Concepts of Care for Patients with Diabetes Mellitus Flashcards
What is Diabetes? What body systems does it affect?
Chronic disorder of metabolism affects glucose. Affects every body system
What is the BIG focus of Diabetes management?
To prevent complications associated with diabetes
What is T1DM? What can cause it?
A condition in which no insulin is created, due to beta cells being destroyed. It can be autoimmune, viral infection, or idiopathic
What are s/s of T1DM?
Polydipsia, polyuria, weight loss, and fatigue
What are risk factors for T1DM?
Genetics and family history
What are some treatment options for a patient with T1DM?
Insulin injections or an Insulin pump
What is T2DM?
Progressive condition in which there is insulin resistance or deficiency
What are risk factors for T2DM?
Age, diet, physical activity, smoking, high BP, weight, etc.
What are some treatment options for a patient with T2DM?
Diet and exercise. Along with medications.
Why are patients prescribed a statin when on metformin or other diabetes medications?
To help lower cholesterol
What is prediabetes? And what is treatment options?
precursor to T2DM and diet and exercise is used as treatment
What is gestational diabetes (GDM)?
occurs during pregnancy and is related to hormones and insulin resistance
What are some indications for screening for Diabetes?
Older than 45, BMI > 25 or >23 in Asian Americans, Hypertension, HDL is less than 35, triglycerides are greater than 250, A1C is greater than 5.7%
What is metabolic syndrome?
Group of conditions that increase the risk for developing CVD, stroke, T2DM, or cause an early death
What are some features of metabolic syndrome?
Wasit circumference >35 (females) or >40 (males), blood glucose >100, Triglycerides > 250, and Hypertension
For diabetes diagnosis what the A1C?
A1C > 6.5%
For diabetes diagnosis what is the fasting glucose like? You will check the glucose level how many times?
Glucose level >126 and is checked TWICE
For diabetes diagnosis what is the random blood glucose like? You will check the glucose level how many times?
Glucose level >200 and is checked TWICE
What is the A1C usually like for patients with prediabetes?
5.7-6.4%
For pregnant patients taking the oral glucose test, what level determines GDM?
Glucose levels >140 2 hours post
What does insulin do?
It works to open the cell membrane allowing glucose to enter into the cell/blood
What is glucagon? What secretes it? How does it work?
Glucagon is used for energy when food intake is low (low glucose) to help maintain a normal BS. It is secreted by alpha cells in the pancreas
During fasting blood glucose is maintained at?
60-120 mg/dl
Besides insulin and glucagon, what is another hormone that regulates glucose? What does it do?
Incretin hormone like GLP-1, it works by stimulating the release of insulin and stop the secretion of glucagon by slowing the rate of gastric emptying
How could slowing gastric emptying help with lowering glucose levels?
Feel full much longer so you wont eat as much
Other hormones will increase blood glucose levels, what are those other hormones?
Epinephrine, norepinephrine, cortisol, and growth hormone
What are S/S of diabetes?
Polyuria, polydipsia, polyphagia, weight loss, blurry vision, feelings of pins and needles at the feet, fruity breath, n/v, reoccurring vaginal infections, dark spots around the neck
What is the goal A1C for a person with Diabetes?
7.0 %
What is a normal A1C?
< 5.7%
If someone has a higher A1C than normal, like patients with diabetes, what does this mean as far as complications?
Blood becomes thicker, which then leads to bad perfusion and that turns into slow healing
What are glucose goals for those with diabetes? Fasting goal and post meal goal:
Fasting: 80-130 and Post meal: <180
What happens when glucose remains in the blood, what happens to the blood?
Sticky cells are made along with thicker blood. They can cause blockages or clots that lead to MI’s, stroke, and/or peripheral artery disease
What happens to a person’s immunity when they have high blood glucose levels?
Immunity will decrease due to the lower count of WBC’s
What effect can high blood sugar have on the eyes?
It can cause diabetic retinopathy due to the damaging of the blood vessels
What is autonomic neuropathy?
There is damage to the nerves of the autonomic nervous system. It can cause orthostatic hypotension, syncope, GI problems, GERD, delayed gastric emptying, vomiting, anorexia
What is nephropathy?
Damage of the vessels in the kidneys due to high blood sugar. It will reduce kidney function and can lead to kidney failure.
Diabetes is the #1 cause of kidney failure? True/False
True
Diabetes can also lead to a lot of other issues including sexual and cognitive, what are these issues?
Men can have erectile dysfunction, women can have reduced vaginal lubrication, UTI’s and yeast infections are more common, and people can have memory issues, brain shrinkage.
What is DKA? Who is more likely to develop this?
