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chronic > chronic exam 1-diabetes > Flashcards

chronic exam 1-diabetes Flashcards

1
Q

beta cells produce

A

insulin

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2
Q

alpha cells produce

A

glucagon

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3
Q

functions of insulin

A 
lowers blood glucose by:
regulates rate of CHO metabolism
promotes glycogen storage
inhibits fats breakdown
inhibits protein breakdown
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4
Q

functions of glucagon

A

raises blood sugar by promoting conversion of glycogen to glucose

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5
Q

name of type 1 diabetes

A

IDDM (insulin dependent diabetes mellitus)

previously called juvenile diabetes

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6
Q

name of type 2 diabetes

A

NIDDM (non-insulin dependent diabetes mellitus)

previously called maturity onset diabetes

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7
Q

type 1 diabetes is characterized by

A

a total lack of insulin production

suggests an autoimmune process that destroys beta cells

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8
Q

type 2 diabetes is characterized by

A

an inadequate production of insulin or increased cellular resistant to the body’s own insulin

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9
Q

type 1 diabetes onset

A

faster onset
usually before 30yo but can occur at any age
tend to be normal weight

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10
Q

type 2 diabetes onset

A

slower onset
usually 35+ years but can occur at any age
tend to be obese

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11
Q

% of diabetics that are type 1

A

10-15%

insulin required by all

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12
Q

% of diabetics that are type 2

A

85-90%
increased familial predisposition
insulin required for 20-30%

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13
Q

clinical manifestations

A
  1. three P’s
  2. weight loss-cant breakdown glucose so it’ll breakdown fat
  3. fatigue/weakness
  4. blurred vision
  5. frequent infections-glucose harbors bacterial growth
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14
Q

three P’s

A

polydipsia-excessive thirst
polyphagia-excessive hunger
polyuria-excessive urination

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15
Q

fasting blood sugar

A

70-110 mg/dL

Diagnosis= FBS>126 on 2 different occasions

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16
Q

glycoslyated hemoglobin

A

Hgb A1C
Hgb molecules combine with glucose to from glycohemoglobin which is stored by red blood cells
the percentage of “glycosylated hemoglobin” can be measured by a blood test (4%-6%)
indicator od an individual’s glucose level for the previous three months

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17
Q

6 food groups

A 
Starch/Bread
Protein/Meat
Dairy/Milk
Fruits
Vegetables
Fats
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18
Q

distributions of calories

A

50-60% Carbs
20-30% Fats
20% protein

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19
Q

dietary considerations

A 
special foods are not necessary
alcohol promotes hypoglycemia
dont skip meals
do strive for regular meal times
do control fat
do use sugar substitutes (equal splenda etc)
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20
Q

net effect of exercise

A

lower blood sugar by transporting glucose into the muscle cell (must be aerobic exercise)

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21
Q

controlling type 2 diabetes

A

may be controlled with diet and exercise alone, or in combination with oral hypoglycemics

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22
Q

original source of insulin

A

beef and pork pancreas

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23
Q

persons using synthetic insulins….

A

have a lower risk of insulin resistance

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24
Q

rapid acting types

A

Humalog (lispro)

Novalog (aspart)

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25
Q

Short Acting types

A

regular

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26
Q

Intermediate acting types

A

NPH (cloudy)

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27
Q

Long acting types

A

Glargine (Lantus)

Detemir (Levemir)

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28
Q

onset peak duration of Rapid Acting

A

Onset: 10-15 min
Peak: 1 hr
Duration: 2-4 hr

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29
Q

onset peak duration of Short Acting

A

Onset: 1/2 hr-1 hr
Peak: 2-4 hr
Duration: 5-7 hr

30
Q

onset peak duration of Intermediate Acting

A

Onset: 2-4 hr
Peak: 6-12 hr
Duration: 18-24 hr

31
Q

onset peak duration of Long Acting

A

Onset: 3-4
Peak: none for lantus; 3-14 hr for detemir
Duration:24-36 hr

32
Q

insulin preparation

A

cloudy
clear
clear
cloudy

33
Q

insulin storage

A

keep vial at room temp
refrigerate spare vials
protect from extreme heat, freezing

34
Q

injection teaching

A

more rapid absorption from abdomen, then arms, then legs

35
Q

lipohypertrophy

A

fat accumulation which occurs at sites of frequent insulin injection

36
Q

injection rotation

A

rotate within each site, spacing injections 1 inch apart

do not se a site longer than a month

37
Q

sulfonylureas

A

Glucatrol, Glimepiride

Stimulates beta cells to produce insulin; increase cellular receptivity

38
Q

Meglitinides

A

Prandin

stimulates beta cells to produce insulin

39
Q

Biguanides

A

Glucophage

Increase cellular receptivity to insulin; decrease hepatic production of glucose

40
Q

Thiazolidinediones (TZDs)

