Ch. 26 Diabetes Mellitus Flashcards
In 2014, how many people in the US had diabetes?
29 million (9.3% of population)
What is the most common type of diabetes?
Type 2 (associated with obesity)
Which states have higher rates of diabetes in the US?
Southern states
Diabetes Insipidus
Fairly rare
Caused by hormone (anti-diuretic hormone)
Seen with very increased thirst and urine output
Diabetes Mellitus
Metabolic disorder caused by altered glucose regulation and utilization
Unable to secrete enough insulin, use insulin effectively, or both
Results in elevated glucose in blood
Type 1 Diabetes: Prevalence in diabetic population
5-10% of cases
Type 1 Diabetes: Age of onset
less than 30 years
Type 1 Diabetes: Associated conditions
Autoimmune disease, viral infection, inherited factors
Type 1 Diabetes: Major defect
Destruction of pancreatic beta cells; insulin deficiency
Type 1 Diabetes: Insulin Secretion
Little or none
Type 1 Diabetes: Requirement for insulin therapy
Always
Type 1 Diabetes: Former names
Juvenile-onset diabetes
Insulin-dependent diabetes (IDDM)
Type 2 Diabetes: Prevalence in diabetic population
90-95%
Type 2 Diabetes: Age of onset
older than 40 years
Seeing Type II in children because of obesity
Type 2: Associated conditions
Obesity, aging, inactivity, inherited factors
Type 2: Major defect
Insulin resistance; insulin deficiency relative to needs
Type 2: Insulin secretion
Varies; may be normal, increased, or decreased
Type 2: Requirement for insulin therapy
Sometimes
Type 2: Former Names
Adult-onset diabetes
Non-insulin dependent diabetes (NIDDM)
Risk factors for pre-diabetes/Type II
- Ages older/equal to 45
- Overweight (BMI greater than/equal to 25)
- Family history
- Race/ethnicity: African American, Hispanic American, Native American, American Indian
- Glucose levels
- History gestational diabetes
- History of giving birth to baby weighing greater than 9lbs
Diagnosis: A1c
Measures amount of glycated hemoglobin
Normal: less than 5.7%
Pre-diabetes: 5.7-6.4%
Diabetes: 6.5% +
Diagnosis: Fasting Plasma Glucose (FPG) [mg/dL]
fast for 8-12 hours, blood drawn, measure glucose level
Normal: less than 100
Pre-diabetes: greater than or equal to 100-125
Diabetes: 126+
Diagnosis: Oral Glucose Tolerance Test (OGTT) [mg/dL]
glucose challenge, drink liquid, measure glucose levels 2 hours after
Normal: less than 140
Prediabetes: 140-199
Diabetes: 200+
Glycated Hemoglobin
The more glucose you have, the more it’s glycated with hemoglobin
Assists healthcare providers to evaluate long-term glycemic control
Measure of glycemic control during previous 2-3 months
HbA1c: less than 6% for non-diabetic persons
HbA1c: less than 7% for DM patients
What are the 2 diseases of long term complications?
Macrovascular Disease
Microvascular Disease
Macrovascular Disease
Damage to heart, brain, periphery (larger blood vessels)
Perhaps more closely related to hyperglycemia
Microvascular Disease
Damage to nerve, eyes, kidneys (smaller blood vessels affected)
Result of Macrovascular Disease
MI = myocardial infarction Stroke (CVA) Peripheral Vascular Disease --decrease circulation to arms and legs --can be a contributing factor to foot ulcers
Result of Microvascular Disease: Eyes
Retinopathy
Diabetes is leading cause of blindness in US
Result of Microvascular Disease: Nerves
Neuropathy
Peripheral Neuropathy:
–watch for gastroparesis
Gastroparesis
Delayed stomach emptying
–person can experience nausea, discomfort, vomiting…
Result of Microvascular Disease: Kidneys
Nephropathy
Diabetes is leading cause of kidney disease in US
Usually takes about 10-15 years before signs of kidney disease occur
S/S Hyperglycemia
*Polydipsia (increased thirst)
*Polyuria (increased urine)
*Polyphagia (increased hunger)
Weight loss
Blurred vision
Fatigue
Glycosuria (glucose in urine)
Acetone breath
Labored breathing (lungs have to work extremely hard to restore pH balance)
*Main S/S of hyperglycemia
S/S Hypoglycemia
Shakes Sweats Blurred vision Confusion Headaches
Nutrient Recommendations: CHO
~50% total kcalories
- -high fiber, whole grain
- -AMDR range: 45-65% for healthy population
Nutrient Recommendations: Fiber
Same as general population
- -women: 25 g/d
- -men: 38 g/d
Nutrient Recommendations: Sugar
Minimize foods and drinks with added sugars
Nutrient Recommendations: Fat
Same as general population
Nutrient Recommendations: PRO
~15-20% kcalories
Nutrient Recommendations: Alcohol
General population BUT effect on glucose-depends on amount of ETOH and food consumed
S/S hypoglycemia similar to inebriation
kcal Increased triglycerides (TG)
Nutrient Recommendations: Micronutrients
Same as general population
Primary Sources of CHO
Breads, crackers, cereal NOT just starches Pasta, rice, grains Starchy vegetables Non-starchy vegetables Milk, yogurt Fruits and juices Sweets and desserts
–>15g CHO in one serving
Meal Planning: Basic CHO Counting
Basic CHO concepts:
- -teaches client to focus mainly on CHO content of foods
- -use tables, exchange lists, food labels, etc. to determine amount of CHO consumed
- -consistent CHO intake
- -portion control
- -still need to watch total kcals if Type II and trying to lose weight
- -key: education on CHO and CHO sources
