Pierce College Summer Boot Camp. Diabetes: Part 1. R eview Part 2. Assessment. Review . Normal glucose metabolism. Diabetes is a disorder of carbohydrate metabolism. Liver produces too much glucose Pancreas secretes insufficient insulin Peripheral tissues resistant to insulin.
Summer Boot Camp
too much glucose
Diabetic older adults
retinopathyManifestations of microvascular disease in diabetes 1
Diabetic older adults
nephropathyManifestations of microvascular disease in diabetes 2
Diabetic older adults
neuropathyManifestations of microvascular disease in diabetes 3
Complications develop due to atherosclerotic changes older adultsMacrovascular changes
disease, control of glucose
alone is not effective!
be required before exercise
Sulfonylureas older adults
StarlixCause pancreas to release more insulin
Biguanides older adults
Should not be used in patients with kidney
damageImprove ability to move glucose into the cell (esp. muscle cells)
Pioglitazone ( older adultsActose)
Rosiglitazone (Avandia)Lower amount of sugar released by liver
What is the patient’s age? older adults
Diabetes becomes more common with age.
Over 90% of adults with DM have type 2 diabetes.
Older adults are less tolerant of fluctuations in blood glucose levels.Medical history
What is the patient’s eating pattern? older adults
Is there polyphagia? Polydipsia? Poor eating habits? History of insidious weight gain? A more recent weight loss?Medical history
Is there a history of visual disturbance? older adults
History of kidney problems?
History of numbness? Tingling? Pain?
Microvascular complications will predispose to diabetic retinopathy , nephropathy, and neuropathy.Medical history
Is there a history of chest pain? Palpitation? DOE? older adults
History of intermittent claudication?
Macrovascular complications produce large vessel atherosclerosis resulting from hyperinsulinemia, dyslipidemias, and hyperglycemia.Medical history
Is there a history of smoking? Hypertension? older adults
Smoking 1 pack of cigarettes a day increases one’s risk of developing type 2 diabetes by 61% over that of the nonsmoker. A diabetic smoker is 3 times more likely to die of cardiovascular disease than the diabetic nonsmoker.
HTN is a major risk factor for diabetes.Medical history
Family history of diabetes increases one’s risk for developing diabetes. Many studies have shown a connection through obesity, hypertension, and metabolic syndrome. NO study has shown there is NO increased risk with a positive family history.Medical history
Patients with diabetes with lower educational and economic levels have been shown to have less utilization of services and monitor their glucose status less frequently that patients with higher educational and economic levels.Medical history
Height and weight disorders?
Obesity contributes to type 2 diabetes
BMI of <25 should be maintained to lower the risk of diabetes.
Risk increases with weight circumference: All women > 31.5”, White and Black men > 37”, Asian men > 35”Physical examination
Blood pressure, including orthostatic disorders?
Having diabetes makes having hypertension and other heart conditions more likely. Diabetes damages arteries and makes them susceptible to hardening.
Orthostatic hypotension can be due to diabetic neuropathy.Physical examination
Fundoscopic disorders? examination
Evaluate for diabetic retinopathy as a result of nerve ischemia from microvascular disease.Physical examination
Thyroid palpation disorders?
Patients with diabetes have a higher risk of thyroid disease. Both are endocrine disorders and may have common autoimmune origins.Physical examination
Skin assessment disorders?
One-third of diabetic patients will develop a skin condition.
Increased glucose in the blood predisposes to skin infections.Physical examination
Foot exam: disorders?
Inspection every 3-6 months
Palpation DP and PT pulses
Diabetic neuropathy leads to decreased awareness of foot trauma and foot ulceration.Physical examination
Patellar and Achilles reflexes annually disorders?
Diabetic neuropathy is a late finding in type 1 diabetes but can be an early finding in type 2.Physical examination
Cardiovascular assessment disorders?
Large vessel atherosclerosis results from hyperinsulinemia, dyslipidemias, and hyperglycemia.Physical examination
Respiratory assessment disorders?
Complications of diabetes are generally cardiac. But, the eventual long term effects on all systems will be evident. Respiratory assessment should be part of the baseline and ongoing assessment.Physical examination
Neurological assessment disorders?
Microvascular disease causes nerve ischemia and results in diabetic neuropathy.
Full assessment of cranial nerves and sensation should be performed.Physical examination
At minimum… disorders?Review of lab values