Diabetes Flashcards
When glucose levels increase
- insulin is released by beta cells in the islets of Langerhans in the pancreas.
- (Insulin has a hypoglycemic effect)
When glucose levels decrease
- glucagon is released by the alpha cells in the islets of Langerhans in the pancreas.
- Glucagon has a hyperglycemic effect
how does insulin work
- pancreatic islets have ß cells that make insulin
- insulin causes the body cells to take in glucose when glucose levels are high. (ie after eating)
- insulin binds to receptor sites to open glucose channels
- glucose enters the cells and is used to make ATP
- too much glucose and it gets stored as glycogen (by liver/muscle) or turned into fat
↑ insulin after a meal does what
Stimulates storage of glucose as glycogen in liver and muscle
Inhibits gluconeogenesis
Enhances fat deposition
↑ protein synthesis
Classic symptoms – the 3 P’s
of diabetes
Polyuria
Polyphagia
Polydipsia
Symptoms of DM type I
- Polyuria (frequent urination)
- Polydipsia (excessive thirst)
- Polyphagia (excessive hunger)
- Weight loss
- Weakness
- Fatigue
Type 1 DM Onset
• Long preclinical period
• Antibodies present for months to years before symptoms occur
• Manifestations develop when pancreas can no longer produce insulin.
> Rapid onset of symptoms
> Present at ED with ketoacidosis
Four major metabolic abnormalities in type 2
1) Insulin resistance
2) Pancreas has decreased ability to produce insulin
3) Inappropriate glucose production from the liver
4) Alteration in production of hormones and adipokines,
Type 2 onset
- Gradual onset
- Person may go many years with undetected hyperglycemia
- Osmotic fluid/electrolyte loss from hyperglycemia may become severe.
- Hyperosmolar coma
Symptoms Type 2
- Nonspecific symptoms
- Fatigue
- Recurrent infection
- Recurrent vaginal yeast or monilia infection
- Prolonged wound healing
- Visual changes
Symptoms of Diabetic Ketoacidosis (DKA)
Dry mucous membranes Rapid and weak pulse Orthostatic hypotension Restlessness, lethargy, confusion Sweet, fruity breath odor (from ketones) Kussmaul’s respirations (deep and labored breathing to decrease [acidic] carbon dioxide levels)
Four methods of diagnosis of diabetes
1) A1C ≥ 6.5%
2) Fasting blood glucose level ≥7 mmol/L
3) Random or casual plasma glucose measurement ≥11.1 mmol/L
4) Two-hour plasma oral glucose tolerance test (OGTT) level ≥11.1 mmol/L when a glucose load of 75 g is used
Goals for DM
- Assuming responsibility for actively managing diabetes
- Maintaining a fasting blood glucose level <125 mg/dL
- Maintaining a hemoglobin A1c level <6.5%
- Preventing complications
- Committing to lifestyle modifications
Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of long-term complications
Caring for DM patients
- Monitoring blood glucose levels before meals and before bedtime
- Administering glucose-lowering agents (GLAs): insulin and/or oral agents (OAs) as prescribed
- Providing food choices for the patient that take into account any dietary restrictions
- Assessing for complications, including hypo- and hyperglycemia
- Providing foot care and assessing for diabetic foot ulcers
- Assessing incisions and wounds for signs of infection
the Rule of 15.for hypoglycaemia
- Administer a fast-acting carbohydrate source (15 g).
- Recheck the blood glucose level in 15 minutes.
- If the blood glucose level is still <70 mg/dL, administer another 15 g of carbohydrates.
- When the blood glucose level is >70 mg/dL, follow up within 15 minutes with a long-acting carbohydrate.
- Recheck the blood glucose level in 1 hour.
Symptoms of Hyperosmolar Hyperglycemic Syndrome
Urinary tract infections Pneumonia Sepsis Any acute illness Newly diagnosed type 2 diabetes
DM diagnostic tests
- HgbA1c ≥6.5%
- FPG level ≥126 mg/dL (7.0 mmol/L) c
- plasma glucose level ≥200 mg/dL
- random plasma glucose value ≥200 mg/dL
Insulins differ with regard to
- Insulins differ with regard to onset, peak action, and duration.
- Characterized as rapid-acting, short-acting, intermediate-acting, long-acting
Problems with insulin therapy
- Hypoglycemia – low blood sugar
- Allergic reaction
- Lipodystrophy – scarring/fat/lumps under skin
- Somogyi effect and Dawn phenomenon
Examples of Oral Agents
- Sulphonylureas – increase insulin production in pancrease
- Meglitinides – increase insulin production from pancrease (
- Biguanides – (metaphormin) reduced glucose production by liver.enchanges glucose sensitivity at tissue levels and improves glucose transfer into cells
- α-Glucosidase inhibitors - starch blocks. They slow absoption of carbs
- Thiazolidinediones – improve insulin sensisitivity and transport
Nutritional Therapy for DM
Fats
Reduce combined saturated fats and trans-fats to less than 7% of energy intake.
Carbohydrates
Sugars, starches, and fibre
Carbohydrate allowance: less than 10% of daily energy should come from sucrose (sugar)
Protein
Contribute 15% to 20% of total energy consumed
Intake should be significantly less than in the general population (i.e., limit of 15%)
How alcohol effects DM
High in calories promotes, hypertriglyceridemia, can cause hyperglycemia. Alchool inhibits breakdown of glycogen by the liver which leads to hyperglycemia
How does exercise effect DM
- ↑ insulin receptor sites
- Lowers blood glucose levels
- Contributes to weight loss
- Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia.
- Best done after meals
DM with Older adults
- Prevalence increases with age.
- Presence of delayed psychomotor function could interfere with treating hypoglycemia.
- Must consider client’s own desire for treatment and coexisting medical problems
- Recognize limitations in physical activity, manual dexterity, and visual acuity
