Adult I Exam 3 - Endocrine Alterations: Diabetes Mellitus Flashcards
Prediabetes
Fasting blood glucose 100-125
2hr OGTT 140-199 (oral glucose tolerance test)
A1C 5.7-6.4%
Diabetes Classifications
DM Type 1 DM Type 2 Hyperglycemia Gestational Diabetes Metabolic Syndrome Hyperglycemia Prediabetes
Alpha cells
Glucagon
Beta cells
Insulin & amylin
Glucose Homeostasis
Balance of glucose uptake & glucose production
S/S high serum glucose
Polyuria
Fruit smelling breath
Polydipsia
Poly
Hyperglycemia S/S
Polyuria
Polydipsia
Polyphagia
Keytones
DM guidelines - Gold Standards
ADA - American Diabetes Association
AACE- American Associations of Clinical Endocrinologist
Primary Prevention of Diabetes
Balanced nutrition & physical activity Weight loss for obese/overweight Physical activity 150min/week Diet- low-carb, low-fat, calorie restricted, or Mediterranean Screening
How often should diabetes screening be performed?
> 45yo &/or BMI >25 at least every 3 years
Diagnosis Criteria for Diabetes
Hgb A1C
Fasting Blood Glucose (FBG)
No calorie intake for 8 hours
Oral Glucose Tolerance Test (OGTT)
Take after 10-12hr fasting
75-100g glucose beverage
2 hours post-load results
Glycosylated hemoglobin (Hgb A1C)
Average blood glucose for previous 120 days
Type 1 DM
.
Type 2 DM
.
Management of Diabetes
.
Blood Glucose Goals
Increased glucose usage when ill so ranges vary
Purpose/action of Insulin
Moves glucose into the cells (stimulates uptake into cell)
Inhibits hepatic glucose production
Action of Glucagon
Releases glucose from liver & cells
.??
Other causes of elevated blood glucose
Stress reaction/response
Steroids
Rapid Acting Insulin
.
Short Acting Insulin
.
Intermediate-Acting Insulin
.
Long-Acting Insulin
Onset = 2-4 hours Peak = NONE Duration = Drug- Teaching-
Mixed Insulin
Advantages: better control/stability, no mixing needed
Disadvantages: get low, stay lower longer, have to adhere to meal & exercise schedule
Sliding Scale Insulin (SSI)
.
Correction Insulin
.
Insulin Pump
.
Insulin Administration & storage
.
Insulin Verification
.
Common Complications of Insulin
.
Hypoglycemia S/S
.
S/S absence of Insulin
.
Chronic Complication - Microvascular
Changes in small blood vessels and organs
Nephropathy
Neuropathy
Retinopathy
Chronic Complications - Macrovascular
Changes in large blood vessels
Why do rotating insulin injection sites
To prevent:
Lipohypertrophy (increase swelling of fat)
Lipoatrophy (loss of fat)- leads slower inconsistent absorption
Hypoglycemia tx actions
.
Risk factors for metabolic syndrome
“apple shape”
Waist circumference…
Target goal BP
<130/80
Weight control & increase activity to achieve
Initiate ACE inhibitor if goal cannot be met
