★Vocabulary★ diabetes mellitus – 糖尿病
literally – ad. 逐字地，按字面意思
glycosuria – n. 糖尿
basement membrane – 基膜，底膜
collagen – n. 胶原
filament – n. 细丝，单纤维
endothelial – a. 内皮的
lining – n. 衬里，内层
remodeling – n. 重塑，改造
atherosclerosis – n. 动脉粥样硬化
plaque – n. 斑块
atherosclerotic plaques –动脉粥样硬化斑块
retinopathy – n. 视网膜病变
neuropathy – n. 神经病变
nephropathy – n. 肾病变
challenge – v. 激发，攻击
postprandial – a. （正）餐后的
glucose challenge test – 葡萄糖激发试验
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Diabetes Mellitus 糖尿病
Diabetes mellitus (literally, “honey urine”) is characterized by complex disturbances in metabolism. Diabetes affects carbohydrate, protein, and fat metabolism. The most frequently recognized clinical signs of diabetes are hyperglycemia (fasting blood sugar level >126 mg/dL) and glycosuria (the presence of sugar in the urine). The alteration in the body’s ability to effectively deal with carbohydrate, fat, and protein metabolism over the long-term results in a thickening of the basement membrane (a thin layer of collagen filament that lies just below the endothelial lining of blood vessels) in large and small blood vessels. This thickening leads to changes in oxygenation of the vessel lining; damage to the vessel lining, which leads to narrowing, vessel remodeling, and decreased blood flow through the vessel; and an inability of oxygen to rapidly diffuse across the membrane to the tissues. These changes result in an increased incidence of a number of disorders, including the following:
l Atherosclerosis: Heart attacks and strokes related to the development of atherosclerotic plaques in the vessel lining 动脉粥样硬化：与血管衬膜动脉粥样硬化斑块发展有关的心脏病发作与中风
l Retinopathy: Resultant loss of vision as tiny vessels in the eye are narrowed and closed Neuropathies: Motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen supply to these nerves is slowly cut off 视网膜病变：脚、腿运动和感觉变化，以及其他神经因供氧的逐渐切断，出现进行变化
l Nephropathy: Renal dysfunction related to changes in the basement membrane of the glomerulus 肾病变：与血管小球基膜变化有关的肾功能障碍
The overall metabolic disturbances associated with diabetes were once thought to be caused by a lack of the hormone insulin. It is now thought that a mosaic of problems, including low insulin and loss of insulin receptor sensitivity, are involved. There is debate over whether prolonged high glucose levels lead to basement membrane changes and complications of diabetes or whether basement membrane thickening is the initial problem that leads to lack of insulin and changes in insulin receptors; whichever comes first, replacement or stimulation of insulin release is the mainstay for treatment of diabetes mellitus.
The diagnosis of diabetes mellitus has involved monitoring of fasting blood glucose levels and sometimes challenging the system with glucose for a glucose tolerance test. However, recent research indicates that the body’s response to food may be a more important indicator of impending diabetes. Current thinking is that a fasting blood glucose level may not be as important as a postprandial blood glucose level, which reveals the body’s ability to respond to a glucose challenge. The importance of looking at a variety of different glucose markers is being stressed.
1. A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to: A. Administer a sedative B. Make sure the client knows all the correct medical terms to understand what is happening. C. Ignore the signs and symptoms of anxiety so that they will soon disappear D. Convey empathy, trust, and respect toward the client.
2. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? A. Pulse B. BP C. Respiration D. Temperature
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答案 Answers 1. D. Convey empathy, trust, and respect toward the client. Rationale: The most appropriate intervention is to address the client’s feelings related to the anxiety. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists. 2. D. Temperature Rationale: An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.
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