Lesson 44: Type 2 Diabetes

 

Type 2 diabetes occurs primarily because of two problems:

1)insulin resistance
2)impaired insulin production

Normally, insulin binds to special receptors on the cell surface which initiate glucose metabolism however with type 2 diabetes insulin is not as effective in causing glucose metabolism. When the cells become resistant to the insulin bond the body tries harder by secreting more insulin. The cells still don't respond so now there is a ton of glucose floating around which leads to hyperglycemia. Eventually the body realizes that secreting all the extra insulin won't help; so the pancreas stops producing it.

 

Unlike Type 1 Diabetes there is still enough insulin in the body to prevent the breakdown of fats which leads to ketones. You will not see DKA in type 2 diabetes. However you may see another acute condition called Hyperglycemic Hyperosmolar NonKetotic Syndrome (HHNS). HHNS occurs when high blood sugar causes severe dehydraton in the client. The client's constant hyperglycemic state (blood sugar over 600) causes osmotic diuresis, resulting in water and electrolyte loss. Several events can cause HHNS:
acute illness (pneumonia)
medications (thiazides)
dialysis

Treatment for HHNS is the same as for DKA: fluid/electrolyte replacement and regular insulin IV. This is the potential risk for type 2 diabetics.

There is no known cause for type 2 diabetes although clients can have predisposing factors such as:
family history
obesity
usually over 40 yrs old
physically inactive
have high blood pressure
African American, Native American, or Hispanic American

 

Signs of type 2 diabetes include:

polyuria
polydipsia
polyphagia

Clients may also experience blurry vision, poor wound healing, or frequent vaginal infections.

Diagnostic tests for type 2 diabetes:

An abnormally high glucose level is the basic criteria
Fasting glucose greater than 126 (fasting=no calorie intake for at least 8 hours)
Hemoglobin A1c greater than 7%

**Hemoglobin A1c measures the blood sugar for the last 3 months

Treatment for type 2 diabetes is primarily weight loss along with exercise. Exercise increases the effective of insulin binding to the cells. Exercise also lowers the blood glucose in diabetics. Eating a well balanced meal will also be emphasized during treatment. If these things are not successful then clients may be started on oral antidiabetics. If oral agents are not effective then the client may need to advance to insulin SQ injections.

NCLEX Review Questions:

What is the primary way type 2 diabetes is controlled?
Why must diabetics inspect their feet daily?
Will exercise increase or decrease the need for insulin?
Will stress increase or decrease the need for insulin?




Answers:

Diet and Exercise
Diabetics may have sores that go unnoticed
Decrease; exercise may cause hypoglycemia
Stress will increase the need for insulin


I hope you enjoyed this short review!