chapter 15 - diabetes Flashcards
what is diabetes melitus
group of serious and chronic disorders affecting metabolism of carb
absence or misuse of insulin = hyperglycemia
precursor is prediabetes (impaired glucose tolerance) - blood glucose levels higher than normal but not high enough to diagnose diabetes + growing insulin resistance
metabolic syndrome (dysmetabolic syndrome)
- constellation of conditions that pose signficiant risk of developing heart disease, stroke, and diabetes
- abn cholesterol
- excess body fat around waist
- increased bp and blood sugar
diabetes insipidus
large amt of urine but not sweet (insipid)
caused by damaged pituitary land
___ millino have diabetes in US (___% percent of US pop) with ____ diagnosed and ___ undignosed
29.1 millin
9.3%
diagnosed: 18.8 mil
diagnomsed: 8.1 mil
what is t2d major cause for
blindness
heart and kidney disease
amputation of toes, feet, and legs
infection
ieath
meaning behind t2d naeme
dibates - flow through (large amt of urine)
mellitus - honey (glucose in urine)
what secretes insulin
beta cells of sislets of Langerhans in pancreas
inadequate production of insulin or body is unable to use insulin it produces
glocuse cant enter cells and accumulate in blood, = hyperglycemia
glucagon role
secreted by alpha cells of islets of langerhans
helps release energy when needed to convert glycogen to glocuse
somatostatin
hormone produced by delta cells of islets of langerhans and hypothalamus
inhibits release of insulin and glocagons
glycosuria
glocuse excreted in urine when hyperglcemia exceeds renal threshold
what causes polyphagia in diabetes
inability to metabolize glucose causes body to break down its own tissue for protein and fat
causes polyphagia and loss of weight, weakness, and fatigue
use of protein from its own tissue causes body to excrete nitrogen
ketones in diabetes
excess fat is broken down, thus liver produces ketones from fatty acids
causes ketonemia and ketonuria
ketoacidos : lead to loss of consciousness and possibly death if not treated w fluids and insulin
neuropathy occurs in ____ of clients w diabetes
60-70%
what is number one cause of need for kidney dialysis
nephropathy
symptoms of diabetes
urinating often
feelign v thirsty
feelnig v hungry even though you have been eating
extreme fatigue
blurry vision
cuts or bruises that are slow to heal
weight loss (even though eating more - T1D)
tingling pain or numbness in hands or feet (T2D)
classification of diabetes (types)
prediabetes
Type 1 diabetes
type 2 diabetes
gestational diabetes
type of diabetes due to toerh causes like drug or chemical induced diabetes
1 in ___ adults ahve prediabetes
3
results indiciate pre-diabetes
fasting glucose of 100 and 125 mg/dL
A1C of 5.7-6.4
OGTT 2hr blood glucose of 140-199 mg/dL
start testing at 45 yo w 3 y intervals
risk facotrs for prediabetes
physical inactivity
first-degree relative w diabetes
members of high risk race or ethnicity (AA, Latino, native or Asian AMerican, Pacific Islanter)
women who delivered babies ? 9lb or had gestatoin diabetes
hypertension
dyslipidemia
PCOS
elevated labs
clinical conditions associated w insulin resistance (severe obesity, acanthosis, nigricans)
history of CVD
type 1 diabetes
juvenile diabetes
body immune system destroys pancraitc beta cells
5% of all diabetes cases
diagnose using blood glucose (over 126 mg/dL)
risk factors include genetics, autoimmune status, environmental factor
treat w exogenous insulin
type 2 diabetes
usually occur after 40 yo
diagnose w fasting glucose of 126 mg/dL, 2 our glcusoe of 200 mg/dL during OGTT, A1C of > 6.5
control w diet and exercise and oral diabetes medication
metformin is original medication
goal of nutrition therapy is maintain healthy glucose, blood pressure, and lipid levels
rapid acting insulin
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
short acting insulin
Regular (Humulin R, Novolin R)
intermediate acting insulin
NPH (Humulin N, Novolin N)
long actign insulin
detemir (Levemir)
Glargine (lantus, Basaglar, Toujeo)
inhaled insulin
afrezza
premixed insulin
Humulin or Novolin 70/30
Novolog 70/30
Humalog 75/25
Humulin 50/50
criteria for testing T2D in asymptomaitc children
overweight (BMI > 85th percentile) +
amily history of T2D in first or second degree relative; race/ ethnicity at risk; signs of insulin restiance or condition associated w insulin resistance (including small-for-gestational age birth wight)
age of iniaitiion (age 10 year or puberty at younger age)
meglitinide
repaglinide
d-phenylalanines
Nateglinide
Thiazolidinedione
Pioglitazone
rosiglitzaone
Nonsulfonylurea
Metformin
Metformin and time-released cpntrolling polymer
Alpha-glucosidase inhibitor
Miglitol
Second gen suflonylureas
Glyburides
Glipizide
Glimepride
Class-bile acid sequestrants (primariyl used to decrease cholesterol)
Colesevelam
DPP-4 inhibitor
