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Common Hlth: Final > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes

A

Chronic multi system disease related to abnormal insulin production, impaired insulin utilization, or both

Pre-diabetes – Glucose is high, but not yet high enough to be diagnosed with DM

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2
Q

Complications

A

Diabetic complications/comorbidities:
1. HTN and CVD

  1. Stroke and MI
  2. Kidney disease (nephropathy)
  3. Diabetic retinopathy
  4. Complications of feet and lower extremities, amputations
  5. Infection
  6. Psychological considerations – increased risk of disordered eating behaviors
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3
Q

T2DM (90-95%)

A

Alterations:
1. Pancreas – Defective beta cell secretion of insulin; resistance stimulates increased insulin secretion and exhaustion of beta cells

  1. Liver – Inappropriate regulation and production of excess glucose
  2. Adipose tissue – Altered production of adipokines (role in glucose and fat metabolism)
  3. Muscle – Defective insulin receptors, insulin resistance, and decreased uptake of glucose
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4
Q

Clinical manifestations

A

CM of T1DM:

  1. Onset is rapid, acute manifestations
  2. Polyuria, polydipsia, polyphagia
  3. Weight loss
  4. Weakness, fatigue
  5. DKA

CM of T2DM:

  1. Nonspecific
  2. Polyuria, polydipsia, polyphagia
  3. Fatigue
  4. Recurrent infections
  5. Recurrent vaginal yeast infection or candida infections
  6. Prolonged wound healing
  7. Visual changes
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5
Q

Diagnostic tests

A

A1C >6.5%

FBG >126 mg/dl

Glucose tolerance test >200mg/dl (after 2 hrs.)

Classic symptoms of:

  1. Hyperglycemia – polyuria, polydipsia, unexplained weight loss
  2. Hyperglycemic crisis – RBG >200 mg/dl
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6
Q

Medical management

A

T1DM:

  1. Lifestyle – diet (45-60g carbs./meal) and increasing exercise
  2. Drug therapy – insulin (IV, insulin pump, basal/bolus)
  3. Monitor for complications

T2DM – similar to T1DM

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7
Q

Nutrition

A

Options:
1. Reducing fat intake

  1. Encourage carbs. with low glycemic index
  2. Restricting the total amount of dietary carbs. (45-60g/meal)
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8
Q

Pharmacologic management

A

T1DM (Insulin management) – short, intermediate, rapid, and long-acting

T2DM:

  1. Insulin – during acute periods of distress
  2. Other meds.: Sulfonurea (glyburide), Biguanide (metformin), alpha glucosidase inhibitor (acarbose, miglitol), and thiazolinediones (rosiglitazone)
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9
Q

Monitoring symptoms

A

Hypoglycemia (BG <70 mg/dl):

  1. Faintness, dizziness
  2. Rapid heartbeat
  3. Hunger
  4. Nervousness, tremor
  5. Changes in vision
  6. Unsteady gait, slurred speech
  7. Seizures, coma

Hyperglycemia:

  1. Weakness, fatigue
  2. Increased urination
  3. Glycosuria
  4. Abdominal cramps, N/V/
  5. HA
  6. Blurred vision
    * *Correction: Notify provider, give insulin as ordered and monitor closely
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10
Q

Nursing management

A

Monitoring pts for S/S of hyper/hypoglycemia

Management of nutrition

Pharmacologic management

Prevent complications

PT EDUCATION:
1. Exercise – moderate intensity aerobic activity (30 min./5 days a week); glucose lowering effects can happen up to 48 hrs. after activity (recommend exercise 1 hr. after meal or 10-15g carb. snack to prevent hypoglycemia)

  1. Nutrition
  2. Medications
  3. Self-monitoring – BG, skin, dental hygiene, wound healing
  4. Knowing when to call their PCP – impaired wound healing, vision changes, BG too low/high

**Care coordination – nutrition, PCP, pharmacy, family

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11
Q

Basal and bolus insulin

A

Basal – long-acting (Glargine, Lantus) regardless if they had a meal, going to surgery, or NPO

