CH 51 The Diabetus Flashcards
a group of metabolic diseases characterized by hyperglycemia, insulin secretion or both.
Diabetes mellitus
classified as IGT or IFG, and refers to a condition in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes.
Prediabetes
family history
- obesity BMI >27
- Race
- Age >45
- previously IGT or IFG
- HTN
- HDL 250
- HX of gestational Diabetes
risk factors for DM
- transports and metabolizes glucose for energy
- stimulates storage of glucose in the liver and muscle(in the form of glycogen)
- signals the liver to stop release of glucose
- enhances storage of dietary fat in adipose tissue
- accelerates transport of amino acids into cells
Insulin
A small amount of insulin is released during fasting periods(overnight and between meals).
basal insulin
this is released when blood glucose levels decrease and stimulates the liver to release stored glucose
glycogen
only accounts for 5-10% of people with diabetes; it is characterized by acute onset, usually before 30. It is characterized by total destruction of beta cells.
- caused by combined genetic, immunologic, and possibly environmental factors.
- There is evidence of an autoimmune response
Type 1 DM
an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign.
autoimmune response
when excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes
osmotic diuresis
acids that disturb the acid base balance, when they accumulate in excessive amounts.
Ketone bodies
causes signs such as abdominal pain, N&V, fruity breath, Kussumaul’s respirations,vomiting, and if not treated decreased LOC, coma, death
symptoms of DKA
initial tx includes fluid, electrolytes and insulin
DKA
most common in people older than 30 who are obese. The 2 main problems are insulin resistance and impaired insulin secretion.
Type 2
includes HTN, hypercholestremia, and abdominal obesity. Beta cells cannot keep up with the increased demand for insulin.
metabolic syndrome
Polyuria, polyphagia, polydipsia, fatigue, irratibility, poorly healing skin wounds, vaginal infections, blurred vision, tingling or numbness of feet and hands.
symptoms of hyperglycemia
- lifestyle modification is the most effective treatment for prevention of type 2 DM.
- DM is also considered a MODIFIABLE risk factor.
prevention of type 2 DM
- causal blood glucose(drawn at anytime) higher than 200
- fasting glucose higher than 126
- 2-hour post load glucose greater than 200
diagnosing DM
50-60% of calories should be from carbs
20-30% fat (less than 10% saturated)
10-20% protein
diet recommendations
soluble fiber-foods such as legumes, oats, and some fruits- plays a role in lowering blood glucose and lipid levels.
insoluble fiber-found in whole grains, cereals, and some vegetables.
-25 g of total fiber should be ingested daily
fiber
- they may have alcohol in moderation
- increases the risk of DKA
- risk of hypoglycemia in patients who take insulin
- advised to consume food with alcohol
alcohol in DM
- Regular exercise lowers blood glucose, and improves insulin utilization.
- Should be done on a regular basis, not sporadic
- at the same time and same amount each day
- start slow and gradually increase
- Patients with BG greater than 250 and have ketones in their urine should not exercise until urine test negative and BG is normal
- should eat 15g of carbs before exercising
- avoid extreme weather
exercise with DM
a blood test that reflects average blood glucose levels over a period of approximately 2-3 months. This is because excess glucose attaches to hemoglobin molecules and the RBC’s last for about 120 days.
-Normal value 4-6% target range for Diabetes is less than 7%
HgbA1c go A1C
onset-10-15 min
peak-1h
duration-2-4hrs
Rapid acting
Humalog
Novolog
Apidrea
onset- 30min-1hr
peak-2-3 hr
duration4-6 hrs
Short acting
Regular
(Humalog R)
Novolin R
onset-2-4hr
peak-4-12 hours
duration16-20 hrs
intermediate acting
NPH
Humulin N
Onset-1 hour
Peak-continous( no peak)
duration-24hrs.
Long acting
Lantus
Levemir
characterized by a relatively normal blood glucose level until approx. 3 AM when the BG levels rise.
Tx- change time of injection from dinnertime to bedtime
Dawn phenomenon
progressive rise in BG from bedtime to morning.
Tx- increase evening dose of NPH or long acting, or instate a dose of insulin before dinner if Pt does not already
Insulin waning
characterized by normal or elevated blood glucose at bedtime, a decrease at 2-3 AM to hypoglycemic levels and a subsequent increase caused by the production of counter regulatory hormones.
tx- decrease evening dose of NPH or increase bedtime snack
Somogyi effeect
absorption rates in order
abdomen>arm>thigh>hip
- Hypergylcemia
- dehydration and electrolyte loss
- acidosis
3 main clinical features of DKA
- Take insulin or oral anti diabetic agents as usual
- test BG levels and test ketones every 3-4 hours
- may need supplemental doses of regular insulin 3-4 hours
- you can’t follow normal meal plan eat soft foods
- if vomiting or diarrhea stay hydrated
- report N&V to HCP
- if unable to retain oral fluids, may require hospitalization
Sick day rules
