★Vocabulary★
insulin-dependent – a. 胰岛素依赖性
noninsulin-dependent – a. 非胰岛素依赖的
adult onset – 成年型
onset – n. 起始，发动
adiponectin – n. 脂连素
polarize – v. 极化
evolve – v. 进化，生长
correlated with – 与相关联
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★RN/ISPN Review ★
Diabetes Mellitus 糖尿病
Diabetes mellitus is classified as either type 1, once called insulin-dependent diabetes mellitus, or type 2, once called noninsulin-dependent diabetes mellitus or adult onset diabetes. Type 1 diabetes is usually associated with rapid onset, mostly in younger people, and is connected in many cases to viral destruction of the beta cells of the pancreas. Type 1 diabetes always requires insulin replacement because the beta cells are no longer functioning.
Type 2 diabetes was once thought to be a disease of mature adults with a slow and progressive onset. However, studies released in 2001 reported that the incidence of type 2 diabetes in teenagers and young adults is increasing markedly. Patients with type 2 diabetes are able to produce insulin, but perhaps not enough to maintain glucose control, or perhaps their insulin receptors are not sensitive enough to insulin, leading to increased serum glucose levels.
Questions are being raised about the impact of early diet and lack of exercise in contributing to this new increase in type 2 diabetes in young people. The treatment of type 2 diabetes usually begins with changes in diet and exercise. Dieting controls the amount and timing of glucose introduction into the body, and weight loss decreases the number of insulin receptor sites that need to be stimulated, as well as the intraabdominal fat that blocks adiponectin release. Exercise increases the movement of glucose into the cells by SNS activation and by the increased potassium in the blood that occurs directly after exercising. Potassium acts as part of a polarizing system during exercise that pushes glucose into the cells. Clinical studies have shown that controlling serum glucose levels can decrease the risk of complications by up to 40%.
When diet and exercise no longer work, other agents are tried to stimulate the production of insulin in the pancreas, increase the sensitivity of the insulin receptor sites, or control the entry of glucose into the system. Injection of insulin may eventually be needed. This concept is often confusing to patients who are learning about diabetes. Type 2 diabetes may evolve over time and the patient eventually require replacement insulin. Timing of the injections of insulin is correlated with food intake and anticipated increases in blood glucose levels, as well as exercise levels and anticipated stress.
1. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. “The best time for me to exercise is every afternoon.” B. “The best time for me to exercise is right after I eat.” C. “The best time for me to exercise is after breakfast.” D. “The best time for me to exercise is after my morning snack.”
2. Glucose is an important molecule in a cell because this molecule is primarily used for: A. Extraction of energy B. Synthesis of protein C. Building of genetic material D. Formation of cell membranes.
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上期答案 1. A. “The best time for me to exercise is every afternoon.” Rationale: A hypoglycemic reaction may occur in the response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. Options B, C, and D do not address peak action times. 2. A. Extraction of energy Rationale: Glucose catabolism is the main pathway for cellular energy production.
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