Pancreatic Disorder (Disorder Mellitus)

Subject: Medical and Surgical Nursing I (Theory)

Overview

Diabetes mellitus is a group of metabolic disease characterized by hyperglycemia resulting from a defect in insulin secretion, insulin action or both. Type 1 or insulin dependent, Type 2 or noninsulin dependent, Juvenile diabetes mellitus., Pregnancy includes diabetes mellitus are its types. Insufficiency of insulin, failure in production of insulin, etc are its causes. Its symptoms include increased appetite, increased thirst, increased urine volume, etc.Exercise improves insulin sensitivity and lowers blood glucose during and after exercise. Exercise session is 5-7 minutes of warm up, stretching exercise.Achieve weight reduction in obese patients to reduce insulin resistance.

Diabetes mellitus is a group of metabolic disease characterized by hyperglycemia resulting from a defect in insulin secretion, insulin action or both.

Diabetic Mellitus result in long time damage dysfunction and failure of various organs especially the heart, kidney, and eyes.

Classification of Diabetic Mellitus

  • Type 1 or insulin dependent.
  • Type 2 or noninsulin dependent.
  • Juvenile diabetes mellitus.
  • Pregnancy includes diabetes mellitus.

Type 1 or insulin dependent (IDDM)

It is characterized by autoimmune beta cell, destruction, which is attributing to a genetic predisposition coupled with one or more viral agents and possible chemical agents. It depends on exogenous insulin to sustain insulin life. Onset generally before the age of 30 years but may occur at any age, person body built is generally lean rarely obese.

Type 2 (non-insulin dependent) (NIDDM)

The majority of 90% people with diabetes mellitus are type2 has strong genetic influence but has no connection with HLAC (human leukocyte antigen).

The absolute requirement of exogenous insulin is episodic.

No requirement for exogenous insulin to sustain life.

Onset usually after 40 years of age but may occur at any age.

Etiology

  • Insufficiency of insulin
  • A failure in production of insulin
  • Drug-induced i.e IV pentamidine.
  • Impaired glucose tolerance \
  • Hereditary predisposition
  • Congenital rubella and cytomegalovirus

 

Clinical features

  • Increased appetite
  • Increased thirst
  • Increased urine volume
  • Visual blurring
  • Fatigue
  • Weight loss
  • Coma

Diagnostic evaluation

  • Complete history and physical examination
  • Blood tests including fasting blood sugar (FBS) postprandial blood sugar (PPBS) glycosylated, hemoglobin, cholesterol, triglyceride levels, blood urea nitrogen and serum creatine.
  • Urine complete analysis
  • Fundoscopic examinations
  • Neurologic examination
  • Monitoring weight
  • Blood pressure monitoring

Medical management

  • Dietary management
  • Oral hypoglycemic drugs
  • Insulin
  • Exercise

Dietary management

  • Low energy weight reducing diet: a daily deficit of 500k.cal provide.
  • Weight maintenance diet
  • High carbohydrates and low in fat.

Types of insulin

  1. Short-acting insulin
    It is regular insulin. It is rapid acting and it is a zinc suspension.
  2. Intermediate-acting insulin
    It is semi lente suspension and composed of natural protamine Hagedorn.
  3. Long-acting insulin
    It Is extended insulin of zinc suspension and having a long action, composed of ultralente protamine insulin.

Rotation of site

The speed with which peak serum concentration are reached to various anatomic sites for injection. The fastest absorption is from the abdomen arm, thigh, and buttocks. Insulin administered subcutaneously for better actions.

Dose of insulin

  • The daily output of insulin by pancreatic islets cell is 30-40 units
  • Blood sugar -300mg/1ooml = 20 units
  • Blood sugar – 200mg- 300mg/100mi = 10 units

Exercise

  • Exercise improves insulin sensitivity and lowers blood glucose during and after exercise.
  • Exercise session is 5-7 minutes of warm up, stretching exercise.

Nursing management

  • The nurse must clarify the insulin prescription in term of type, strength and species.
  • Observe for the symptoms of hyperglycemia
  • Reduce overall blood sugar and minimize fluctuation
  • Achieve weight reduction in obese patients to reduce insulin resistance
  • Avoid weight gain
  • Avoid atherogenic diets.
  • Advice to a patient not to skip meals.
  • Educate the patient about exercise.

Complications

Acute complications

  • Hypoglycemia
  • Diabetic ketoacidosis
  • Hyperglycemia coma’

Chronic complication

  • Microvascular- diabetic retinopathy, nephropathy, neuropathy, radiculopathy.
  • Macrovascular- dyslipidemia, hypertension, coronary artery disease

References

  • accessmedicine.mhmedical.com/content.aspx?bookid=339&sectionid=42811318
  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
  • https://www.pancreasfoundation.org/patient-information/about-the-pancreas/common-disorders-of-the-pancreas/
  • study.com/academy/lesson/disorders-of-the-pancreas-types-symptoms-treatments.html
Things to remember
  • Diabetic Mellitus result in long time damage dysfunction and failure of various organs especially the heart, kidney, and eyes.
  • Blood tests including fasting blood sugar (FBS) post prandial blood sugar (PPBS) glycosylated, hemoglobin, cholesterol, triglyceride levels, blood urea nitrogen and serum creatine.
  • Low energy weight reducing diet: a daily deficit of 500k.cal provide.
  • Achieve weight reduction in obese patients to reduce insulin resistance
  • Advice to a patient not to skip meals.
Questions and Answers

Hyperglycemia brought on by a deficiency in insulin secretion, action, or both characterizes the group of metabolic diseases known as diabetes mellitus. Long-term damage, dysfunction, and failure of many organs, particularly the heart, kidneys, and eyes, are consequences of diabetes mellitus.

Classification of Diabetic Mellitus:

  • Depending on insulin or type 1.
  • Non-insulin-dependent type 2.
  • Diabetes mellitus in children.
  • Diabetes mellitus occurs throughout pregnancy.

Type 1 or insulin dependent (IDDM):

  • It is characterized by the death of beta cells by the immune system, which is attributed to a hereditary predisposition in conjunction with one or more viral agents and sometimes chemical agents. For insulin to remain alive, exogenous insulin is required. Person's body type is often lean, with few exceptions, and symptoms typically appear before the age of 30, however they can happen at any age.

Type 2 (non insulin dependent) (NIDDM):

  • 90% of those with diabetes mellitus are type 2, which has a substantial hereditary component but is unrelated to HLAC (human leukocyte antigen).
  • Episodic use of exogenous insulin is absolutely necessary.
  • Life can be sustained without exogenous insulin.
  • Usually begins after the age of 40, but it can start at any age.

Etiology:

  • Absence of enough insulin
  • A lack of insulin production
  • Drug-related, such as IV pentamidine.
  • Inadequate glucose tolerance
  • A hereditary propensity
  • Congenital cytomegalovirus and rubella

Medical management:

  • Dietary control
  • OTC hypoglycemic medications
  • Insulin
  • Exercise

Dietary management:

  • Low-calorie weight loss diet: 500 kcal of caloric deficit per day.
  • Diet to maintain weight
  • Fat-free with a high carbohydrate content.

 

Nursing management:

  • The nurse must specify the kind, strength, and species of insulin prescribed.
  • Keep an eye out for hyperglycemia symptoms.
  • Generally lower blood sugar levels and lessen volatility
  • Reduce insulin resistance in obese people by helping them lose weight
  • Avoid gaining weight
  • Abstain from atherogenic foods.
  • A patient is advised not to skip meals.
  • Inform the patient about physical activity.

 

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