Diabetes Flashcards
Give a brief history of diabetes
Clinical features similar to diabetes mellitus described more than 3500yrs ago by ancient Egyptians .
•Indians/Arabs – had also described it , eg Avicenna , an arabian physician described among other things the complications – peripheral neuropathy, gangrene and erectile dysfunction
•Araetus of Cappodocia( 81-133AD)- named it Diabetes- TO SIPHON(named so cuz the people w Diabetes were urinating bunch as in they were losing fluid
•Thomas Willis – Britain ( 1675)- added Mellitus which means Sweet
Macleod and Collin isolated insulin
Insipidus means tasteless
What is diabetes
Explain how it occurs
Diabetes mellitus is heterogenous group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
Or it is a complex chronic metabolic disease and is associated with relative or absolute impaired insulin secretion
Along with varying degrees of peripheral resistance to insulin
So in a normal person, the pancreas produces jnsuoin and this insulin binds to insulin receptors on the cell to allow glucose to enter into the cell
In type 1 diabetes, the pancreas doesn’t produce the insulin in the first place so it can’t bind to the insulin receptors hence it stays outside in the blood.
In type 2, the pancreas produces but the cell doesn’t respond to the insulin produced properly so the insulin is there alright but the glucose is still in the blood.
Name five types of diabetes
How does phaeo cause high bp and dm
How do steroids cause high glucose
How does Cushing syndrome cause dm
ADA classification:
Type 1
•Type 2
•Monogenic diabetes
•LADA
•DM associated with endocrinopathies- acromegaly, cushings, pheo( catecholamines produced too much. Leads to high bp and One of the classical symptoms of pheochromocytoma crisis is hyperglycemia [1] that might be caused by increased insulin resistance in peripheral tissues and impaired insulin secretion [2]. ) ,glucagonoma
•Genetic syndrome- downs , turners syndrome, klienefelters syndrome
•Drug induced eg- steroids or glucocorticoids , post transplant medication, iv pentamidine
•Dx of exocrine pancreas- ca pancreas, pancreatitis, trauma, pancreatectomy, cystic fibrosis
•GESTATIONAL DM
Phaeo:
Catecholamines and a number of other hormones released during stress states contribute to the development of hyperglycemia by directly stimulating glucose production and interfering with tissue disposal of glucose.
Epinephrine causes a prompt increase in blood glucose concentration in the postabsorptive state. This effect is mediated by a transient increase in hepatic glucose production and an inhibition of glucose disposal by insulin-dependent tissues.
Norepinephrine (NE) and epinephrine (Epi) help maintain normal blood glucose levels by stimulating glucagon release(Insulin controls whether sugar is used as energy or stored as glycogen. Glucagon signals cells to convert glycogen back into sugar. Glucagon is a glucoregulatory peptide hormone that counteracts the actions of insulin by stimulating hepatic glucose production and thereby increases blood glucose levels.) , glycogenolysis, and food consumption, and by inhibiting insulin release.
Steroids:
How do steroids induce or bring on diabetes? Normally, the liver reduces the amount of glucose it releases in response to insulin. Steroids make the liver less sensitive to insulin so it carries on releasing glucose even if the pancreas is releasing insulin.
Steroids can increase your blood sugar level in different ways. They can:
cause the liver to release more glucose
stop glucose being absorbed from the blood by the muscle and fat cells
reduce the body’s sensitivity to insulin.
All these things can mean too much glucose stays in your blood. This can lead to diabetes.
Cushing’s syndrome is a condition in which can occur if you have high levels of the stress hormone, cortisol, in your blood. Cortisol increases our blood pressure and blood glucose levels and diabetes is one complication which can result from untreated Cushing’s syndrome.
