foods
- Lean meats (ex. chicken, or turkey breast)
- Legumes and beans
- Fish (ex. salmon, cod)
- Plant based protein (ex.
chia seeds, lentils)
- Eggs and Soy foods
- Protein helps keep blood glucose levels stable,
promotes satiety, and beats cravings
- Try to incorporate
plant-based fats in your
diet as it helps lowers risk
for heart disease
- Avocado
- Nuts and Seeds (ex.
almonds, walnuts,
sunflower seeds)
- Healthy oils (ex. olive oil,
flaxseed oil, sesame oil)
- Reduce the amount of fats
from animal meat
- Avocado
- Proteins
- Have foods that have a low glycemic
load and high fibre content, such as
complex carbohydrates.
- Whole
wheat
- Vegetables
- Fruits
- Quinoa
- Whole
wheat
- Avoid simple carbohydrates
because they raise blood
glucose levels
- White bread, potatoes, & pasta
- Sweets: cookies, pastries, cake
- White bread, potatoes, & pasta
- Fats
- Energy input should not be
more than energy output
- REDUCTION IN CALORIES
- BLOOD GLUCOSE MONITORING
- Check blood glucose levels before
and after meals and when you
are doing physical activity
- Self-Monitoring of Blood Glucose (SMBG)
- Self-monitoring can give patients
the confidence and freedom to live
their life without being too worried
about their diagnosis
- Diabetics can make their own
decisions about what to eat and
how to maintain a healthy active
lifestyle
- Requires training from a health care professional
- Self-monitoring can give patients
the confidence and freedom to live
their life without being too worried
about their diagnosis
- Glucometer to Check Blood Glucose Levels
- Use a lancet to obtain blood sample from the side of a
fingertip and add it on channel of the glucose meter strip
- Make sure enough blood is inputted and wait for results
- Target level of blood glucose BEFORE meals
= 4 -7 mmol/L
- Target level of blood glucose AFTER meals
= under 8.5 mmol/L
- Target level of blood glucose AFTER meals
= under 8.5 mmol/L
- Target level of blood glucose BEFORE meals
= 4 -7 mmol/L
- Make sure enough blood is inputted and wait for results
- Use a lancet to obtain blood sample from the side of a
fingertip and add it on channel of the glucose meter strip
- Check blood glucose levels before
and after meals and when you
are doing physical activity
- PHYSICAL ACTIVITY
- Exercise has numerous benefits for diabetic patients
- Physical activity decreases
blood glucose levels thus
reducing hyperglycemia
- It can increase insulin
receptor sites so that cells
can store more glucose
- Weight loss
- Physical activity decreases
blood glucose levels thus
reducing hyperglycemia
- Aim to have at last 150 minutes
of moderate to vigorous physical
activity a week
- Moderate to vigorous activity includes an
increase in heart rate and respiratory
rate, and involves perspiration
- Brisk walking
- Biking
- Dancing
- Sports: Badminton, tennis
- Swimming
- Brisk walking
- Moderate to vigorous activity includes an
increase in heart rate and respiratory
rate, and involves perspiration
- To prevent hypoglycemia from occurring during
exercise, have a snack every 20-30 minutes.
Examples of snacks: fruit, granola bars, yogurt.
