PNUR 124
Week 11: Diabetes
1. Discuss current issues, trends and research related to diabetes mellitus.
What is Diabetes:
o Diabetes is “a multisystem disease related to abnormal insulin
production, impaired insulin utilization, or both” (Lewis et al. 2019, p.
1287).
o A common chronic endocrine disorder of impaired glucose regulation
that affects the function of all cells and tissues.
o There are different types (Type I, Type 2, Gestational Diabetes along with
other conditions resulting in hyperglycemia)
Prediabetes
o Also known as impaired glucose tolerance (IGT) or impaired fasting
glucose (IGT)
o Occurs with fasting or 2-hr plasma glucose level higher than normal (6.1-
6.9 with IFG; 7.1-11 mmol/L for IGT)
o Increased prevalence in Canada (up to 6 million cases).
o 50% of individuals develop DM
o Often symptomatic
o Health promotion is critical; maintain healthy weight, exercising regularly,
healthy diet, medications as prescribed)
Gestational Diabetes
o Develops during pregnancy
o Hyperglycemia can develop during pregnancy because of the secretion of
placental hormones, which causes insulin resistance.
o Detected between 24 and 28 weeks of gestation
o Occurs in about 3% of pregnancies in Non-indigenous population; 2-3 x
higher in Indigenous peoples.
o First line therapy = nutritional counselling, if ineffective may require
insulin therapy
o 10% progress to DM after pregnancy
Secondary Diabetes
o DM can occur because of another medical condition (schizophrenia,
Cushing’s syndrome, hyperthyroidism, immunosuppressive therapy, TPN)
o Medication use (corticosteroids, Dilantin, atypical antipsychotics
(clozapine).
o Pancreatic diseases and hormonal abnormalities
Risk Factors for Diabetes
o Family history of diabetes (i.e., parents or siblings with DM)
o Obesity (BMI> 25 kg/m2)
o Ethnicity (e.g., African descent, Latino, Asian Americans, Indigenous)
o Age (> 45 years)
o Hypertension (with BP > 140/90)
,PNUR 124
o High cholesterol levels (LDL)
o History of gestational diabetes or delivery of babies over 9 pounds
2.
Differentiate
between
Type I
and
Type 2
diabetes
in terms
of
etiology
and
treatment
modalities.
Type 1 Diabetes
o Also known as insulin dependent diabetes
o Associated with genetic disposition
o Involves beta-cell destruction leading to absolute insulin deficiency
o Is an autoimmune disorder
o Occurs in individuals who are < 30 yrs. (peak onset 11-13 yrs. old)
o Clinical Manifestations of T1
Hyperglycemia (as there is no insulin to transport glucose into the
cells)
Hyperosmolality (increase glucose in blood draws water from the
intracellular spaces in the vascular circulation)
Polyuria
Polydipsia
Polyphagia
Fatigue and malaise; weight loss
Vaginal yeast infections
Blurred vision (osmotic effects = swelling of lenses)
DKA
Type 2 Diabetes
, PNUR 124
o Occurs due to decreased production of insulin by the pancreas
o Involves metabolic abnormalities (insulin resistance, metabolic syndrome
– abdominal obesity, HTN, Dyslipidemia)
o Occurs in individuals who are > 35 years, with up to 90% being obese at
time of diagnosis.
o Is the most prevalent type of diabetes
o High risk populations (Indigenous, Latin America, South Asian, and African
descent)
o No longer known as “adult onset” DM, now seen in children and
adolescents.
o Clinical Manifestations of T2
Slow onset of manifestations
Hyperglycemia
Fatigue
Polyuria and polydipsia can occur
Weight loss
Recurrent infections
Prolonged wound healing
Visual acuity changes
Painful peripheral neuropathy in feet
3. Discuss best practices of self-care management of diabetes for maintaining blood
glucose levels through diet planning, sick day management, lifestyle choices and
exercise.
The Role of Obesity
o Obesity reduces available insulin receptor sites, leading to insulin
resistance
o Central obesity, defined as waist circumference > 40 inches in men, and
>35 inches in women.
o Three-quarters of older adults wit type II are overweight
o All older adults develop insulin resistance
o Weight loss with diet and exercise can reduce insulin resistance
o With enough weight loss, the client may not need oral medications
Complications of Diabetes
o Acute
Diabetic Ketoacidosis (fats are broken down
due to lack of insulin; triad of
hyperglycemia, ketosis, metabolic acidosis,
and dehydration).