Caused by the decrease of insulin, so Blood sugar will be come very high. Ketones are created. Someone with T1DM is more likely to develop this/
How fast does DKA occur and what are S/S?
DKA’s onset is abrupt. S/S include Kussmaul breathing, n/v, abdominal pain, acidic breath or fruity breath
What is the treatment for DKA? Does anything have to be monitored?
Treatment includes fluid resuscitation and insulin therapy. So giving saline and glucose. Make sure to monitor potassium levels
When giving treatment for DKA what is one thing you have to watch out for if you give them quickly?
Cerebral edema needs to be monitored for
What is HHS? What does blood glucose levels look like?
When blood glucose levels are extremely high for a long period of time due to osmotic diuresis. Blood glucose levels can be 600+ mg/dl
What is osmotic diuresis?
Increased urination due to substances like glucose. These substances create an osmotic effect that prevents their reabsorption in the kidneys
How does HHS differ from DKA?
HHS has little to no ketones being produced and is a gradual onset. While DKA produces ketones and has a abrupt onset
HHS is more commonly seen in what type of diabetes?
T2DM
In HHS serum osmolality is changed and that could lead to?
Neurological problems and a coma to occur is serum osmolality is > 350 mOsm/L
What is normal serum osmolarity?
270-300 mOsm/L
What is the treatment for HHS? What is the goal?
Fluid resuscitation is used due to being severely dehydrated. Normal Salines with monitoring of glucose and electrolytes are done. Goal is from glucose to decrease by 50-70 mg/dl per hour
What is hypoglycemia?
Low glucose or too much insulin. Blood sugar is low
What are s/s of hypoglycemia
Mimics stroke signs: sweating, pale, increased hunger, lack of coordination, sleepiness, irritability
What is the treatment for hypoglycemia?
Rule of 15 is used unless patient is unconscious, then you would use a glucagon kit
What things can help manage diabetes?
Nutrition therapy, regular exercise, stress management, and diabetes education
What can nutrition therapy help with?
Helps with weight loss, lower cholesterol, and improve BP
What are the physical activity guidelines for a diabetic?
Check glucose before working out: if lower than 100, eat some carbs and recheck. If higher than 200, DON’T exercise and check for ketones
When is drug therapy used for diabetics?
When non-medical interventions are not working
What is a SGLT2 inhibitor? What does it do? Give examples
It is a diabetes medication that helps lower blood glucose by stopping the reabsorption of glucose and sodium in the kidneys. Examples: empagliflozin, dapagliflozin, canagliflozin. TIP** MEDS END IN -FLOIZIN
What is metformin? What does it do? What is restrictions it has?
It is a diabetes medication that inhibits liver glucose production. It needs to be held if eGFR is <30 (kidney issue) or needs to be held 24 hours if having a IV contrast procedure. Can cause GI problems
What are GLP-1 agonists or incretin mimetics? What do they do? Give examples? What problems do they cause?
Works like GLP-1 to decrease glucose levels by inhibiting glucagon secretion and it delays gastric emptying. Semaglutide and Liraglutide. TIP** ENDS IN -IDE. Can cause GI issues
What is the goal of insulin therapy?
Goal is to replicate natural insulin release pattern from the pancreas
What are the different types of Insulin?
Long-lasting, intermediate, Short, and Rapid
What is Long-lasting insulin? How long does it last? What is its peak? Can it be given through and IV? Give an example
Long lasting insulin or basal insulin delivers small amounts of insulin throughout the day to help stabilize BS all day. Lasts 24 hours and has NO peak. It cannot be given through IV. Examples are Levemir and Lantus
What is Intermediate insulin? How long does it last? What is its peak? Can it be given through and IV? Give an example
Intermediate insulin is also a longer-lasting insulin, just not as long as Long-lasting. It lasts about 18-24 hours and peaks at around 4-12 hours. It cannot be given through and IV. Examples include: NPH and combination insulin
What is Combination insulin? Give Examples
They work as a basal and a mealtime insulin, cannot be given every meal though. Examples are 70/30 and 75/25
What is NPH?
An intermediate insulin that is used to cover BS between meals and to satisfy overnight insulin
What is Short-acting insulin? How long does it last? What is its peak? Can it be given through and IV? Give an example
Short- acting insulin is used to take before meals, usually 30 mins before. It can be used for IV’s and Insulin pumps. It has a duration of 12 hours and peaks at 2-4 hours. Example is regular insulin
What is Rapid- acting insulin? How long does it last? What is its peak? Can it be given through and IV? Give an example
Rapid acting insulin or mealtime insulin is used to lower BS fast after meals. Can be given 10 mins before meal. It lasts for 3-5 hours and peaks at 1-2 hours. It cannot be given through IV. Examples are Humalog and Novolog. TIP** ENDS IN -LOG
