Chapter 27: MNT IN Diabetes Mellitus Flashcards
a chronic disease that occurs either when the pancreas do not produce enough insulin or when the body cannot effectively use the insulin it produces
diabetes mellitus
organ that produce insulin (beta cells of the langerhans of this organ)
pancreas
hormone that regulates blood sugar
an anabolic hormone synthesized by the beta cells of Langerhans of the pancreas, which facilitates the entry of glucose into the cells
insuin
or raised blood sugar
a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, esp. the nerves and blood vessels
hyperlgycemia
diabetes - types
previously known as insulin-dependent, juvenile or childhood onset
type 1 diabetes
characterized by deficient insulin production and requires daily administration of insulin
cause: unknown and it not preventable with current knowledge
type 1 diabetes
symptoms include excessive excretion of urine (polyuria), excessive thirst or drinking (polydipsia), constant hunger (polyphagia), weight loss, vision changes, and fatigue
*symptoms may occur suddenly
type 1 diabetes
diabetes - types
formerly non-insulin dependent or adult-onset
type 2 diabetes
results from the body’s ineffective use of insulin
comprises 90% of people with diabetes around the world and is largely the result of excess boy weight and PA
type 2 diabetes
symptoms may be similar to T1DM, but are often less marked
the disease may be diagnosed several years after onset once complication have already arisen
this type of diabetes was seen only in adults, but it is now also occurring in children
type 2 diabetes mellitus
is hyperglycemia with onset or first recognition during pregnancy
gestational diabetes
symptoms are similar to type 1 and 2 diabetes
most often diagnosed thru prenatal screening rather than reported symptoms
gestational diabetes
are intermediate conditions in the transition between normoglycemia and diabetes
people with IGT or IFG are at high risk of progressing to type 2 dm, although this is not predictable
this may cause large gestational-aged infants and hypertension
impaired glucose tolerance (IGT)
impaired fasting glycemia (IFG)
features of T1DM
characteristics: age, onset
type #: viral infection, onset
type 1
features of T1DM
characteristics: insulin required?
type #: yes
type 1
features of T1DM
characteristics: cell response to insulin
type #: normal
type 1
features of T1DM
characteristics: acute complications
type #: hyperglycemia with ketoacidosis
type 1
features of T1DM
characteristics: prevalence in diabetic population
type #: 5-10%
type 1
other names
IDDM
Juvenile-onset diabetes
ketosis-prone diabetes
brittle diabetes
type 1 diabetes
IDDM meaning for type 1 diabetes
insulin-dependent diabetes mellitus
features of T1DM
characteristics: age, onset
type #: obesity, hereditary, onset
type 2
features of T1DM
characteristics: insulin required?
type #: sometimes
type 2
features of T1DM
characteristics: cell response to insulin
type #: resistant
type 2
features of T1DM
characteristics: acute complications
type #: hyperglycemia without ketoacidosis
type 2
features of T1DM
characteristics: prevalence in diabetic population
type #: 90-95%
type 2
other names
NIDDM
adult-onset diabetes
ketosis-resistant
diabetes
stable diabetes
type 2
NIDDM meaning for type 2 diabetes
non-insulin dependent diabetes mellitus
diabetes - risk factors
blood uric acid: >7.0 mmol
hyperuricemia
diabetes - risk factors
urine albumin: >50 mg albumin/24 hrs
microalbuminuria
diabetes - risk factors
high density lipoprotein (HDL): <35 mg/dL or 0.90 mmol/l
dyslipidemia
diabetes - risk factors
triglyceride: 150 mg/dL (2.8 mmol/L)
dyslipidemia
diabetes - risk factors
total cholesterol: >200 mg/dL
dyslipidemia
diabetes - risk factors
previous IGT with oral glucose tolerance test 2-hr value _____ (7.7-11.0 mmol/l)
140-199 mg/dl
diabetes - risk factors
previous gestational diabetes, macrosomic, or large-for-gestational-age infant (_____/8kg lb birth weight); poor obstetrical history
3.7 kg
diabetes - risk factors
bmi of _____ (especially waist-to-hip ratio >1), or waist circumference >80cm for females and >90cm for males
> 23 kg/m2
diabetes - etiology
-beta-cell destruction usually leading to absolute insulin deficiency
-autoimmune
-idiopathic
type 1 diabetes
diabetes - etiology
may range from relative insulin deficiency to a predominantly secretory defect with or without insulin resistance
type 2 diabetes
diabetes - etiology
pregnancy hormones (placental lactogen, cortisol, prolactin, and progesterone) oppose the action of insulin
gastrointestinal diabetes
diabetes - diagnosis
plasma blood glucose _____ mg/dL both casual (random) or postprandial
> 200 mg/dL
diabetes - diagnosis
fasting blood sugar of _____ mg/dL
> 126 mg/dL
diabetes - complications
damage to the large blood vessels
macroangiopathies
diabetes - complications (macroangiopathies)
diabetes can increase the risk of _____ (CHD) by 300%
coronary heart disease