- Monitor blood glucose levels
before, during, and after
physical activity
- Exercise has numerous benefits for diabetic patients
- ANTI-DIABETIC MEDICATION
- INSULIN
- Administration Sites
- Abdomen
(most
preferable site)
- Arm
- Thigh
- Buttocks
- It is important to rotate
injection sites for a
particular area
- Insulin should not
be given orally
- Injections are to
be given
subcutaneously
- Pinch 2 inches of skin and
inject straight at 90 degrees
OR grasp 1 inch of skin and
inject at a 45 degree angle
- Contact a health care
provider if you have any
questions about
administering injections
- Pinch 2 inches of skin and
inject straight at 90 degrees
OR grasp 1 inch of skin and
inject at a 45 degree angle
- Injections are to
be given
subcutaneously
- Insulin should not
be given orally
- Abdomen
(most
preferable site)
- Types of Insulin
- Rapid Acting
- Onset: 15 minutes
- Peak: 30 - 60 minutes
- Duration: < 5 hours
- Duration: < 5 hours
- Peak: 30 - 60 minutes
- Administer:
0 - 15
minutes
before meal
- Example: lispro
- Onset: 15 minutes
- Short Acting
- Onset: 60 minutes
- Peak: 2 - 3 hours
- Duration: 5 - 7 hours
- Duration: 5 - 7 hours
- Peak: 2 - 3 hours
- Administer:
30 - 45
minutes
before meal
- Example: regular insulin
- Onset: 60 minutes
- Intermediate Acting
- Onset: 1 - 4 hours
- Peak: 8 - 12 hours
- Duration: 18 - 24 hours
- Duration: 18 - 24 hours
- Peak: 8 - 12 hours
- Administer:
30 - 60
minutes
before meal
- Example: Isophane
insulin suspension (NPH)
- Onset: 1 - 4 hours
- Long Acting
- Onset: 4 - 8 hours
- Peak: 12 - 24 hours
- Duration: 36 hours
- Duration: 36 hours
- Peak: 12 - 24 hours
- Administer: once a day;
morning or before
bedtime
- Example: Extended
insulin zinc suspension
- Onset: 4 - 8 hours
- Rapid Acting
- Side Effects of Insulin
- Dawn Phenomenon
- Hyperglycemia occurs when
patient wakes up. Growth factor
hormones are released, therefore
increasing blood sugar levels.
- Hyperglycemia occurs when
patient wakes up. Growth factor
hormones are released, therefore
increasing blood sugar levels.
- Somogyi Phenomenon
- Occurs when a patient takes too much
insulin before bed, thus causing
hypoglycemia when asleep. But then, later
in the morning as glucocorticoid
concentrations from circadian rhythms are
released, it causes hyperglycemia.
- Occurs when a patient takes too much
insulin before bed, thus causing
hypoglycemia when asleep. But then, later
in the morning as glucocorticoid
concentrations from circadian rhythms are
released, it causes hyperglycemia.
- Lipodystrophy
- abnormal
distribution of
fat in the body
- abnormal
distribution of
fat in the body
- Allergic reaction
- Hypoglycemia
- Dawn Phenomenon
- Monitor blood sugar levels
- Administration Sites
- BiGUANIDE
- Reduces gluconeogenesis
by the liver
- Slows gastrointestinal
absorption of glucose
- Increases insulin receptor
sensitivity
- Increases insulin receptor
sensitivity
- Example: metformin
- Slows gastrointestinal
absorption of glucose
- Side Effects:
gastrointestinal
problems
- Contraindications: renal dysfunction,
unstable or acute congestive heart failure,
liver disease, surgery, iodinated dyes
- Contraindications: renal dysfunction,
unstable or acute congestive heart failure,
liver disease, surgery, iodinated dyes
- Reduces gluconeogenesis
by the liver
- SULFONYLUREAS
- Acts as a secretagogue to
promote insulin production
- Example: Glipizide
- Example: Glipizide
- Side Effects: hypoglycemia,
weight gain, hyperinsulinemia
- Contraindications: renal insufficiency,
hepatic insufficiency
- Contraindications: renal insufficiency,
hepatic insufficiency
- Acts as a secretagogue to
promote insulin production
- MEGLITINIDES
- Stimulates insulin to be
released from pancreatic beta
cells
- Requires frequent
administration, and good for
patients with an irregular
lifestyle.
- Example: Prandin
- Requires frequent
administration, and good for
patients with an irregular
lifestyle.
- Side Effects:
hypoglycemia
- Contraindications: diabetic
ketoacidosis
- Contraindications: diabetic
ketoacidosis
- Stimulates insulin to be
released from pancreatic beta
cells
- THIAZOLIDINEDIONES
- Improves insulin sensitivity
and reduce glucose production
- Side Effects: fluid retention,
heart failure, anaemia, weight
gain, bladder cancer, bone
fractures in women
- Contraindications: history of
heart failure, hepatic disease
- Contraindications: history of
heart failure, hepatic disease
- Example: Troglitazone
- Improves insulin sensitivity
and reduce glucose production
- ALPHA GLUCOSIDASE INHIBITORS
- Prevents digestion rate of
carbohydrates to reduce absorption of
glucose in blood.
