Diabetes mellites and diabetes incipidus.pptx

presented by - Gaurav Karanjekar

1. Diabetes mellites Presented by, Gaurav Karanjekar

2. Meaning of diabetes mellitus The word diabetes, meaning "Siphon" was first given by the Greek physician Arateus in the 2nd century. In the 17the century, it was observed that urine of diabetic patients was sweet, so the word mellitus, meaning ‘ honey' was added to it. Diabetes = Siphon Mellitus = Honey Diabetes mellitus is known as " Madhumeha " in Ayurveda. It is also known as "rich man's disease"

3. introduction Diabetes mellitus is a clinical disorder in which blood sugar levels are abnormally high known as Hyperglycemia. It occurs due to absence or insufficient production of Insulin. It is a chronic condition, as it lasts lifetime, but can be well controlled.

4. definition Diabetes mellitus is a group of metabolic diseases and heterogenous disorders characterized by high levels of blood sugar (glucose) in the blood that result from defects in insulin secretion, or action, or both. Diabetes mellitus is defined as fasting blood glucose of 126 milligrams per deciliter (mg/dL) or more.

5. Incidence rate Diabetes affects an estimated 537 million worldwide between the age of 20-79 .

6. NORMAL INSULIN METABOLISM

7. Normal insulin metabolism

8. CLASSIFICATION OF DIABETES The most frequent diabetes forms are…..... Type I diabetes Type 2 diabetes . Other forms of diabetes include..…. Gestational diabetes, Pre-diabetes Diabetes associated with other conditions,

9. TYPE 1 DIABETES About 5 percent to 10 percent of those with diabetes have type 1 diabetes. Type 1 diabetes formerly called……… juvenile diabetes mellitus, insulin-dependent diabetes mellitus, or IDDM

10. Process of type 1 diabetes Genetic factor Environmental Stress Immune response against altered beta cells Autoimmune Attack Type 1 Diabetes Mellitus

11. Causes of type 1 diabetes The exact cause of type 1 diabetes is unknown, Occur due to family history of diabetes , alcohol consumption, removal of the pancreas by surgery and autoimmune processes. When complete destruction of beta cells occurs, no insulin secretion occurs in the bloodstream that causes type 1 Diabetes mellitus.

12. Type 2 diabetes Accounting for 90% to 95% of those with diabetes, type 2 diabetes is the most common form of the condition. In type 2 diabetes mellitus (formerly called adult-onset diabetes mellitus, non-insulin-dependent diabetes mellitus, or NIDDM),

13. pathophysiology Sedentary lifestyle + Genetics +Diet high in refined carbs/low in micronutrients   Insulin levels increase in bloodstream   Cells become resistance to insulin Blood glucose and insulin levels are high  

14.   Pancreas decreases insulin production   Blood glucose levels remain high   Type 2 diabetes

15. Causes and Risk factors Heredity Obesity or being overweight Lack of exercise Physical inactivity Family history of diabetes High-fat diet H igh cholesterol Pre-diabetes Polycystic ovary syndrome Gestational diabetes High alcohol intake High blood pressure

16. Gestational Diabetes Gestational Diabetes is defined as any degree of glucose intolerance with its onset during pregnancy. This type of diabetes usually occurs during pregnancy and ends after the birth of the child. Causes: Being overweight or obese. Not being physically active . polycystic ovary syndrome. Having family member with diabetes.

17. Pre-Diabetes Pre-Diabetes is a new term for impaired glucose tolerance. It is characterized by glucose levels that are higher than normal, but not high enough to be diagnostic of diabetes.

18. Diabetes Associated With Other Conditions When diabetes is caused as the result of another condition is termed as secondary diabetes. It may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease.

19. CLINICAL MANIFESTATION

20. Diagnostic evaluation Fasting Blood Glucose Test:- involves measuring blood glucose after not eating or drinking for 8 to 12 hours. A normal fasting blood glucose level is less than 100 mg/dL.