Hyperosmolar hyperglycemic state (HHS)
Hypoglycemia
Hyperglycemia
Week 11: Diabetes
1. Discuss current issues, trends and research related to diabetes mellitus.
What is Diabetes:
o Diabetes is “a multisystem disease related to abnormal insulin
production, impaired insulin utilization, or both” (Lewis et al. 2019, p.
1287).
o A common chronic endocrine disorder of impaired glucose regulation
that affects the function of all cells and tissues.
o There are different types (Type I, Type 2, Gestational Diabetes along with
other conditions resulting in hyperglycemia)
Prediabetes
o Also known as impaired glucose tolerance (IGT) or impaired fasting
glucose (IGT)
o Occurs with fasting or 2-hr plasma glucose level higher than normal (6.1-
6.9 with IFG; 7.1-11 mmol/L for IGT)
o Increased prevalence in Canada (up to 6 million cases).
o 50% of individuals develop DM
o Often symptomatic
o Health promotion is critical; maintain healthy weight, exercising regularly,
healthy diet, medications as prescribed)
Gestational Diabetes
o Develops during pregnancy
o Hyperglycemia can develop during pregnancy because of the secretion of
placental hormones, which causes insulin resistance.
o Detected between 24 and 28 weeks of gestation
o Occurs in about 3% of pregnancies in Non-indigenous population; 2-3 x
higher in Indigenous peoples.
o First line therapy = nutritional counselling, if ineffective may require
insulin therapy
o 10% progress to DM after pregnancy
Secondary Diabetes
o DM can occur because of another medical condition (schizophrenia,
Cushing’s syndrome, hyperthyroidism, immunosuppressive therapy, TPN)
o Medication use (corticosteroids, Dilantin, atypical antipsychotics
(clozapine).
o Pancreatic diseases and hormonal abnormalities
Risk Factors for Diabetes
o Family history of diabetes (i.e., parents or siblings with DM)
o Obesity (BMI> 25 kg/m2)
o Ethnicity (e.g., African descent, Latino, Asian Americans, Indigenous)
o Age (> 45 years)
o Hypertension (with BP > 140/90)
,PNUR 124
o High cholesterol levels (LDL)
o History of gestational diabetes or delivery of babies over 9 pounds
2.
Differentiate
between
Type I
and
Type 2
diabetes
in terms
of
etiology
and
treatment
modalities.
Type 1 Diabetes
o Also known as insulin dependent diabetes
o Associated with genetic disposition
o Involves beta-cell destruction leading to absolute insulin deficiency
o Is an autoimmune disorder
o Occurs in individuals who are < 30 yrs. (peak onset 11-13 yrs. old)
o Clinical Manifestations of T1
Hyperglycemia (as there is no insulin to transport glucose into the
cells)
Hyperosmolality (increase glucose in blood draws water from the
intracellular spaces in the vascular circulation)
Polyuria
Polydipsia
Polyphagia
Fatigue and malaise; weight loss
Vaginal yeast infections
Blurred vision (osmotic effects = swelling of lenses)
DKA
Type 2 Diabetes
, PNUR 124
o Occurs due to decreased production of insulin by the pancreas
o Involves metabolic abnormalities (insulin resistance, metabolic syndrome
– abdominal obesity, HTN, Dyslipidemia)
o Occurs in individuals who are > 35 years, with up to 90% being obese at
time of diagnosis.
o Is the most prevalent type of diabetes
o High risk populations (Indigenous, Latin America, South Asian, and African
descent)
o No longer known as “adult onset” DM, now seen in children and
adolescents.
o Clinical Manifestations of T2
Slow onset of manifestations
Hyperglycemia
Fatigue
Polyuria and polydipsia can occur
Weight loss
Recurrent infections
Prolonged wound healing
Visual acuity changes
Painful peripheral neuropathy in feet
3. Discuss best practices of self-care management of diabetes for maintaining blood
glucose levels through diet planning, sick day management, lifestyle choices and
exercise.
The Role of Obesity
o Obesity reduces available insulin receptor sites, leading to insulin
resistance
o Central obesity, defined as waist circumference > 40 inches in men, and
>35 inches in women.
o Three-quarters of older adults wit type II are overweight
o All older adults develop insulin resistance
o Weight loss with diet and exercise can reduce insulin resistance
o With enough weight loss, the client may not need oral medications
Complications of Diabetes
o Acute
Diabetic Ketoacidosis (fats are broken down
due to lack of insulin; triad of
hyperglycemia, ketosis, metabolic acidosis,
and dehydration).
Hyperosmolar hyperglycemic state (HHS)
Hypoglycemia
Hyperglycemia