Correctional (fingerstick prior to meal) and nutritional (must eat 1/2 carbs.) insulin given immediately after meal

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12
Q

Prevention of complications

A

Treat DM to prevent:
1. ANGIOPATHY – Treat with tight glucose control to prevent damage to BVs due to chronic hyperglycemia (it is the leading cause of diabetes-related death; macro- and microvascular)

  1. Blindness
  2. Cataracts
  3. Charcot joints
  4. Damage to arterial walls
  5. Gangrene (wound healing)
  6. Glaucoma
  7. Nephropathy
  8. Osteoporosis
  9. Peripheral neuropathy
  10. Alzheimer’s and vascular dementia
  11. Hearing impairment
  12. Stroke
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13
Q

Angiopathy: Macrovascular

A

Disease of large and medium-size vessels – Presents as: CVD, cerebrovascular disease, PVD

Happens in populations with uncontrolled diagnosis in relation to hyperglycemia, excess fatty acids and insulin resistance

Decrease risk factors (yearly screening):

  1. Obesity
  2. Smoking
  3. HTN
  4. High fat intake
  5. Sedentary lifestyle
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14
Q

Angiopathy: Microvascular

A

Thickening of vessel membranes in capillaries and arterioles

Presents as:
1. Retinopathy – annual eye exam

  1. Nephropathy – BUN, Cr., GFR, creatine clearance; and urine microalbumin
  2. Peripheral neuropathy – monofilament testing; Report tingling/loss of sensation and monitor extremities closely
  3. Autonomic neuropathy (affects all body systems) – i.e. Gastroparesis; postural hypotension, resting tachycardia, painless MI; sexual function (erectile dysfunction, decreased libido, increased vaginal infections); neurogenic bladder (urinary incontinence)
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15
Q

Wound healing

A

Defect in mobilization of inflammatory cells and impaired phagocytosis = Recurrent or persistent infections

Treat quickly and aggressively

Prevent by:

  1. Hand hygiene
  2. Flu vaccine
  3. Early detection
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16
Q

Exercise and caloric output

A

Caloric output:
1. LIGHT (100-200 kcal/hr) – driving, fishing, teaching, secretarial work, light housework

  1. MODERATE (200-350 kcal/hr) – active housework, cycling, bowling, dancing, gardening, walking briskly
  2. HIGH (400-900 kcal/hr) – aerobic exercise, hard labor, ice skating, soccer, running, chopping wood
17
Q

Nutrition plan

A

CARBOHYDRATES (130g/day minimum or 45-60g/meal) – fiber 25-30g/day, non-nutritive sweetness, and low glycemic index

PROTEIN – 15-20% total calories

FAT – <7% total calories, limit trans. fat, and >2 servings of fish/week (polyunsaturated fats)

ETOH – 2 drinks/day (men) and 1 drink/day (women)

**15g of carbs. = 1 small piece of fresh fruit (4 oz.), 1 cup of canned/frozen fruit, 1 slice of bread/tortilla, 1 cup of oatmeal, 1/3 cup of pasta/rice, 4-6 crackers, 1/2 English muffin/hamburger bun, 1 cup of black beans/starchy vegetables, or 1/2 serving of medium French fry

18
Q

Glycemic index

A

LOW GI (<55):

  1. 100% stone-ground whole wheat or pumpernickel bread
  2. Oatmeal, oat bran, muesli
  3. Pasta, converted rice, barley, bulgar
  4. Sweet potato, corn, yam, lima/butter beans, peas, legumes, and lentils
  5. Most fruits, non-starchy vegetables, and carrots

MEDIUM GI (56-69):

  1. Whole wheat, rye, pita bread
  2. Quick oats
  3. Brown, wild, basmati rice, couscous

HIGH GI (>70):

  1. White bread or bagel
  2. Corn flakes, puffed rice, bran flakes, instant oatmeal
  3. Shortgrain white rice, rice pasta, macaroni and cheese mix
  4. Russet potato, pumpkin
  5. Pretzels, rice cakes, popcorn, saltine crackers, melons, and pineapples

Common Hlth: Final (14 decks)

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