Diabetes Flashcards
What is pre-diabetes
- increased risk of diabetes
- higher blood glucose levels (100-125 mg/dl) but not high enough to be diabetes
- impaired glucose tolerance
- can sometimes be reversed or controlled before it becomes diabetes
- becoming more common in younger population
Type 1 diabetes
- 🚫 insulin production
- “insulin dependent” ‼️ rest of life
- autoimmune, the beta cells in pancreas are destroyed -> unable to produce insulin
Type 2 diabetes
- non insulin dependent
- body can produce insulin, the amount may be decreased or body may be “insulin resistant” where the body fails to respond to insulin it produces
Risk factors for type 2
- age >40
- obesity
- Family history
- gestational diabetes
- inactivity
- ethnicity ( American Indian, Hispanic, African American)
- metabolic syndrome
Metabolic syndrome
- A collection of Metabolic risk factors that accelerate the onset of diabetes
- includes high blood pressure high blood sugar excess body fat around the waist abnormal cholesterol levels
Gestational diabetes
- during pregnancy hormones cause increased insulin resistance, increasing blood glucose levels
- once placenta supersets from uterus after birth, glucose levels return to normal
Iatrogenic diabetes
- caused by treatment for another condition (medically induced)
- occurs when medical treatment results in increased blood sugar level
- most commonly cause by treatment with corticosteroids
Symptoms of diabetes
- 3P’s
- frequent urination POLYURIA
- frequent thirst POLYDYPSIA
- hunger POLYPHAGIA
- fatigue
- weight loss
- blurred vision
- slow healing of wounds
Diagnosing diabetes
- fasting blood sugars on 2 separate occasions
- 60-99 normal
- 100-125 prediabetes
- > 125 diabetes
Diagnosing diabetes part two
Glucose tolerance test (glycola test)
- baseline fasting blood glucose level obtained
- glucose is administered orally
- blood glucose levels drawn every hour for up to three hours to assess glucose metabolism
Diagnosing diabetes part three
- hemoglobin A1C
- Reflects blood sugar trends over approximately 120 days (average level for over 3-4 months)
- ## the higher the serum blood glucose level, the more glucose is bound to hemoglobin
A1C
Non diabetic= under 6
Good control for diabetic patient= 6-7
Poor control= over 7
Treatment for type 1 diabetes
- can’t be cured but can be treated
- dietary management-> small frequent meals with reduced amounts of carbohydrates
- insulin must be provided to regulate glucose metabolism
- insulin injections
- insulin pumps
- Early treatment of medical conditions such as infections is also important
Treatment for type two diabetes
STEP 1 = lifestyle modification through diet and exercise and weight management
STEP 2 = oral antidiabetic medication (monitor blood sugar) oral meds help insulin be used better
STEP 3 = addition of insulin therapy ( as they age)
Sliding scale insulin
- based on what the sugar is right now
- Manages increased BGL
- overage the already have
- based on sugars before the meal
Prandial insulin
Take care of what patient WILL eat “mealtime insulin/rapid acting”
Basal insulin
“Background insulin”
Long acting
Keeps levels constant
Oral anti diabetic medications
Work to decreased serum blood glucose by
- increasing pancreatic insulin release
- Enhancing cell sensitivity to insulin
Complications of diabetes
- heart disease and stroke
- High blood pressure
- Blindness
- kidney disease
- nervous system disease
- amputations
- dental disease
- Pregnancy complications
How to provide the best care
- provide education to patients about managing diabetes
- Provide diet appropriate for diabetic patients
- low fat
- low carbohydrates
- Calorie control based on American diabetes Association guidelines
- provide daily exercise
- Monitor laboratory values
- blood glucose levels
- hemoglobin A1C levels
- monitor weight
- monitor for hyper/hypoglycemia
- treat infections and other illnesses promptly
HYPERglycemia
- increased thirst
- headaches
- difficulty concentrating
- Blurred Vision !
- Frequent Urination !
- Fatigue 😴
- Weight Loss !
- Blood glucose more than 180
- Fasting blood glucose over 99
HYPOglycemia
- Sweating !
- Tremors !!
- Anxiety
- hunger
- dizziness !
- headache
- cloudy vision !!
- confusion!!!!
- abnormal behavior
- loss of consciousness
- serum blood glucose level below 60
Overall goals for managing patients with diabetes
- maintain weight to keep body mass index <25
- maintain normal blood sugar levels
- fasting = 60-99
- post prandial= < 140?
- maintain HgbA1C < 7
- prevent complications- wounds, infections, peripheral neuropathy, renal failure, etc
DKA symptoms
thirst frequent urination nausea abdominal pain weakness fruity-scented breath‼️ confusion.
DKA
It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic
Rapid acting insulin (bolus)
Covers insulin needs for MEALS EATEN at the same time as the injection and used with longer acting insulin
TYPES: humalog (LISPRO) novolog ( ASPART) apidra (GLULISINE)
given to manage post prandial blood sugar (sugar from a meal) and to manage transient hypoglycemia
ONSET: 5-15 mins
PEAK: 1hr
DURATION: 3 Hr
Short acting
Covers insulin needs for meals eaten within 30 to 60 minutes
- regular humulin ( novolin), velosulin ( for pump)
- regular insulin is the only insulin administered via IV route
ONSET: 30-60 mins
PEAK: 2hr
DURATION: 8h
intermediate acting
Covers insulin needs for about half the day or overnight and is often combined with rapid or short acting insulin
- NPH, lente
ONSET: 2hr
PEAK: 8hr
DURATION: 16 hr
Not predictable, may peek when blood sugar is at the lowest
Long acting (basal)
Covers insulin needs for about one full day and is often combined when needed with rapid or short acting insulin
- ultralente, lantus, levemir, detemir!
- provides a continuous basal rate to regulate blood sugar levels between meals
ONSET: 2hr
NO PEAK !!!‼️
DURATION: 24 hr
Sick day rules
- take meds no matter what
- monitor blood sugar 3-4 hr instead of 4-6 hr
- adjust carb intake to blood sugars levels ( BS down, increase carb) ( BS up, decrease carbs)
Foot care
1) wash feet w/ mild soap & warm water
2) pat feet dry
3) examine feet for cuts, swelling or redness
4) use lanolin on feet to prevent dryness
5) use mild foot powder on sweaty feet
6) don’t use commercial remedies for calluses or corns
7) clean cuts with warm water & mild soap -> cover w/ clean dressing
8) report infection to HCP
9) cut toenails evenly with rounded contour
10) separate overlapping toes with cotton
11) avoid open-toe, open-heel, high heels
12) wear clean, absorbent (cotton/wool) sock that have not been mended
13) don’t wear clothing that leaves impressions
14) don’t use hot water bottles/ heating pads to warm feet
15) guard against frostbite
16) exercise feet daily
Metformin ( glucaphage)
Most common for type 2 to help control blood sugar along with diet and exercise
Causes abdominal “stress” pain, diarrhea-> if they can stay with it, they should get used to it 4-6wk
Keep blood sugar levels below
200 to avoid damage to organs
Oral med for diabetes work in 3 ways
1) increase cell sensitivity to insulin
2) decrease glucagon release from liver
3) increase release of insulin
How long can a body withstand ketosis before damage
Body should not stay in ketosis for more than 2 weeks or it can lead to damage to the kidneys