A

Avandia, Actos

Decrease insulin resistance by increasing receptor sensitivity

41
Q

Alpha-glucosidase Inhibitors

A

Precose

Delay digestion of complex carbs

42
Q

Incretin Mimetics

A

decrease glucagon secretion from pancreas, increase insulin release

43
Q

DDP-4 Inhibitors

A

Inhibit enzyme that inactivates incretin

44
Q

Diabetic Ketoacidosis

A

usually occurs in type 1 diabetes
As a result of severe insulin deficiency, the body resorts to breakdown of fats and proteins since it cannot utilize glucose

45
Q

DKA pathophysiology

A 
ketone production (incomplete fat metabolism) 
acidosis
profound dehydration (due to osmotic diuresis)
Hyperkalemia (potassium shifts out of the cells)
46
Q

DKA causes

A

undiagnosed Diabetes
omitting insulin especially on sick days
not enough insulin in relation to a physical stressor

47
Q

DKA stressors

A 
cause a sympathetic response which mobilizes glycogen from the liver resulting in hyperglycemia
surgery
infection
trauma
illness
48
Q

DKA clinical manifestations

A 
3P's 
dehydration
tachycardia
hypotension
warm, dry skin
n/v
fruity breath
Kussmaul Respirations
49
Q

Kussmaul Respirations

A

increases rate and depth to blow off CO2 and raise pH

50
Q

DKA diagnostics

A

pH 350 mg/dL
positive serum acetone
positive ketonuria
potassium >5.0

51
Q

DKA management

A

IV fluids
IV insulin (regular only, continuous low dose)
IV K+ prn (as pH improves, K levels drop)

52
Q

DKA complications

A

hypovolemic shock
coma
death

53
Q

HHNK

A

hyperglycemic, hyperosmolar Nonketotic Coma
primarily occurs in T2Diabetes
insufficient insulin prevents ketoacidosis but not severe hyperglycemia

54
Q

HHNK causes

A

often the same precipitating factors as for DKA

55
Q

HHNK clinical manifestations

A 
severe hyperglycemia (>1000mg/dL)
severe dehydration
hypotension
tachycardia
hypovolemic shock leading to coma
56
Q

HHNK Management

A

Rapid IV fluid replacement to correct fluid deficit

continuous low dose infusion of regular IV insulin

57
Q

hypoglycemia (insulin reaction)

A

Most common type one diabetic’s related to insulin therapy with the rapid onset

58
Q

Causes of hypoglycemia (insulin reaction)

A

Excessive insulin, delayed or skipped a meal, alcohol usage, excessive exercise without calorie supplementation

59
Q

Clinical manifestations of hypoglycemia (insulin reaction)

A

Shakiness, palpitations, dizziness, anxiety, hunger, headache, confusion, irritable, fatigue, diaphoresis, may appear as if person is drunk

60
Q

management of hypoglycemia (insulin reaction) in conscious

A

orange juice
jam, honey
hard candy
“regular” soda

61
Q

management of hypoglycemia (insulin reaction) in unconscious

A

glucagon subQ

dextrose 50% IVP

62
Q

microvascular disease

A

Disease of the small blood vessels; more common in type one diabetics; includes retinopathy, nephropathy, and neuropathy

63
Q

Retinopathy

A

Diabetic retinopathy increases the risk of glaucoma (increased intraocular pressure) and cataracts

64
Q

Management of retinopathy

A

Slow the onset and progression buy near euglycemia (near normal blood glucose levels)
photocoagulation (laser therapy) to coagulate bleeding

65
Q

Nephropathy

A

Damage blood vessels become leaky allowing proteins to form deposits in the vessels
deposits decrease oxygenation resulting in death of kidney cells

66
Q

Management of nephropathy

A

Euglycemia (“normal” blood sugar levels)

dialysis or kidney transplant for end-stage renal disease

67
Q

Neuropathy

A

Deterioration of nerves due to nerve hypoxia

68
Q

sensorimotor neuropathy

A

bilateral and distal paresthesias characterized bu numbness, tingling, burning pain, or weakness

69
Q

autonomic neuropathy

A

can affect CV, GI, Urinary, or other function

70
Q

atherosclerosis

A

damage to blood vessels due to increased lipid and cholesterol levels with fatty plaque formation, increasing risk of coronary heart disease, HTN, MI

71
Q

home blood glucose monitoring

A

test 1-4 times a day (before/after meals)
keep diary of results
stress good control of FBS

72
Q

Sick Day care

A 
test BS q4hr
sip fluids q1hr
if vomiting, take regular soda or easily tolerated foods 
if BS> 300mg/dL, test urine for ketones
DO NOT skip insulin or oral medication

chronic (17 decks)

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