Diabetes Flashcards
What is diabetes?
Either course leads to too much glucose in the bloodstream that over time can cause damage to multiple body systems and organs
Is a chronic, long-term condition that occurs either when the body cannot produce enough insulin (as in ___) or it can’t use the insulin it’s making effectively as it should (___)
Type 1; Type 2
Pathophysiology - Type 1 Diabetes Mellitus
Autoimmune process (insulin-producing ß cells of pancreas destroyed)
(?) Excess/lack of insulin
Quick onset
Total insulin deficiency develops within 1 year
Requires lifetime exogenous (from external source) insulin
“juvenile” diabetes
Can develop after a pancreatic resection
Lack
Pathophysiology - Type 2 Diabetes Mellitus
Defect at the cellular membrane
Insulin resistance; glucose is (?) released into / kept in the bloodstream
More insulin is needed to work effectively
Pancreas cannot keep up with the demand ⇒ leads to ß cell failure & disease progression
“adult onset”; have also seen in children d/t the obesity epidemic
Kept
In later stage of type 2, insulin declines & 30% of clients end up needing exogenous insulin
Labs Associated with Diabetes
Fasting Blood Sugar (FBS) or fasting blood glucose (FBG)
<100 mg/dL is normal
>126 mg/dL for a diagnosis of diabetes
120-126 mg/dL ⇒ prediabetes
Glucose Tolerance Test (GTT)
Give 75g of oral or IV glucose after FBS is drawn
Check blood glucose levels at specific intervals
At 1 hr, 2 hrs
Normal ⇒ 140 mg/dL or less
140-199 mg/dL ⇒ signifies impaired glucose tolerance or pre-diabetes
200+ mg/dL ⇒ diagnosis of DM in non-pregnant adult
Urine Glucose
Glucosuria
Urine Acetone (lower levels)
Ketones can be present in urine from other diseases like dehydration
Ketonuria
?
Glucose attaches to hgb for life of the RBC
↑ glucose = greater # of hgb that’s glycosylated
Reading reflects avg blood glucose levels for past 2-3 mos
Test 2x year if well-controlled & quarterly if poorly controlled
Glycosylated Hemoglobin A1C
Glycosylated Hemoglobin A1C
5.7 - 6.4 = ?
>6.4 = ?
pre-diabetes
diabetes
Clinical Manifestations (Signs & Symptoms)
? = increased thirst
? = increase in frequency of urination
Blurred vision ⇒ elevated glucose causes lens of eye to swell
Fatigue
Infection ⇒ immune system function decreases
? = increased appetite
More urination overnight, especially with type 1
Polydipsia
Polyuria
Polyphagia
Clinical Manifestations (Signs & Symptoms) cont’d
Vaginitis
Bladder infections
Poor wound healing d/t decreased peripheral circulation
Kidney disorders d/t damage from elevated glucose levels; damage vessels in the kidney
Impotence in men (inability to achieve erection or orgasm)
Type ___ = obesity; gradual onset of symptoms
Type ___ = weight loss; rapid onset of symptoms
2
1
Clinical Manifestations: Hyperglycemia
Polydipsia / polyphagia
Glycosuria / fruity breath (d/t ketone buildup excretion in the lungs)
Kussmaul’s respirations
Dehydration (electrolytes lost through kidneys w/increased urination)
Itchy skin / fatigue/lethargy / irritation
If not corrected, can progress to DKA, coma & death
Hot & dry = sugars high
Clinical Manifestations: Hypoglycemia
Headache (migraines) / blurred vision (d/t brain not getting enough energy) / diplopia
Drowsiness / ataxia (loss of muscle control)
Paresthesia / weakness / muscle spasms / tachycardia / palpitations
Tachypnea (rapid breathing) / hunger / nausea / diaphoresis (sweating)
Too much insulin
Too little food intake or delayed meal
Excessive exercise
70 mg/dL and lower
Alcohol
Rx’s like oral hypoglycemic agents
Diabetes Self-Management Education (DSME)
Physical activity (150 min/wk) moderate intensity, aerobic
Nutritional changes
Insulin
Oral antidiabetic agents
Self-monitoring blood glucose (SMBG)
Monitoring glycosylated hemoglobin A1C levels
* Team approach
* Education by a certified diabetes nurse educator
* Losing 5% of total body weight can reduce effects of diabetes significantly (in context of Type 2)
* Limit alcohol (it can cause delayed hypoglycemia)
* Best time for exercise is 60-90 min following a meal as that is when blood glucose levels will be highest
* Modified exercise programs for Type 1
Avoid processed foods & sugar-sweetened things
Carbs before workout
Protein
Fats (decrease mono-unsaturated; intake omega-3’s)
Learn about different macronutrients and their distribution
Carbs/fiber-containing carbs (whole grains, fruits, vegetables)
Carb-counting - especially for Type 1
15-20g of carbs; i.e. 4-6 oz fruit juice/glass of milk
Non-starchy vegetables (i.e. spinach, cauliflower, lettuce, broccoli, onions, peppers)
Lowfat proteins
Low glycemic index diet or low glucose control
> Low A1C by 5%
> Decreases hypoglycemic events
> Reduces incidence of microvascular complications
> Lowers LDL, increases HDL
> Reduces risk of cardiovascular disease
> Facilitates weight loss
> Oral, IV glucose
Insulin
* Used w/any type of diabetic diagnosis (most common in type 1 treatment)
* Majority of insulin is human insulin - few allergic reactions occur
* Administered subcutaneously or intravenously
* Only regular insulin can be given IV
?
