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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the incidence and economic impact of diabetes.

  2. Distinguish clinical differences in type 1, type 2, and gestational diabetes.

  3. List screening and diagnostic criteria for diabetes.

  4. Discuss therapeutic goals for blood glucose, blood pressure, and lipids for a patient with diabetes.

  5. Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.

  6. Compare oral agents used in treating diabetes by their mechanisms of action, time of action, side effects, contraindications, and effectiveness.

  7. Select appropriate insulin therapy based on onset, peak, and duration of action.

  8. Discuss the signs, symptoms, and treatment of hypoglycemia.

  9. Define diabetic ketoacidosis and discuss treatment goals.

  10. Develop a comprehensive therapeutic monitoring plan for a patient with diabetes based on patient-specific factors.

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KEY CONCEPTS

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  • Image not available. Diabetes mellitus (DM) describes a group of chronic metabolic disorders characterized by hyperglycemia that may result in long-term microvascular, macrovascular, and neuropathic complications.

  • Image not available. Type 1 DM (T1DM) is usually diagnosed before age 30 years but can develop at any age. Autoimmune destruction of the β cells causes insulin deficiency.

  • Image not available. Type 2 DM (T2DM) accounts for approximately 90% to 95% of all diagnosed cases of DM, is progressive in its development, and is often preceded by an increased risk for diabetes (previously known as prediabetes). A combination of insulin deficiency, insulin resistance, and other hormonal irregularities, primarily involving glucagon, are key problems with T2DM. The majority of people with T2DM are overweight, and an increasing number of cases in children have been observed.

  • Image not available. DM treatment goals include reducing, controlling, and managing long-term microvascular, macrovascular, and neuropathic complications; preserving β-cell function; preventing acute complications from high blood glucose levels; minimizing hypoglycemic episodes; and maintaining the patient's overall quality of life. To achieve the majority of these goals, near-normal blood glucose levels are fundamental; thus, glycemic control remains a primary objective in diabetes management.

  • Image not available. Patients and clinicians can evaluate disease state control by monitoring daily blood glucose values, hemoglobin A1c or estimated average blood glucose values, blood pressure, and lipid levels.

  • Image not available. Oral and injectable agents are available to treat patients with T2DM who are unable to achieve glycemic control through meal planning and physical activity.

  • Image not available. Insulin is the primary treatment to lower blood glucose levels for patients with T1DM, and the addition of injected amylin may decrease fluctuations in blood glucose levels.

  • Image not available. Uncontrolled blood pressure plays a major role in the development of macrovascular events as well as microvascular complications, including retinopathy and nephropathy, in patients with DM. The American Diabetes Association (ADA) recommends that systolic blood pressure goals for patients with DM be individualized but generally set at less than 130 mm Hg. The diastolic blood pressure goal for patients with DM is less than 80 mm Hg.

  • Image not available. Peripheral neuropathy is a common complication reported in T2DM. This complication generally presents as pain, tingling, or numbness in the extremities.

  • Image not available. Lower extremity amputations are one ...

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