- Example: acarbose
- Example: acarbose
- Side Effects: hypoglycemia,
gastrointestinal problems
- Contraindication: chronic
intestinal disease
- Prevents digestion rate of
carbohydrates to reduce absorption of
glucose in blood.
- INSULIN
- NUTRITION
- Nurses, along with the health care team, ensure
that patients are educated about type 2 diabetes
and all about anti-diabetic medication. Diabetics
need to know how to have proper nutrition and
have a physically active lifestyle. Additionally,
monitoring blood glucose level is vital for each
diabetic individual.
- DIAGNOSIS
- Diagnostic Tests
- Glycated haemoglobin (HbA1c)
- A blood test that measures the amount of glucose bound to
red blood cells. The higher the amount of glucose, the higher
the HbA1c reading.
- Takes the average number based of 2 or more blood tests within
the last 3 months.
- Diabetes = HbA1c result higher than 48
mmol/mol
- Diabetes = HbA1c result higher than 48
mmol/mol
- Takes the average number based of 2 or more blood tests within
the last 3 months.
- A blood test that measures the amount of glucose bound to
red blood cells. The higher the amount of glucose, the higher
the HbA1c reading.
- Fasting blood sugar test
- A blood test taken after an overnight fast.
- Diabetes = result of 7.0 mmol/L
- Prediabetes = result between 5.6 - 6.9 mmol/L
- Prediabetes = result between 5.6 - 6.9 mmol/L
- Diabetes = result of 7.0 mmol/L
- A blood test taken after an overnight fast.
- Random Sugar Test
- A random blood sugar test taken regardless if an
individual has eaten recently
- Diabetes = a result higher than 11.1 mmol/L or higher
- Diabetes = a result higher than 11.1 mmol/L or higher
- A random blood sugar test taken regardless if an
individual has eaten recently
- Oral Glucose Tolerance Test
- A blood test is taken after an overnight fast
- A sugary drink is given to drink afterwards, and then blood
sugar levels are tested periodically for two hours.
- Diabetes = a result higher than 11.1 mmol/L after two hours
- Diabetes = a result higher than 11.1 mmol/L after two hours
- A sugary drink is given to drink afterwards, and then blood
sugar levels are tested periodically for two hours.
- A blood test is taken after an overnight fast
- Prevention
- Maintain weight by
exercising and eating healthy
- Reduce alcohol intake, and stop smoking
- Visit your doctor regularly to
prevent risk for cardiovascular
disease and risk for diabetes
- Risk Factors
- Family History
- An individual is has a higher
chance getting type 2 diabetes if
their parent or sibling has the
disease
- An individual is has a higher
chance getting type 2 diabetes if
their parent or sibling has the
disease
- Sedentary Lifestyle
- Aim to be physically active so that your weight is
controlled and glucose is used as energy instead of
being stored as becoming fat deposits
- Aim to be physically active so that your weight is
controlled and glucose is used as energy instead of
being stored as becoming fat deposits
- Age
- An aging individual is at a higher risk for
developing type 2 diabetes due to weight
gain and less physically active
- An aging individual is at a higher risk for
developing type 2 diabetes due to weight
gain and less physically active
- Poor personal health
- High blood pressure
- High levels of low
density lipoprotein
- High blood pressure
- Ethnic background
- Several races are more susceptible to having type 2
diabetes (ex. African Americans, Pacific Islanders, Asian
Americans)
- Several races are more susceptible to having type 2
diabetes (ex. African Americans, Pacific Islanders, Asian
Americans)
- Family History
- Maintain weight by
exercising and eating healthy
- Glycated haemoglobin (HbA1c)
- With the increasing in incidence of type 2
diabetes, testing for diabetes is very important.
Individuals that are over the age of 45, and
persons with a body mass index of 25 or higher
should be tested for diabetes to rule out this
disease.
- Coping with Diabetes
- Have a strong social support network
with family and friends or those that
also have the same diagnosis
- Seek support for your doctor and support for
your mental health. You should never go
through this alone
- Practice mindfulness and relaxation.
Attend meditation or yoga classes.
- Exercise regularly so that you body releases endorphins which makes
you happier, and reduces stresses and worries
- Have a strong social support network
with family and friends or those that
also have the same diagnosis
- Diagnostic Tests
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