Insulin dose that is shorter-acting; to cover needs for 1 meal or shorter period of time
Bolus
?
Insulin that is longer acting; injected 1 or 2x/day
Basal
___ Insulin
Longer-acting
i.e. NPH / Lantus / Novolog 70/30 / Levemir
Basal
___ Insulin
Covers 1 meal or 1 short period of time
i.e. Humalog, Novolog, Regular
Bolus
Oral Hypoglycemic Agents
* Used with Type ___ diabetes only!
Can often be discontinued once weight loss/loss of body fat occurs
Stimulates insulin release from the pancreatic beta-cells (Type ___ diabetics don’t have these), reduces glucose output from the liver, and increases the uptake of glucose in the tissues
Discontinued during acute hospitalizations and resumed after discharge
Common agents: ___, glipizide, glyburide, glimepiride, acarbose, and glitazones
2
1
metformin
Self-Monitoring Blood Glucose
Allows clients to try to normalize and stabilize blood glucose levels throughout the day
Amount and timing of checks can vary amongst individuals
Diabetes and Illness
Blood glucose levels can raise during acute illness
Acute illness can lead to diabetic ketoacidosis in Type ___ diabetes, and ___ in Type 2 diabetes
Increased risk for severe complications with vomiting, diarrhea, and fever
> Clients should monitor their blood glucose every 2-4 hrs until sx’s subside
1
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
?
Seen in type 1 diabetes
A life-threatening emergency
Most common causes include a decreased or missed dose of insulin, illness or infection, uncontrolled disease in a previously undiagnosed person
Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance
Treatment
Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) - Treatment
Provide supplemental insulin; fluid & electrolyte replacement
Monitored in an intensive care unit setting
Identify precipitating factor(s) & educate client
Which electrolyte is of especial importance to monitor?
Potassium (K+)
Hypo- & hyperkalemias can cause dysrhythmias ⇒ which can be fatal
Diabetic Ketoacidosis (DKA) - Dehydration ⇒ Acidosis ⇒ Electrolyte Imbalance
d/t fluid loss
Total fluid loss of 15% of total body wt isn’t unusual for DKA
Without insulin, glucose is unable to transfer into the cells
As glucose stays in plasma, it has an osmotic effect
Pulls H2O into intravascular space, causing cellular dehydration
Body then excretes H2O, glucose, & electrolytes in the urine
Problem d/t lack of insulin
Releases protein & fat from tissues to be converted into glucose by the liver
Fatty acids present here transition into ketones and this overwhelms the body, leading to ketonemia and ketonuria
?
Occurs in type 2 or older adults
Symptoms can be vague
A life threatening emergency
Four Signs:
Blood glucose level of ___ or greater
Absence of or slight ___ - lipolysis doesn’t occur so there’s no presence of ___ here
Plasma ___ (leading to)
Profound ___
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
600 mg/dL
ketosis; ketones
hyperosmolality
dehydration
Other Complications of Diabetes
?
Blurred vision r/t narrowing of vessels in the eyes b/c of increased amount of glucose in the plasma
Encourage frequent eye exams
Diabetic retinopathy
?
A paralysis of the stomach w/delayed gastric emptying
Alters absorption of food & leads to problems with glycemic control
Gastroparesis
?
Involves kidneys narrowing of blood vessels d/t overwhelming amount of glucose within the bloodstream
Affects gastric and intestinal motility; erectile dysfunction; bladder-, cardiac-, vascular tone
Diabetic nephropathy
?
Is a lack of sensation in the extremities (especially lower)
Leads to wounds on the feet
Diabetic neuropathy
