Ch. 26 Diabetes Mellitus

Question 1

In 2014, how many people in the US had diabetes?

Answer 1

29 million (9.3% of population)

Question 2

What is the most common type of diabetes?

Answer 2

Type 2 (associated with obesity)

Question 3

Which states have higher rates of diabetes in the US?

Answer 3

Southern states

Question 4

Diabetes Insipidus

Answer 4

Fairly rare

Caused by hormone (anti-diuretic hormone)

Seen with very increased thirst and urine output

Question 5

Diabetes Mellitus

Answer 5

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

Question 6

Type 1 Diabetes: Prevalence in diabetic population

Answer 6

5-10% of cases

Question 7

Type 1 Diabetes: Age of onset

Answer 7

less than 30 years

Question 8

Type 1 Diabetes: Associated conditions

Answer 8

Autoimmune disease, viral infection, inherited factors

Question 9

Type 1 Diabetes: Major defect

Answer 9

Destruction of pancreatic beta cells; insulin deficiency

Question 10

Type 1 Diabetes: Insulin Secretion

Answer 10

Little or none

Question 11

Type 1 Diabetes: Requirement for insulin therapy

Answer 11

Always

Question 12

Type 1 Diabetes: Former names

Answer 12

Juvenile-onset diabetes

Insulin-dependent diabetes (IDDM)

Question 13

Type 2 Diabetes: Prevalence in diabetic population

Answer 13

90-95%

Question 14

Type 2 Diabetes: Age of onset

Answer 14

older than 40 years

Seeing Type II in children because of obesity

Question 15

Type 2: Associated conditions

Answer 15

Obesity, aging, inactivity, inherited factors

Question 16

Type 2: Major defect

Answer 16

Insulin resistance; insulin deficiency relative to needs

Question 17

Type 2: Insulin secretion

Answer 17

Varies; may be normal, increased, or decreased

Question 18

Type 2: Requirement for insulin therapy

Answer 18

Sometimes

Question 19

Type 2: Former Names

Answer 19

Adult-onset diabetes

Non-insulin dependent diabetes (NIDDM)

Question 20

Risk factors for pre-diabetes/Type II

Answer 20

1. Ages older/equal to 45
2. Overweight (BMI greater than/equal to 25)
3. Family history
4. Race/ethnicity: African American, Hispanic American, Native American, American Indian
5. Glucose levels
6. History gestational diabetes
7. History of giving birth to baby weighing greater than 9lbs

Question 21

Diagnosis: A1c

Answer 21

Measures amount of glycated hemoglobin

Normal: less than 5.7%
Pre-diabetes: 5.7-6.4%
Diabetes: 6.5% +

Question 22

Diagnosis: Fasting Plasma Glucose (FPG) [mg/dL]

Answer 22

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+

Question 23

Diagnosis: Oral Glucose Tolerance Test (OGTT) [mg/dL]

Answer 23

glucose challenge, drink liquid, measure glucose levels 2 hours after

Normal: less than 140
Prediabetes: 140-199
Diabetes: 200+

Question 24

Glycated Hemoglobin

Answer 24

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

Question 25

What are the 2 diseases of long term complications?

Answer 25

Macrovascular Disease | Microvascular Disease

Question 26

Macrovascular Disease

Answer 26

Damage to heart, brain, periphery (larger blood vessels) Perhaps more closely related to hyperglycemia

Question 27

Microvascular Disease

Answer 27

Damage to nerve, eyes, kidneys (smaller blood vessels affected)

Question 28

Result of Macrovascular Disease

Answer 28

``` MI = myocardial infarction Stroke (CVA) Peripheral Vascular Disease --decrease circulation to arms and legs --can be a contributing factor to foot ulcers ```

Question 29

Result of Microvascular Disease: Eyes

Answer 29

Retinopathy Diabetes is leading cause of blindness in US

Question 30

Result of Microvascular Disease: Nerves

Answer 30

Neuropathy Peripheral Neuropathy: --watch for gastroparesis

Question 31

Gastroparesis

Answer 31

Delayed stomach emptying | --person can experience nausea, discomfort, vomiting...

Question 32

Result of Microvascular Disease: Kidneys

Answer 32

Nephropathy Diabetes is leading cause of kidney disease in US Usually takes about 10-15 years before signs of kidney disease occur

Question 33

S/S Hyperglycemia

Answer 33

*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

Question 34

S/S Hypoglycemia

Answer 34

``` Shakes Sweats Blurred vision Confusion Headaches ```

Question 35

Nutrient Recommendations: CHO

Answer 35

~50% total kcalories - -high fiber, whole grain - -AMDR range: 45-65% for healthy population

Question 36

Nutrient Recommendations: Fiber

Answer 36

Same as general population - -women: 25 g/d - -men: 38 g/d

Question 37

Nutrient Recommendations: Sugar

Answer 37

Minimize foods and drinks with added sugars

Question 38

Nutrient Recommendations: Fat

Answer 38

Same as general population

Question 39

Nutrient Recommendations: PRO

Answer 39

~15-20% kcalories

Question 40

Nutrient Recommendations: Alcohol

Answer 40

General population BUT effect on glucose-depends on amount of ETOH and food consumed S/S hypoglycemia similar to inebriation ``` kcal Increased triglycerides (TG) ```

Question 41

Nutrient Recommendations: Micronutrients

Answer 41

Same as general population

Question 42

Primary Sources of CHO

Answer 42

``` 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

Question 43

Meal Planning: Basic CHO Counting

Answer 43

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