State some characteristics of type 1 DM,which people does it usually occur in,what does it usually present w,state three antibodies that are identified in the blood of someone w type 1 DM
About 5 percent of all diabetics
•X’RISED BY cell mediated AUTOIMMUNE DESTRUCTION OF THE B CELLS
•USUALLY OCCURS IN CHILDREN
•HOWEVER ADULTS CAN ALSO HAVE TYPE 1- LADA
•USUALLY PRESENTS WITH DKA
•AUTOANTIBODIES IDENTIFIED INCLUDE- ICA, GAD65, IA-2A,
Type 1 is insulin dependent
Beta cells produce insulin so if it’s destroyed by antibodies there won’t be enough insulin
Type 1 continued
•Exact cause not known
•Associated with HLA DR/DQ
•MAY BE TRIGGERED BY VIRAL INFECTION
What is LADA and state the full meaning
Not a type of DM on it own
•Category to identify adults with Type 1 diabetes
•Associated with autoantibodies
Latent autoimmune diabetes of adulthood (LADA)
Explain type 2 diabetes
About 90-94% of all diabetics
•X’rised by insulin insensitivity and relative insulin deficiency
•Usually occurs in adults
•However due to childhood obesity, incidence increasing in children
•Usually associated with complications at the time of diagnosis
Name the characteristics of ominus octet
INSULIN RESISTACE IN THE MUSCLES- >POOR GLU UPTAKE
•INSULIN RESISTANCE IN THE LIVE-> OVERPRODUCTION OF GLU
•B CELL FAILURE
•INCREASE LIPOLYSIS
•INCREASE GLUCOSE ABSORPTION BY THE KIDNEYS
•INCRETIN DEFICIENCY/RESISTANCE
•INSULIN RESISTANCE IN THE BRAIN
•ALPHA CELL HYPERPLASIA> HYPERGLUCAGONOMA
State the differences between type 1 and type 2 diabetes
Type 1 the onset is sudden
Type 2 onset is gradual
Type 1 occurs at any age (mostly young people)
Type 2 occurs mostly in adults
Type One occurs in thin or normal people
Type 2 occurs in obese people
Ketoacidosis is common in type 1
It’s rare in type 2
Autoantibodies is usually present in type 1
It’s absent in type 2
Endogenous insulin is low or absent in type 1
It’s normal,decreased or increased in type 2
50percent concordance in identical twins in type 1
90 percent concordance in identical twins in type 2
Type 1 is less prevalent
Type 2 is more prevalent
90percent concordance
State the differences between LADA and type 2 diabetes
LADA-LOWER BMI
Type 2-INCREASED BMI
LADA-USUALLY NOT ASSOCIATED WITH Type 2-METABOLIC SYNDROME
ASSOCIATED WITH METABOLIC SYNDROME
LADA-NOT ASSOCIATED WITH POSITIVE FAMILY HISTORY
Type 2-POSITIVE FAMILY HISTORY
LADA-AGE OF ONSET 30-50YRS
Type 2-AGE OF ONSET >50 YRS
LADA-C- PEPTIC LEVELS ARE LOW
Type2-C- PEPTIDE LEVELS NORMAL OR HIGH
LADA-AUTOANTIBODIES PRESENT
Type2-AUTOANTIBODIES ABSENT
LADA-ASSOCIATED WITH SPECIFIC HLA –HLA DQB1
Type 2-GENETICS IS COMPLEX
State the two types under monogenic diabetes Mellitus
What is monogenic dm
What is MODY
1.Neonatal DM-What Is Neonatal Diabetes? Neonatal diabetes mellitus is a rare form of diabetes that occurs within the first 6 months of life. Our bodies need insulin to help our cells make energy. Infants with this condition do not produce enough insulin, which increases blood glucose levels.
2.MODY
Monogenic diabetes is a rare condition resulting from mutations (changes) in a single gene. In contrast, the most common types of diabetes—type 1 and type 2—are caused by multiple genes (and in type 2 diabetes, lifestyle factors such as obesity).
MODY stands for “Maturity-onset diabetes of the young” and was given that name in the past because it acted more like adult type of diabetes (Type 2 Diabetes) but was found in young people. MODY limits the body’s ability to produce insulin, but is different than the juvenile type of diabetes (Type 1 Diabetes).
Name four Characteristics of MODY
USUALLY OCCUR IN YOUNG INDIVIDUALS/ CHILDREN
•AUTOSOMAL INHERETANCE PATTERN
•MORE THAN 8 GENETIC MUTATIONS IDENTIFIED
•COMMON TYPES- HNF4B, GCK, HNF-1A ETC
•SOME OF THESE INDIVIDUAL ARE SENSITIVE TO SULPHANYLUREAS
Name the complications of DM
•TYPICALLY GROUPED INTO
•MICROVASCULAR COMPLICATIONS (small vessels)eg- nephropathy, retinopathy, NEUROPATHY
•MACROVACULAR COMPLICATIONS eg peripheral artery dx, stroke, myocardial infarction
•RECURRENT INFECTIONS- UTIs , SKIN INFECTIONS( FURUNCULOSIS, CELLULITIS ,FORNIER’S GANGRENE ETC)