21. Cont ……. Random Blood Glucose Test- A random blood glucose level of 200 mg/dL (11.1 mmol/L)

22. Cont ….. Glycated Haemoglobin A1C Test (A1C) –

23. CONT…… Oral Glucose Tolerance Test (OGTT)

24.   Normal   Impaired Tasting glucose or glucose tolerance   Overt diabetes   Fasting glucose   2 hours after OGTT   <100 mg/dl <6.1 mmol/1 <140 mg/dl <7.8 mmol/1 110-125 mg/dl 6.1-6.9 mmol/1 140-199 mg/dl 7.8-11.1 mmol/1   126 mg/dl 7.0 mmol/1 > 200 mg/dl > 11.1 mmol/1  

25. COMPLICATION OF DIABETES MELLITUS

26. MANAGEMENT OF DIABETES

27. management There are five components of Diabetic Management Pharmacologic al therapy Nutritional Management Education of Diabetes Exercise to lower Blood Glucose Blood Glucose Monitoring

28. Pharmacologic therapy A. Insulin Therapy 1. Rapid-Acting Insulin –

29. Long-Acting Insulin extended insulin zinc insulin ( Ultralente ) and insulin glargine (Lantus).

30. 3. Short Acting Insulin regular insulin (Humulin R, Novolin R), and insulin zinc (Lente).

31. Storage of insulin Insulin products should be stored at +2 ˚C to +8 ˚C

32. Insulin syringe insulin pen

33. PROCESS OF SELF INJECTING INSULIN BY SYRINGE

34. PROCESS OF SELF INJECTING INSULIN BY PEN

35. ROTATION OF INSULINE:-

36. Oral Antidiabetic Agents Sulfonylurea drugs Glipizide ( glucotrol , glucotrol XL), Glyburide ( diabeta , glynase prestab , micronase ) and Glimepiride ( amaryl ) are prescribed most often.

37. Cont …. Meglitinides : such as repaglinide ( Prandin ), have effects similar to sulfonylureas, but patient is not as likely to develop low work quickly, and the results fade rapidly. Biguanides : Metformin (Glucophage, Glucophage XR) is the only drug in this class available

38. Alpha-glucosidase inhibitors Acarbose ( Precose ) And Miglitol ( Glyset ). Thiazolidinediones rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos),

39. Drug combinations such as Glucovance , which contains both glyburide and metformin

40. Transplantation If the patient is unable to control blood sugar levels with conventional treatment, a pancreas transplant may be considered. With a successful pancreas transplant, patient would no longer need insulin therapy.

41. EXERCISE Four kinds of activity can help diabetic patient. Patient can - 1. Be Extra Active Every Day

42. CONT… 2. Do Aerobic Exercise :

43. 3. Do Strength Training 4.Stretch:

44. NUTRITIONAL MANAGEMENT

45. MONITORING BLOOD GLUCOSE Self-monitoring of blood glucose (SMBG)

46. ( Dka ) Diabetic ketoacidosis

47. Diabetic ketoacidosis A serious diabetes complication where the body produces excess blood acids (ketones). This condition occurs when there isn't enough insulin in the body. It can be triggered by infection or other illness.

48. Causes of dka Illness .  Missing  insulin  shots, Other causes of DKA include: Physical injury, such as from a car accident. Alcohol or drug use. Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

49. Clinical manifestation

50. Diagnosis of dka Urine Ketone Tests-

51. Management of dka Correct dehydration Replace insulin Replace potassium Treatment of any precipitating illness

52. HEALTH EDUCATION I ndividualized meal plan Assist with sensory impairment Demonstrate self insulin injection self care skills importance of exercise Maintain skin integrity stop smoking Attend diabetes education. Follow up

53. NURSING CARE PLANS Nursing Assessment Obtain a history of current problems, family history, and general health history. Perform physical examination

