Diabetes Flashcards
Diabetes Mellitus (DM)
Condition in which body does not properly process food for use as energy. Pancreas makes hormone insulin to help glucose get into cells; in diabetics, body either doesn’t make enough insulin or cannot use its own efficiently. Causes sugars to build up in blood and toxins to build up from use of fats for energy.
Type 2 Diabetes
Adult onset. Non-insulin-dependent diabetes mellitus (NIDDM). Body does not produce enough insulin (or has insulin resistance) to counter high blood sugar levels. Might be manageable with diet changes/glucose monitoring. Accounts for 90-95% of cases. 21 million in US, and 27% of those over 65. Prevalent because risk factors are weight, exercise, diet, and stress (all common problems in this country). Cause unknown, but could be:
• Genetic factors
• Obesity
• Aging
Insulin’s Function
Insulin helps your body turn blood sugar (glucose) into energy. It also helps your body absorb/store it in your muscles, fat cells, and liver to use later, when your body needs it. Also affects other metabolic processes such as breakdown of fat or protein.
• Increases cellular transport of Glucose
• Converts Glucose to Glycogen (for storage in liver/muscles)
• Promotes cell growth
Gangrene
Gangrene develops when blood supply to an area of the body is interrupted.
People with diabetes have an increased risk of developing gangrene. This is because the high blood sugar levels associated with the condition can damage your nerves, particularly those in your feet, which can make it easy to injure yourself without realizing. A wound can be the start of gangrene.
High blood sugar can also damage your blood vessels, restricting the blood supply to your feet. Less blood means your feet will also receive fewer infection-fighting cells, so wounds will take longer to heal and are more likely to become infected.
Long Term Complications of Diabetes
Long term complications are blindness (from cataracts/retinal damage), renal (kidney) failure, nerve damage, atherosclerosis (hardened arteries), gangrenous infection (often requiring amputation).
2 Common Eye Diseases (list)
1) Age-related Macular Degeneration (AMD)
2) Diabetic Retinopathy (DR)
Age-Related Macular Degeneration (AMD)
Eye disease that can blur your central vision. Loss or blurring of central vision makes it harder to see faces, read, drive, or do ADLs. AMD happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye). Common condition—a leading cause of vision loss in older adults.
Diabetic Retinopathy (DR)
High levels of sugar in the eye’s blood vessels can make them swell/leak. As it worsens, bvs can become blocked so retina not getting oxy/nutrients. New bvs form to help, but they are fragile and can rupture/bleed, blocking light from reaching retina, causing blurred vision and floating spots; can lead to blindness if untreated.
Leading cause of blindness in those under 65. Control blood sugar to reduce risk by 76%, and slow it by up to 54%.
Damage to Central Retina
Diabetic retinopathy (DR) can cause retinal damage. Damage to central retina diminishes both high and low contrast visual acuity, impairing accurate identification of objects. Can be misdiagnosed as impaired attention or cognition.
Visual Acuity
Ability to discern shapes/details of the things you see. (One factor of overall vision.)
Low Vision
Low vision is vision loss that can’t be corrected with glasses, contacts or surgery. It isn’t blindness as limited sight remains. Low vision can include blind spots, poor night vision and blurry sight. The most common causes are age-related macular degeneration, glaucoma and diabetes.
Framework for Low Vision Interventions
1) Use of corrective lenses
2) Adequate lighting
3) Good ergonomic positioning
4) Increase contrast enhancement (high contrast type; mark edges of stairs)
5) Simplification of environment (reduce clutter)
6) Resize written materials
7) Provide sensory substitutes (rubber bands on doorknobs; talking books)
8) Restructure routines (use time of day with best light; use pill organizer)
9) Visual skills/referrals (see vision specialist)
Tx for Diabetic Retinopathy
In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.
In later stages, it’s important to start treatment right away — especially if you experience changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.
INJECTIONS: Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.
LASER TX: To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.
EYE SURGERY: If your retina is bleeding a lot or you have a lot of scars in your eye, your eye doctor may recommend a type of surgery called a vitrectomy.
Type 1 Diabetes
Juvenile onset. Less common (20%). Insulin-dependent diabetes mellitus (IDDM) - MUST take insulin since body doesn’t produce. “Brittle diabetes.” Immune system attacks insulin-producing cells in pancreas. Cause unknown, but could be linked to:
• Autoimmune response
• Genetic predisposition
• Inciting event
Obesity and DM
- Increases resistance of body to absorption of glucose
- Accumulation of fats around cells/liver decreases receptivity of body to metabolize glucose
- Results in deposition of glucose into bloodstream and eliminated through urine
