CH 51 The Diabetus

Question 1

a group of metabolic diseases characterized by hyperglycemia, insulin secretion or both.

Answer 1

Diabetes mellitus

Question 2

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.

Answer 2

Prediabetes

Question 3

family history

• obesity BMI >27
• Race
• Age >45
• previously IGT or IFG
• HTN
• HDL 250
• HX of gestational Diabetes

Answer 3

risk factors for DM

Question 4

• 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

Answer 4

Insulin

Question 5

A small amount of insulin is released during fasting periods(overnight and between meals).

Answer 5

basal insulin

Question 6

this is released when blood glucose levels decrease and stimulates the liver to release stored glucose

Answer 6

glycogen

Question 7

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

Answer 7

Type 1 DM

Question 8

an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign.

Answer 8

autoimmune response

Question 9

when excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes

Answer 9

osmotic diuresis

Question 10

acids that disturb the acid base balance, when they accumulate in excessive amounts.

Answer 10

Ketone bodies

Question 11

causes signs such as abdominal pain, N&V, fruity breath, Kussumaul’s respirations,vomiting, and if not treated decreased LOC, coma, death

Answer 11

symptoms of DKA

Question 12

initial tx includes fluid, electrolytes and insulin

Answer 12

DKA

Question 13

most common in people older than 30 who are obese. The 2 main problems are insulin resistance and impaired insulin secretion.

Answer 13

Type 2

Question 14

includes HTN, hypercholestremia, and abdominal obesity. Beta cells cannot keep up with the increased demand for insulin.

Answer 14

metabolic syndrome

Question 15

Polyuria, polyphagia, polydipsia, fatigue, irratibility, poorly healing skin wounds, vaginal infections, blurred vision, tingling or numbness of feet and hands.

Answer 15

symptoms of hyperglycemia

Question 16

• lifestyle modification is the most effective treatment for prevention of type 2 DM.
• DM is also considered a MODIFIABLE risk factor.

Answer 16

prevention of type 2 DM

Question 17

• causal blood glucose(drawn at anytime) higher than 200
• fasting glucose higher than 126
• 2-hour post load glucose greater than 200

Answer 17

diagnosing DM

Question 18

50-60% of calories should be from carbs
20-30% fat (less than 10% saturated)
10-20% protein

Answer 18

diet recommendations

Question 19

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

Answer 19

fiber

Question 20

• 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

Answer 20

alcohol in DM

Question 21

• 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

Answer 21

exercise with DM

Question 22

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%

Answer 22

HgbA1c go A1C

Question 23

onset-10-15 min
peak-1h
duration-2-4hrs

Answer 23

Rapid acting
Humalog
Novolog
Apidrea

Question 24

onset- 30min-1hr
peak-2-3 hr
duration4-6 hrs

Answer 24

Short acting
Regular
(Humalog R)
Novolin R

Question 25

onset-2-4hr
peak-4-12 hours
duration16-20 hrs

Answer 25

intermediate acting
NPH
Humulin N

Question 26

Onset-1 hour
Peak-continous( no peak)
duration-24hrs.

Answer 26

Long acting
Lantus
Levemir

Question 27

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

Answer 27

Dawn phenomenon

Question 28

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

Answer 28

Insulin waning

Question 29

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

Answer 29

Somogyi effeect

Question 30

absorption rates in order

Answer 30

abdomen>arm>thigh>hip

Question 31

• Hypergylcemia
• dehydration and electrolyte loss
• acidosis

Answer 31

3 main clinical features of DKA

Question 32

• 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

Answer 32

Sick day rules