54. Nursing diagnosis Deficient fluid volume related to osmotic diuresis (from hyperglycemia ), excessive gastric losses: diarrhea , vomiting and restricted intake: nausea, confusion as evidenced by increased urinary output, dilute urine, weakness; thirst; sudden weight loss, dry skin/ mucous membranes, poor skin turgor and hypotension, tachycardia, delayed capillary refill. Imbalanced nutrition: less than body requirements related to insulin deficiency, decreased intake: anorexia, nausea, gastric fullness, abdominal pain; altered consciousness as evidenced by increased urinary output, dilute urine, reported inadequate food intake, lack of interest in food, recent weight loss; weakness, fatigue, poor muscle tone, diarrhea and increased ketones. Risk for Infection related to high glucose levels, decreased leukocyte function, alterations in circulation and preexisting respiratory infection or UTI. 

55. Cont …   Impaired skin integrity related to decreased sensation, alteration in circulation to lower extremities, decreased activity / mobilization, lack of knowledge of skin care as evidenced by poor skin turgor, dry skin and altered sensorium. Fatigue r/t decreased metabolic energy production, altered body chemistry: insufficient insulin and infection as evidenced by overwhelming lack of energy, inability to maintain usual routines, decreased performance and impaired ability to concentrate, disinterest in surroundings. Powerlessness related to long-term illness that is not curable and dependence on others as evidenced by reluctance to express true feelings; influence over situation, apathy, withdrawal, anger, does not monitor progress,

56. Cont ….. Activity Intolerance related to poor glucose control and decreased muscular strength as evidenced by generalized weakness, increased respiratory rate, body weakness, lack of energy, weight loss . Risk for disturbed sensory perception related to endogenous chemical alteration: glucose/ insulin and/or electrolyte imbalance. Deficient knowledge regarding disease, treatment, self-care, and discharge needs related to lack of exposure/recall and unfamiliarity with information resources as evidenced by questions/request for information, verbalization of problem and inaccurate follow- through of instructions,

57. PREVENTION We do not yet know of a way to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases. Maintain a healthy weight. Increase physical activity levels.. take medication as directed.

58. Cont … Drink an adequate amount of water and avoid taking too much salt. Lifestyle modification. The skin should be taken care The feet should be washed and examined daily.

59. MYTHS RELATED TO DIABETES

60. UNDERSTANDING : MYTH 1 Nobody in my Family has diabetes so, I won’t get it.

61. Understanding: myth 2 Only Obese Get Diabetes

62. Understanding: myth 3 Eating Sugar Cause Diabetes

63. Understanding: myth 4 Prediabetes Always Lead To Diabetes

64. Understanding: myth 5 Diabetes Is A Disease Of Riches

65. Understanding: myth 6 All Forms Of Diabetes Are Same

66. Diabetic insipidus

67. definition Diabetic insipidus is a disorder of the posterior lobe of the pituitary gland characterized by a deficiency of antidiuretic hormone (ADH), or vasopressin. Great thirst (polydipsia) and large volumes of dilute urine characterize the disorder.

68. 1. Central diabetic insipidus central Diabetic insipidus is an inadequate response of ADH to plasma osmolarity, which occurs when an organic lesion of the hypothalamus, infundibular stem or posterior pituitary partially or completely blocks ADH synthesis , transport or release

69. Causes the cause is unknown. Damage to the pituitary gland Most commonly due to cranial surgery, Hypothalamic or pituitary tumors , Aneurysm, Thrombosis, Infection, Inflammation, Head injury, Skull fracture and immunologic disorders.

70. 2. Nephrogenic Diabetic insipidus : Nephrogenic Diabetic insipidus is caused by an inadequate renal response to ADH . Nephrogenic Diabetic insipidus occurs when there's a defect in the renal tubules the structures in kidneys that cause water to be excreted or reabsorbed.

