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Type 1 Diabetes

Also called Juvenile Diabetes or IDDM (Insulin-Dependent Diabetes Mellitus). It is normally found in people under 30, there is Beta Cell Destruction and No Insulin production due to an autoimmune response. This is 10% of diabetes case.

S/S of Type 1 Diabetes

Rapid Onset, Fatigue, Increased Infections, Weight Loss, and the 3 Ps (Polyuria, Polydispia, and Polyphagia).

Type 2 Diabetes

Also called NIDDM (Non-Insulin-Dependent Diabetes Mellitus). It is normally found in people over 30, Beta cells wear out and the body is not getiing the glucose due to overproduction of insulin or there is too little insulin production. This is 90% of diabetes cases.

S/S of Type 2 Diabetes

History of Hypertension, Fatigue, Decreased energy, Frequent Infections, Slower healing, and mild symptoms.

S/S of both types of Diabetes

Nocturia, Weakness/Fatigue, Blurred Vision, Dry Skin, Pruritus, Shiny Skin on Lower extremities due to poor circulation, Cold feet/legs, Impotence, Vaginal Infections, GI symptoms.

Normal Blood Glucose Level before eating

70-110 mg/dl

Normal Blood Glucose Level after eating

80-140 mg/dl

Insulin

Hormone secreted by the pancreas for glucose metabolism, helps convert glucose to glycogen (glycogenesis),stimulates active transport of glucose into cells. It also promotes fatty acid synthesis and conversion into fat.

Diagnostic Tests for Diabetes

Glucose Tolerance Test (GTT) or Glycosylated Hemoglobin

Qualitative Diabetic Diet

Less structured diet that stresses moderation using the food pyramid reducing use of simple carbs, fats, and alchohol and even distribution throughout the day (Snacks if on insulin, or more food with exercise).

Quantitative Diabetic Diet

Diet Measure by amounts of food, 55-60% carbs, 10-20% protein, and up to 30% fats. Diabetic Exhange System and Weight Loss if appropriate.

Food needs related to exercise

Extra food needed before, during, and after high physical activity especially in type 1

Exchange system

groups foods together because they are alike. Foods on each list have about the same amount of carbohydrate, protein, fat and calories. In the amounts given, all choices on each list are equal. Any food on the list can be exchanged or traded for any other food. The lists are grouped into three main groups: carbohydrate group; meat and meat substitute group; and fat group.

Nutrient Balance

Carbs will be 60-70% of your total kcals, Protein will be 15-20% of your total kcals, Fats will be 25-30% of your total kcals

Food distrubution

Spread out throughout the day with a usual pattern of either 4 or 6 meals a day. Factors determined by daily activity level, exercise times, and med types and times.

Exercise benefits

exercising muscles use glucose more effectively, increases sensitivity, and decreases BP/prevents hypertension. Exercising alone also helps lower blood glucose.

How to treat hyperglycemia

give oral carbs, glucagon, IV glucose

Alchohol occasional use is OK if

Taken with food, not substituted for food. Insulin dose does not increase.

During Illness

maintain food intake, maintain medication regimen. If unable to eat replace with caloric beverages, have frequent intaker throughout the day and closely monitor Blood glucose.

During Travel

Research available foods, plan for snacks and time changes, carry a source of sugar, wear an ID, and have a physician's letter for insulin/syringes

When Dining Out

Preplan and choose an appropriate site and request and appropriate prep method for your food

During stress

Body may take a flight or fight response which in diabetic patients there is not enough insulin to put the extra energy into cells . Insulin antagonism increases blood glucose.

Exercise in Type 1 Diabetes

Unusual or extra exercise is dangerous without adjustments as there is an increased use of glucose. Increased breakdown of fatty acids leads to Ketosis. Avoid injection of insulin into muscle groups that will be exercised, also avoid exercise at peak times of insulin Snack before and during exercise and check BG before exercising, do not begin exercising until BG is under control..

Exercise in Type 2 Diabetes

Lowers plasma glucose levels, increases sensitivity of insulin recpetors, decreases LDL and triglycerides. Aerobic exercise for 30-60 mins 3-4 times a week

Rapid-Acting Insulins

onset of 15-30 min, peaks at 30-90 minuts and has a duration of 3-5 hours. they appear clear, examples include Humalog and Novolog

Short-Acting insulins

Onset of 30-60mins, peaks at 2-4 Hours, and has a duration of 5-8 hours. They appear clear, examples include Humulin R and Novolin R. Only Insulin used in an IV. also called regular insulin.

Intermediate-Acting Insulins

Onset of 1-2 hours, peaks at 4-10 hours, and has a duration of 18-24 hours. They appear cloudy, examples include Humulin N and Novolin N.

Long-Acting Insulins

Onset of 1-4 hours, peaks effect is minimal, and has a duration of up to 24 hours. They appear clear, examples include Lantus and Levemir

Fixed Combinations of Insulin

Already mixed insulin 50/50 (NPH/Regular) 70/30 (NPH/Regular) and 75/25 (Lispro Protamine or NPH/Lispro)

Oral Anti-diabetics

Not an Oral Insulin, only for type 2 diabetes patients. contraindicated with no endogenous insulin production.

Sulfonylureas

A class of antidiabetic drugs that are used in the management of type 2 diabetes. They act by increasing insulin release from the beta cells in the pancreas. Example: glyburide

Biguanides

A class of antidiabetic drugs that are used in the management of type 2 diabetes. They act by decreasing glucose production in the liver. Example: metformin

alpha-glucosidase inhibitors

A class of antidiabetic drugs that are used in the management of type 2 diabetes. They act by preventing the digestion of carbohydrates which are normally converted into simple sugars, so it reduces the impact of carbs on blood sugar. Examples: acarbose, miglitol

Thiazolidinediones

Also known as glitazones, is class of antidiabetic drugs that are used in the management of type 2 diabetes. They act by increasing insulin sensitivity of the cells and increases glucose uptake in fat and muscle, also lowers production by liver. Examples: rosiglitazone, pioglitazone

Meglitinides & D-phenylalanines

A class of antidiabetic drugs that are used in the management of type 2 diabetes. They act by Stimulating insulin secretion from the pancreas

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