diabetes - complications (macroangiopathies)
_____ among diabetic starts early, progresses faster and is more widespread
atherosclerosis
diabetes - complications (macroangiopathies)
15% of diabetics will develop _____, and 50% will have recurrence within 2 years; 20% of people with ulcers will undergo amputation
foot ulceration
diabetes - complications
damage to the small blood vessels
microangiopathies
diabetes - complications (microangiopathies)
the damage to the blood vessel supplying blood to the eyes, causing impaired vision and, eventually, blindness
symptoms: blurred vision, black spots on vision, and fluctuating vision
diabetic retinopathy
diabetes - complications (microangiopathies)
deterioration of the nerve tissues; includes damage to the blood vessel, supply of blood to the hands and feet resulting in numbness, loss of sensation or “pins and needles,” carpal tunnel syndrome, and gastroparesis
neuropathy
diabetes - complications (microangiopathies)
damage to the blood vessel supplying blood to the kidneys, leading to impairment of kidney function, and eventually, kidney failure
diabetic nephropathy
results to uncontrolled production of ketones by the liver that leads to acidosis due to increased glucose production
diabetic ketoacidosis (DKA)
diabetes - characteristics (DKA)
hypoglycemia, metabolic acidosis (blood pH <_____), and positive ketones in the urine and blood
pH <7.35
diabetes - characteristics (DKA)
DKA is often associated with type 1 diabetes, but it may also occur in type 2 diabetes, particularly when associated with a major intercurrent illness
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diabetes - signs and symptoms (DKA)
-acetone odor of the breath
-nausea and vomiting
-diffuse abdominal pain (seen in 30% of patients)
-rapid breathing
-blurred vision
-
a syndrome of marked diabetic stupor, hyperglycemia, and hyperosmolarity in the absence of ketosis due to dehydration of brain cell
this is due to the osmotic pressure exerted by the significant amount of glucose in the blood, causing the withdrawing out the water from the cell; insufficient insulin, defective insulin in the cell
nonketotic hyperosmolar coma
nonketotic hyperosmolar coma - characteristics
occurs in elderly patients w/ or w/o history of t2dm and is always associated with severe _____
dehydration
nonketotic hyperosmolar coma - characteristics
_____ (2) often occur days to weeks prior to the presentation of the syndrome
polyuria and polydipsia
nonketotic hyperosmolar coma - characteristics
impaired _____ function, which prevents clearance of excess glucose in the liver
renal function
nonketotic hyperosmolar coma - characteristics
there is no metabolic acidosis due to the presence of circulating insulin and lower levels of counterregulatory hormones
-
death of tissue due to loss of blood supply, with or without bacterial infection
gangrene
nonketotic hyperosmolar coma - characteristics
overdose of insulin
insulin shock
nonketotic hyperosmolar coma - characteristics
depressed immune function
infection
diabetes - mgmt (medical)
medical drugs: 2 drugs for glucose control
insulin and/or hypoglycemic drugs
these drugs are more convenient, require lower insulin dose, have higher compliance, and show less weight gain
sometimes, are best taken with insulin
oral hypoglycemic drugs
oral hypoglycemic drugs - types
stimulate insulin secretion once or twice a day; may cause disulfiram reactions (nausea, vomiting, headache, and cramps associated with intake of alcohol); contraindicated against pregnancy, liver, and renal insufficiency
sulfonylurea drugs
oral hypoglycemic drugs - types
site of action of sufonylurea drugs
pancreas
oral hypoglycemic drugs - types
suppress glucose production, increase glucose uptake in the peripheral tissues
biguanides
site of action of biguanides
liver
oral hypoglycemic drugs - types
lessen insulin resistance; may cause dry mouth, contraindicated against tissue hypoxia (shock), acute blood loss, myocardial infarction, heart failure, pulmonary embolism, arterial circulatory disorders, consumptive diseases, severe generalized infection, and fasting states (less than 1kcal/day)
metformin and pioglitazone
metformin and pioglitazone site of action
fats and muscles as insulin synthesizer
oral hypoglycemic drugs - types
delay absorption of CHOs; hypoglycemic drug taken at the start of a meal; may cause diarrhea and abdominal pains
alpha-glucosidase inhibitors
alpha-glucosidase inhibitors site of action
gut
gestational diabetes - dietary mgmt
20% CHO at _____; no concentrated sugars, with snacks (including bedtime)
breakfast
_____ kcal.kg for pregnant women with BMI of 20 to 26 kg/m2
30 kcal/g
_____ kcal/kg for pregnant women who are obese prior to pregnancy
<30 kcal/g
gestational diabetes - dietary mgmt
_____ kcal/kg actual weight
24 kcal/kg
gestational diabetes - dietary mgmt
CHO: 35-45%
CHON: 20-25%
Fat: 35-40%
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