Pancreatic Endocrine Disorders

Diabetes Mellitus

Hormone disorders of the pancreas

Specialized cell of pancreas, produce insulin Insulin for glucose uptake into the cells American Diabetes Association defines

Group of metabolic diseases

Hyperglycemia Defects in insulin secretion Insulin action

Classification of Diabetes Disorders

Type 1

Insulin dependent

Type 2

Non-insulin dependent
During pregnancy

Gestational diabetes

Impaired glucose metabolism

Signs and Symptoms

Polyuria Polydipsia Polyphagia Blurred vision Mood changes Weight loss

Numbness and tingling in the extremities Infections

Type 1

Immune-mediated

Autoimmune destruction of beta cells Antibodies Inhibit cell function Without an identifiable cause Genetic predisposition Trigger

Idiopathic

Type 1

Goal

Metabolic stabilization Restore weight Minimize negative impact

Type 2

Pancreas produces insulin Tissues insulin resistant Not dependent on insulin injection to sustain life. May require insulin for glucose control

Goals for treatment

Achieve glucose control Prevent vascular complications

Macrovascular Microvascular

Gestational Diabetes

2nd or 3rd trimester After delivery no longer a medical condition At risk developing type 2 later in life

Impaired Glucose Homeostatasis

Glucose above normal range

Does not meet criteria for diagnosis of type2

At risk for developing type 2 and macrovascular complications

Elevated blood glucose

Impaired insulin secretion Altered carbohydrate absorption Increased basal hepatic glucose production Decreased insulin-stimulated glucose uptake

Impaired Glucose Homeostasis

Goals of treatment

Relief of symptoms Prevent complications Nutrition therapy Exercise Weight reduction

Insulin

Proper insulin management Types of insulin

Ultra-rapid, short acting Rapid, short acting Intermediate acting Long acting

Complications of Diabetes

Hypoglycemic reaction

To much insulin in relation to glucose intake Signs and symptoms

Weak, headache Feelings of hunger Nervousness, perspires Dizziness, confusion

Hypoglycemia reaction

Treatment

Carbohydrates Glucagon

Somogyi phenomenon

Hypoglycemic, compensatory rebound hyperglycemia Body correcting problem by increasing glucose production not enough glucose for insulin to act Body secrets glucagon to correct hypoglycemia

Complications of Diabetes

Hyperglycemia Diabetic Ketoacidosis (DKA) results from a lack of effective insulin Signs and Symptoms

Weak, drowsiness, vomiting Thirst, dehydration, Breathing and pulse rapid and deep

hyperglycemia

Treatment

Fluids and electrolyte replacement Vital sign monitored frequently Check urine for ketones Evaluate mentation

Nonketotic Hyperosmolar State

Elevated blood glucose >600, without ketosis Causes

Severe stress, diurectics, undiagnosed diabetes Hyperglycemia, severe dehydration

Signs and symptoms

Infections

Aggravates diabetes Increase glucose concentration

Damage blood vessels Susceptible to infections Yeast and fungal infections

Infections

Treatments

Diabetes management essential Injury prevention measures

Surgical Complications

Prone to infections

Poor wound healing Impaired circulation-microvascular Glucose monitoring Signs of complications Meticulous skin care

Post-operative care

Macrovascular Complications

High blood glucose may increase arteriosclerosis Decreased blood flow causes oxygen deprivation in tissues Diabetic ulcers Hypertension, peripheral vascular disease, coronary artery disease

Neuropathy

Diabetic neuropathy

Nerve damage

Peripheral and autonomic neuropathy

Retinopathy

Loss of the functional retinal tissue blindness

Client Teaching

Physician Glucose monitoring Nutrition Medication Healthcare

Foot care Vision impairment