71. Causes An inherited (genetic) disorder or a chronic kidney disorder. Pyelonephritis, Amyloidosis, Destructive uropathies, Polycystic disease and Intrinsic renal disease. Certain drugs, such as lithium, tetracycline, General anesthetics such as methoxyflurane, demeclocycline also can cause nephrogenic diabetic insipidus.

72. 3. Psychotic diabetic insipidus Psychogenic Diabetic insipidus is caused by an extreme large fluid intake, which may be idiopathic or related to psychosis. Drinking too much liquid can be the result of abnormal thirst caused by damage to the thirst-regulating mechanism, situated in the hypothalamus.

73. Clinical manifestation frequent urination drink large amounts of fluid Dehydrated Other symptoms include………….. fever, changes in level of consciousness, hypotension, tachycardia. headache, visual disturbances due to electrolyte imbalance and dehydration. The patient may report abdominal fullness, anorexia, and weight loss

74. Risk factors • Have a family history of the disorder. • Take certain medicines, such as diuretics, that could lead to kidney problems. • Have high levels of calcium or low levels of potassium in their blood. • Have had a serious head injury or brain surgery.

75. complication The 2 main complications of diabetes insipidus are  dehydration and electrolyte imbalance .

76. Diagnostic evaluation   Urinalysis : Urinalysis is the physical and chemical examination of urine.

77. Cont …. Water Deprivation Test : This test helps determine the cause of Diabetic insipidus. Patient will be asked to stop drinking fluids two to three hours before the test so that doctor can measure changes in body weight, urine output and urine composition when fluids are withheld. Doctor may also measure blood levels of ADH during this test.

78. Antidiuretic Hormone (ADH) Test : After the water deprivation test, endocrinologist will give a small dose of ADH, usually as an injection. This will show how body reacts to the hormone and can help identify which type of Diabetic insipidus patient have.

79. M.R.I.

80. management Depend upon the type of diabetic insipidus Central diabetic insipidus : desmopressin as a nasal spray, as oral tablets or by injection

81. Cont …… Nephrogenic diabetic insipidus doctor may prescribe a low-salt diet to help reduce the amount of urine kidneys make. Patient will also need to drink enough water to avoid dehydration. Drugs used to treat nephrogenic Diabetic insipidus include: anti-inflammatory medication (indomethacin) and Chloropropamide : Potenciate action of reducing polyuria.

82. Cont …. Psychogenic Diabetic Insipidus : There is no specific treatment for this form

83. Medical management a) Vasopressin ( Pitressin ) -IM, Effective for 24 to72hrs. b) Lypressin ( Diapid nasal Spray) - Absorbed through nasal mucosa -Duration of action 4 to 6 hrs - may cause chronic nasal irritation.

84. Cont … c) Desmo- pressin acetate. -administered into the nose. - Duration of action 12 to 24 hrs d) Hydro- Chlorothiacin : - Reduce the urine volume

85. Surgical management HYPOPHYSECTOMY Removal of pituitary gland may performed for the treatment of primary tumor of the pituitary gland.

86. Nursing management Advice for medication Monitor symptoms Maintain fluid amount Provide mouth care Monitor vital sign Use nasal spray

87. Nursing diagnosis Risk for fluid volume deficit r/t disease process. Imbalanced Nutrition Less than Body Requirements related to insufficiency of insulin, decreased oral input. Fluid Volume Deficit related to osmotic diuresis. Risk for Infection related to hyperglycaemia.

88. Health education Instruct the patient to administer demopresin by nasal insufflation or by mouth. Advice the patient about possible drug adverse effect for eg. Head aching. Tell him to report any weight gain. Advise the patient to carry his medication with him all time. Give written instruction on vasopressin administration . Weight daily to monitoring fluid retention / fluid loss. Encourage for follow up.

89. Summery Here I summarized my topic, today we are discuss with introduction, definition, types, etiological factor, clinical manifestation, management of diabetes mellitus

90. ANY