Sitagliptin
Saxagliptin
Linagliptin
AlogliptinS
SGLTZ inhibitor
Canagliflozin
Dapagliflozin
Empagliflozin
opamine receptor agonist
Bromocriptine Mesylate
Combinatio ndrugs
Glcuovance, Avandamet, Metaglip
ACTOplus Met, Avandaryl, Duetact, Janumet, Kmobigylze XR, Kazano, Oseni, Juvisync, Jentadueto, Invokamet, Xigduo XT, Glyxambi
incretin mimetics
injected same as insulin but not insulin
used in conjunction w oral med to lower A1C to less than 7% (American diabetes association prefer outcomes less than 7% for clients w diabetes, American college of endocrinology preers less than 6.5%)
Pramlintide
used in clients w t1d
lowers blood sugars by assisting insulin injected at meals to lower postmeal blood sugar levels
suppress potmeal glucagon release, slows gastric emptying, and decreasing appetite
act on beta cells in pancreas to increase glucose-dependent insulin secretion
gestational diabetes
occurs during pregnancy btwn weeks 16 and 28
diagnosed w OGTT
if not responsive to diet, exercise, or oral medication, insulin injection therapy w be used
avoid concentrated sugars
usually disappear after infant is born
women who have had gestational diabetes have 35-60% chance of developing T2D
secondary diabetes
infrequent
caused by certain drugs or by disease of pancreas like steroid meds can increase blood sugars and client can develop steroid induced diabetes
treatments for diabetes
lose 7% of body weight
increase mod intensity physical activity to at least 150 min a week
control blood glucose levels
provide optimal nourishment for client
prevent symptoms and thus delay complications
diet alone or diet w insulin or oral guclose lowered medication plus regulated exercise and regular monitoring of clients blood glucose levels
dietitan for type 2 diabetes
ned to know client diets history, food likes and dislikes, and lifestyle
client cal needs depend on age, activities, lean muscle mass, size, and resting energy expendtirute
carb intake for diabetes
whole grains
veg
fruits
legumes
dairy products w emphasis on foods higher in fiber and lower in glycemic load should be advised over other sources esp those contain sugars
how much should sodium be limited
<2300 mg a day
treatment for T1D
nurtition plan that balances cal and nutrient needs w insulin therapy and exercise
meals and snacks be composed of similar nutrients and cal and eaten at reg time
small meals pus 2 to 3 snacks may be more helpful in maintaining steady blood glucose levels than 3 large meals
carb counting for pt w t2d
starch and bread category, milk and fruit placed under heading of carb
4 carb breakfast
protein for lunch and dinner
only 1 or 2 fat per meal
2 carb and 1 oz protein for evenignsnacks
given in terms of exchanges rather than as particular foods
high fiber
25-35 g of dietary fiber daily
increased fiber requires increased water intake
for clients dosing insulin based on g of carb, priotn of fiber may be subtracted (fi fiber content is greater than 5g half the grams of fiber may be subtracted from total carb for which client is doing)
sucralose
splenda
made from sugar molecule altered so body can t absorb
600x sweter than sugar
linked int to increased leukemia in mice in utero
Aspartame
equal nutrasweet
2 amino acids: phenylalanine, aspartic acid
200x sweeter than sugar
least desirable sweenter to use bc linked to cancer in rats and mice
Saccharin
350x sweeter than sugars
linked to bladder cancer in rodents
acesulfmae-potassium
equal original or equal spoonful
200x sweetre than sugar (used w sucralose or aspartame to cut bitterness )
two studies showed risk for cancer in rats
Advantame
20,000x sweeter than sugar
safe bc v small amount used in food
Neotame
8000x sweeter than sugar
no safet concerns by rarely used
Stevia Lead Extract
high purified
viewed as safe
whole-lead stevia or crude stevia not allowed in foods
alchohol and diabetes
if cnonsumed on empty stomach, may experiecne hypoglycemia
exericse and T2D
helps body use glucose by increasing insulin receptor sites and stimulating creation of glucagon
lowers cholesterol and bp and reduces stress and body fat as it toens muscles
helps improve wt control, glucose levels, and CV system
exercise and T1d
exercise can complicate glucose control
lowers glucose level = hypoglycemia
exogenous insulin
protein
must be injected bc if swallowed would be digetested
human insulin is most common; synthesized in lab similar to how pancreas makes it
- animal insulin are rarely used bc contain antibodies
for t1d 2 or more injections daily w more than one type of insulin (rapid vs long acting (for gen use regardless of meal))
insulin pump therapy
deliver insulin in 2 ways: basal rate and premeal bolus
basal; very rapid acting insulin delivered continuously throughout day (keep gucose in check btwn meals and during night)
premeal bolus; cover food eaten during meal