If person is getting boils by heart check for diabetes
Hyperglycemia isn’t as dangerous as hypoglycemia but hypo is an emergency
True or false
True
Cortisol pushes sugar into the blood while insulin pushes sugar to the tissues true or false
True
CAUSE OF BLINDNESS IN ADULTS ( 20-70YRS)
•LEADING CAUSE OF NON TRAUMATIC LOWER EXTREMITY AMPUTATION
•ESRD ABOUT 20-30%
In DM true or false
True
What are the typical symptoms of insulin deficiency
Typical symptoms of insulin deficiency- polyuria, polydipsia, polyphagia, weight loss
•Take history of possible complications
How is DM diagnosed
What is the normal ,prediabetic and diabetic values or ranges for RBS,FBS,HbA1C,OGTT
FBS RBS use two or more values to determine if a person has diabetes
If the person has the classical signs of diabetes you can accept a high value of FBS or RBS checked once
FBS
3.9-5.5-normal
≥5.6-<7-prediabetes
>7-diabetes Mellitus
RBS
4-7.8-normal
≥7.8-<11-prediabetes
>11-diabetes Mellitus
OGTT
3.9-5.5-normal
≥7.8-<11-prediabetes
> 11-DM
HBA1C
<5.6-normal
≥5.6-<6.4-prediabetes
>6.5-DM
Name ten tests that are done in DM
FBC •BUE/CR •LFT RFT •HBA1C •UACR •LIPIDS •URINE R/E
- TEST FOR AUTOANTIBODIES-
- ICA- ISLET CELL CYTOPLASMIC ANTIBODIES
- GAD- GLUTAMIC ACID DECARBOXYLASE AUTOANTIBODIES
- INSULIN ANTIBODIES
- IA-2A- INSULINOMA ASSOCIATED-2 AUTOANTIBODIES
C PEPTIDE LEVELS
•GENETIC TESTS FOR SPECIFIC MUTATIONS
How is DM managed,pharmacological,non pharmacological
MULTIDICIPLINARY- •Dietician •Physical Therapist •Nurses •Clinicians •Ophthalmologists •Podiatrists
DRUGS or pharmacological
•ORAL HYPOGLYCEMIA DRUGS
•ORAL HYPOGLYCEMIC AGENTS- BIGUANIDES, TZD, SU, MEGLITINIDE, DPP4 INHIBITORS, GLP 1 AGONISTS, SGLT 2 ANTAGONISTS
•INSULIN-
- CONTROL OF HYPERTENSION
- CONTROL OF LIPID LEVELS
- SCREEN FOR EARLY ONSET OF COMPLICATIONS AND INSTITUTE APPROPRIATE CARE
FBS/GLUCOSE PROFILE •3-4 MONTHLY HBA1C •YEARLY LIPIDS •YEARLY UACR •YEARLY OPHTHOMOLOGIST REVIEW
It’s better to catch diabetes early at the pre diabetic stage true or false
True
Name some complications of diabetes Mellitus
Acute- hypoglycemia, hyperglycemia, hhs, dka
•Chronic- microvascular and macrovascular
What blood glucose value is considered as hypoglycemia
State four causes of hypo
And six symptoms of hypo
Blood glucose < 3.1mmol/l
•Mismatch of carbohydrate availability and hypoglycemic agents
Causes •Overdosage of insulin or hypoglycemic agents •Undereating •Unplanned exercise •Skipping or omitting meals •Stress / overexertion
Symptoms
Sweating •Lightheadedness •Tremors •Palpitations •Irritability/ behavioural changes/confusion •Yawning •Anxiety •Seizures •Comapermanent brain damage death
How is mild hypoglycemia managed
Give simple sugars p.o.(15gm of rapid acting sugar) Examples: -8oz of fruit juice 8oz of skim milk 3glucose tablets 3-4oz of regular soft drinks 3-4pieces of hard candy 1tbsp of sugar 5ml of pure honey
Ask patient to identify cause of hypoglycemia and try to avoid such incidents.
•Should carry fast sugar around
- Nil per os if confused or unconscious
- Should follow up with complex carbohydrate and proteins
15/15 rule
Explain the 15/15 rule
Should check blood sugar levels in 15min, if less than 5mmol/l, should repeat 15mg of sugar until normal levels is attained
•Contact medical care provider if the more than 3 hypoglycemic episodes per week
How is hypoglycemia managed in an unconscious patient
25mls -» of 50% dextrose till the patient is conscious
•Then set up 5% dextrose
Glucagon1mg subq,IM,IV follow with intravenous or oral carbs Action:hormone -raises BS levels Onset of 10 minutes Duration of 25minutes Position -side lying S/E: N/V
How is hypoglycemia considered gerontological
Cognitive defects - not recognize S and S
Decreased renal function-oral hypoglycemic meds stay longer in the body
More likely to skip a meal
Vision problems-inaccurate insulin draws
What are the nursing measures in hypoglycemia
Follow protocol Carry simple sugars at all times S and S or hypoglycemia How to prevent hypoglycemia Check FSBS if you suspect Encourage to wear ID bracelet Teach family that belligerence(hostile attitude and aggressiveness) is a sign of hypoglycemia
