Lecture Notes on Endocrine Disorders: Diabetes Mellitus Type 2

Introduction

• Focus on Type 2 Diabetes within endocrine disorders.
• Importance of active learning and application in nursing rather than just preparing for exams.

Overview of Diabetes

• Defined by American Diabetes Association as metabolic diseases with high blood glucose levels (hyperglycemia) due to insulin issues.
• Diabetes links to numerous top causes of death: cardiovascular diseases, cerebrovascular accidents, cancer, Alzheimer's, and cirrhosis.

Key Hormones in Blood Sugar Control

• Insulin: Made by pancreatic beta cells, lowers blood glucose by allowing cell uptake.
  • Mitigates rapid glucose increase, prevents short-term toxicity.
  • Chronic high glucose leads to insulin resistance, characterized by cells reducing insulin receptor expression.
• Glucagon: Counter-regulatory hormone, signals liver to release stored glucose when blood levels are low.

Development of Type 2 Diabetes

• Begins with chronic hyperglycemia managed by high insulin levels until cells become resistant.
• Influenced by diet (high carbs, especially processed foods) and sedentary lifestyle.

Metabolic Syndrome

• A set of symptoms increasing the risk of Type 2 Diabetes.
• Diagnosed when a person has 3 or more of these:
  • Waistline > 40 inches (men) / 35 inches (women).
  • Blood pressure ≥ 130/85 mm Hg or on medication.
  • Triglycerides > 150 mg/dL.
  • Fasting blood glucose > 100 mg/dL or on glucose-lowering meds.
  • HDL < 40 mg/dL (men) / 50 mg/dL (women).

Causes and Risk Factors

• Excessive intake of carbs, lack of physical activity.
• Certain medications can increase risk (thiazide diuretics, beta blockers, etc.).
• Risk factors: family history, obesity, gestational diabetes, age, race/ethnicity.

Clinical Manifestations

• Symptoms include polyuria, polydipsia, polyphagia, fatigue, vision changes, neuropathy.
• Assessments should include glucose monitoring, eye and nerve health, and lifestyle factors.

Diagnosis and Monitoring

• A1c tests for average glucose over 3-4 months.
• Regular monitoring of lipid levels, kidney function, and potential complications.

Management and Treatment

• Lifestyle changes: diet (low-carb, whole foods), exercise, weight management.
• Possible medications to increase insulin sensitivity.
• Emerging strategies: intermittent fasting.

Complications

Short-term:

• Hyperglycemic hyperosmolar state (HHS): Extreme stress-induced hyperglycemia, fluid and electrolyte imbalances.

Long-term:

• Macrovascular: Cardiovascular disease, cerebrovascular incidents.
• Microvascular: Retinopathy, kidney damage.
• Neuropathy: Peripheral nerve damage, GI and cardiac complications.

Nursing Care and Interventions

• Prevention through education on lifestyle changes and metabolic syndrome.
• Encouraging regular glucose monitoring and early diagnosis.
• Collaborative care with specialists as needed.
• Non-judgmental support for lifestyle and dietary changes.

Emotional and Psychosocial Considerations

• Recognize the emotional impact of lifestyle changes.
• Be supportive, non-judgmental, understanding patient struggles and fears.

Conclusion

• Review learning objectives, put knowledge into practice, ensure understanding of Type 2 Diabetes management.