EXAM 3 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
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Chapter 59 “Diabetes”
- Diabetes Mellitus 1: Autoimmune disease where there is no insulin production, seen in
young, nonobese people. The body will attack itself and will not produce insulin.
Insulin allows us to use the energy source which is glucose. Every cell needs glucose
to carry out functions. Brain needs it to think and respond for example. What
happens is that an autoimmune response occurs, and the pancreas is not creating
insulin. Usually seen in younger population. These people are not obese, they will
have to take insulin injections daily for survival.
- Diabetes Mellitus 2: happens later in life sometimes in kids, most common diabetes.
Major contributor is obesity. Pancreas still produces insulin, but it is not enough. The
person eats too much sugar and carbs, and the pancreas can only do so much. Our
body becomes resistant to recognize insulin is there b/c of too much fat deposits. Diet
is so high in sugars and carbs that it is way too much for the insulin the body
produces to be enough. If people with type 2 diabetes lose weight and change the diet,
they can reverse the process b/c the body is still producing insulin. If not they’ll be
on oral meds (not insulin). These help body use the insulin it has or decrease glucose.
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Process Explained
When we eat food, it gets broken down by stomach, digestive enzyme and fluids.
Carbs and sugar get broken down into glucose and every cell needs it to work.
Glucose will just be freely flowing if we don’t have insulin. Insulin allows the cell door
to be open and it is the transporter into the cell for glucose. Glucose needs it to get
into the cell, Insulin is its KEY!
After you eat, the pancreas (even 10 mins before meal) secretes insulin, the amount
depends on what you eat. Our body holds on to stored sugar (liver) in case sugar
gets low. Body will excrete basal rate of insulin as well to keep everything stable. (70-
110) (homeostasis).
Type 1 will require insulin injections daily to survive
Type 2 probably not, but we do see some bc they do not manage themselves, not
controlling the diet or not worried about it. There are parameters as to when u will
need insulin.
Our body has a lot of backup mechanisms to keep it working properly
Type 1 back up mechanism will be to burn fat and use that as energy since no
insulin to work w glucose (this is why they lose weight)
Pancreas produces glucagon and insulin
Glucose is an energy source for our cells
To get glucose into the cell to be used, insulin is they key that unlocks the door
Insulin keeps blood glucose level from getting too high and keeps blood lipid levels in
normal range
Glucagon does the opposite – it brings up the glucose level when low
Lack of insulin and too much glucose is awful for our body.
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Hyperglycemia
Insulin receptor is door and insulin is key. There, glucose can’t move into the cell
With no insulin, glucose is flowing in blood stream, but no way of getting into the
cell.
3 P’s for both types. End result for both is the same (hyperglycemia)
Polyuria (b/c we have so much sugar in the body and blood stream, when the blood
vessels go to kidneys, they kidneys notice there’s too much, so they try to get rid of it
by peeing it out. The kidneys become overworked so they can go into kidney failure.
We want to pee out all the sugar!
Polydipsia (increased thirst) when u pee out all the time you’re going to get
dehydrated b/c you’re also peeing out all the fluids. They drink more than normal b/c of
the thirst!
Polyphagia: (hunger) especially true for Type 1: body doesn’t have insulin, when
they eat food and it breaks down, the glucose is flowing but since there is not insulin,
glucose doesn’t get to cell, cells are starving, whole body is starving. They also pee
the glucose out since there is no insulin to take it to where it needs to go. So, they’re always
hungry
Ketones (what your body produces with type 1) Why? Because when you don’t have
insulin. The body has the backup mechanism of burning the stored fat when it cannot burn
glucose. The byproduct of burning off fat stores is that ketones are produced. You can
see them in the urine.
Kussmaul’s respirations (when the pt is in diabetic ketoacidosis which is a
complication) blood sugar level extremely high) too much acid in the body.
Respirations will be increased and have more depth to make up for the acid. Rotten
Fruity breath b/c of sugar.
Electrolyte imbalances like K+ (Hyperkalemia)
Risk factors
- Smoking, inactivity, obesity, hypertension, high cholesterol and triglycerides. (When
someone has a few of these or all it is called Metabolic Syndrome) These are all
modifiable. (DM2)
- NON-modifiable: African American, Hispanic, American Indian, Alaska Indian, family
history can lead to diabetes as well. (DM1) (If you have a family history, living a healthy
lifestyle can help prevent it) Type 1 is not preventable but type 2 is!
How do we diagnose diabetes?
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