Chp 14 Diabetes Flashcards
As of 2015 - percent of the US with DM
9.4%
2012 - US DM costs total
Direct
Indirect
$245 billion
$176 B direct
$69 B indirect
5 counter regulatory hormones to insulin
1) glucagon
2) epinephrine
3) norepinephrine
4) growth hormone
5) cortisol
Elevated depressive sx and/or depression affect how many pts?
1 in 4
Diabetes distress
emotional issues related to worries and burdens living with chronic disease – in the ABSENCE of depression
Hyperglycemia sx
Increased thirst, excessive urination, unusual fatigue, unexplained hunger, rapid weight loss, slow healing cuts and infections
What % of people have T1DM
5-10%
What % loss of body weight can reverse insulin resistance?
5-7%
Insulin resistance, 3 factors
1) overweight/obesity
2) physical inactivity
3) poor diet
WHR increased = 2.5x risk
Pre-diabetes defn
Where does it occur primarily, i.e. tissue
What percent Americans with it?
A state of relative insulin resistance
Muscle - limited capacity to store CHO
38%
DX criteria for DM - A1c, fasting glucose, oral GTT
Pre-diabetes A1c criteria
6.5% or higher
>126 mg/dL
2 hour value >/equal to 200
Pre-DM: 5.7-6.4%
Fasting glucose normal
Pre-DM levels
70-99 mg/dL
Pre-DM: 100-125 mg/dL
GTT pre-DM values, 2 hour post prandial
140-199 mg/dL
US Preventive Services Task Force recs for screening glucose (age related)
As part of a CV risk assessment, ages 50-70, AND overweight/obese
What tissues do DM meds target?
pancreas - increase insulin release
liver - decrease glucose output
muscles - more responsive to insulin
gut - slow down absorption of CHO and glucose
kidneys - releasing excess glucose in urine
Basal insulin meets what need in context to food?
covers NON food related insulin needs – covers background need through the day
Health and wellness goals for DM and preDM revolve around 4 points
Self mgt to —> lower insulin —> manage BG levels —> result in wt loss —> assist in keeping weight off
Other factors affecting BG
stress, hydration, hormones, and illness
Exercise - safety recs:
BG levels
Threshold (elevated) and warning signs
Range of 80-180
Above 250 okay IF no ketones are present
Stipulations for >300 mg/dL while exercising…..
no ketones present
CAN use caution at mild to moderate intensity until BG decreases
How to decrease risk for DM
1) weight control
2) physical activity @ least 150 minutes per week
3) medical nutrition therapy
4) f/u counseling
Losing ____ pounds improves insulin action, lowers systemic inflammation, reduces A1c, enhances HDL and lowers LDL, reduces risk of T2DM
What % of starting weight applies here?
10 pounds
5-7%
Rec activity levels
Duration: 150 minutes at least per week/ 75 minutes more intense (aerobic) —– 8-10 exercises, 1-3 sets, 10-15 reps (resistance)
Frequency: 3-7 days/week (aerobic) —– 2-3 days (strength)
When to refer
Evaluation and diagnosis info
Annual assessment
New cx factors
Transition of care
Lowering inflammation and risk of developing metabolic diseases…..(2 things)
1) eating more fiber
2) being active
