CH. 21 Diabetes Flashcards
Symptoms of Type 1 diabetes?
- Glycosuria
- Polyuria
- Dehydration
- Polydipsia
- Polyphagia
- Blurred vision
- Fatigue
- Irritability
What is a healthy glucose blood range?
70-110 mg/dL
Diagnostic criteria for diabetes?
*2 positive tests on different days: Start with random
- Random glucose: 200 mg/dL or higher + Classic
symptoms - Fasting glucose: 126 mg/dL or higher after 8 hour fast
- Plasma glucose: 2 hours after 75 gram glucose load
- Oral Glucose Tolerance Test (OGTT): 200 mg/dL or higher - Hemoglobin A1c: Measure of %hemoglobin that has a glucose attached to it. Good test to monitor over time.
- 6.5% or higher
- Only used to diagnose type 2
At risk numbers for diabetes? Fasting and HbA1c
Fasting glucose: 100-125 mg/dL
HbA1c: 5.7-6.4%
HbA1c ranges?
- HbA1c 4-6%: Non diabetic
- HbA1c equal to or greater 6.5%: Diabetes diagnosis
- HbA1c 5.7-6.4%: prediabetes
Acute complication of Type 1?
Diabetic Ketoacidosis (DKA)
Bodys response to DKA?
- elevated blood glucose worsens
- glycosuria
- Dehydration
- electrolyte imbalances
Medical treatment of Type 1?
Insulin therapy
Types of insulin?
Rapid acting, short acting, intermediate acting, long acting, mixtures
*There is a basal rate and then right before someone eats they will take an insulin bolus amount
How much insulin?
15 g. of Carb/ 1 unit fast acting insulin
- Half given as back ground basal dose
- Half given as bolus dose before eating
What does bolus depend on?
- pre meal glucose levels
- carb content of the meal
- body weight
- insulin sensitivity
Symptoms for Type 2 diabetes?
- Asymptomatic
- any symptom of type 1 + the following
- Tingling in hands and feet
- slow weight gain
- slow healing wounds
- frequent infection
Complications of type 2?
Hyperosmolar hyperglycemic syndrome (HHS)
characteristics of HHS?
- severe hyperglycemia
- severe dehydration
- electrolyte imbalances
- NO KETOSIS
- evolves slowly
Symptoms of HHS?
- glucose levels 600-1000 mg/dL
- severe dehydration
- neurological abnormalities
- Abnormal reflexes
- Motor impairment
- seizure
- coma
Treatment of HHS?
- insulin therapy (not as effective so used with meds)
- medications to decrease cellular resistance to insulin
- fluid and elec. replacement
General complication of both types?
Hypoglycemia: Low blood glucose (below 50 mg/dL)
- most frequent cause of diabetic coma
- accounts for 3-5% of diabetes related deaths
Cause of hypoglycemia?
*anything that decreases glucose levels in the blood
- excess insulin
- antidiabetic drugs
- prolonged exercise
- skipped meals
- inadequate food intake
- alcohol consumed without food
Symptoms of hypoglycemia?
- hunger
- shakiness and dizziness
- sweating
- heart palpitations
- mental confusion
- coma
Treatment for hypoglycemia?
- give 15-20 g. of glucose
- tabs
- 4 oz. juice
- 4-5 saltines
What if someone passes out?
- do not give food
- inject glucagon
- call for help
Chronic diabetes complications for both types?
- macrovascular
- microvascular
- nervous system
Macrovascular complications?
*Damage to large blood vessels
- cardiovascular disease
- Peripheral vascular disease (blood in limbs)
- claudication: pain while walking from inadequate oxygen transport
- Foot ulcers
- Gangrene
- Amputation
Microvascular complications?
*Damage to small blood vessels
- retinopathy: damage to capillaries in retina
- nephropathy: damaged to specialized capillaries in the kidneys
- neuropathy:
- deep pain or burning in legs and feet
- numbness and tingling in hands and feet
- weakness and cramping in legs and hands
- disturbances in bladder and bowel function
- sexual dysfunction
- Constipation
- gastroparesis: delayed stomach emptying
Medical treatment for type 2?
Oral anti-diabetic drugs: Make cells more sensitive
- inhibit liver glucose production (Metformin)
- improve insulin secretion
- delay carb digestion
- Suppress appetite
- suppress glucagon secretion
Dietary treatment of all diabetes?
- Carb counting
- 45-65% total calories…45% for diabetics - Minimize sugar intake to population recommendations
- Sat. Fats below 7% (@ risk for CVD)
- Protein: 20% of calories or more
- Fiber greater than 50 g/day may improve glycemic control but hard to tolerate
Dietary treatment for non macronutrients?
- Alcohol: Limit 1 drink for women and 2 for men. Consume with food to avoid hypoglycemia.
- Avoid fructose (affects blood lipid levels)
- Consider artificial sweeteners