Diabetes Flashcards
Diabetes Mellitus
metabolic disorder characterized by the presence of hyperglycemia from defective insulin secretion, action or both
Metabolic syndrome
a collection of risk factors that increased an individuals chance of developing cardiovascular disease and DM
GERTH HTN Dyslipidemia Insulin resistance dysglycemia
DM Pathophysiology
Pancreas
- beta cells regulate insulin (increases cellular uptake of glucose)
- alpha cells regulate glucagon (increases release of glucose by the liver)
Type 1
Pancreatic beta-cell destruction, autoimmune response
= lack of insulin secretion
Typically <30yrs
cachexic appearance
Diagnosis is predisposed by stress
Insulin required for survival
Type 1 Manifestations
Polyuria Polydipsia Polyphagia Weight loss Ketonuria and Ketoacidosis
Type 2
Insulin resistance
- body tissues do not respond to action of insulin
- decreased responsiveness of beta cells to hyperglycemia
- decreased ability to produce insulin
Onset >45
Slow gradual onset
combination of environmental and genetic factors
Insulin may be necessary
Type 2 Manifestations
Weakness and fatigue Chronic blurred vision Recurrent infections neuropathic pain Weight gain
DM Goals of care
Reduce symptoms
Prevent and manage complications
Delay onset and progression
Attain a desirable body weight
Glycogen
Stored glucose in the liver and muscle
Glucose
Source of energy in the body
Glucagon
Strongly opposes the action of insulin (stimulates conversion of glycogen to glucose)
Gluconeogenesis
making glucose from non-carbohydrate sources
Glycogenolysis
glycogen breakdown to make glucose
Hyperglycemia symptoms
Polyuria
Polydipsia
Polyphagia
Hypoglycemia Symptoms
Diaphoresis, tremors, hunger, nervousness, anxiety, pallor, palpations
Irritability, visual disturbances, difficulty speaking, confusion, coma
Hypoglycemia Tx
Treat if BS <4mmol/L
Dysphagia = administer 13-20g simple carb
Diabetic Ketoacidosis (DKA)
Profound deficiency of insulin
hyperglycemia + dehydration
Cells are starved for glucose and fats are metabolized instead
Usually because of the mismanagement of DM lifestyle
S&S DKA
polyuria, polyphagia, polydipsia
Dehydration
N/V, abd pain, Kussmauls resps
BG > 14mmol/L
Ketones in blood and urine
DKA tx
HYDRATE!! (dilute glucose)
- bolus 1-2 L
- IV access
Insulin infusion
- 3-4 mls per hour
- need to be careful because you want to make sure to keep K in normal range
Maintain electrolytes
Hyperglycemic, Hyperosmolar, Nonketotic Syndrome (HHS)
occurs in pts able to produce insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis and ECG depletion
People with DM type 2
Chronic Complications of DM
Insulin resistance
Dyslipidemia and risk of vascular complications
Macrovascular complications (coronary artery disease, stroke, HTN, PVD
Microvascular complications (retinopathy, neuropathy, peripheral)
DM Care
A1C (optimal glycemic control) BP Cholesterol < 1.2 mmol/L Drugs (ACE inhibitors, statins, ASA if indicated) Exercise and Eating healthy
Screening for complications
Smoking cessation
Self management of stress and other barriers of self care
SMBG/Blood glucose testing
A way to monitor DM
- All people taking insulin or oral hypoglycemic meds
- before meals and after meals
- Keep accurate record of activities to compare rhythms of heart in comparison
Pharmacological management
oral antihyperglycemic agents
- sulfonylureas (glyburide) - increase beta cell production
- Biguanides (metfomin) - decrease glucose production by liver
Rapid insulin
onset: 10-15 minutes
peak: 60-90 minutes
Duration: 3-5 hours
Short acting insulins
onset: 1 hour
peak: 2-4 hours
Duration: 5-8 hours
Intermediate Acting insulins
onset: 1-3 hours
peak: 6-8 hours
duration: 12-16 hours
Extended Long acting insulins
onset: 1-2 hours
peak: none
Duration: 24 hours
Lispo, aspart
Rapid acting insulin
humulin R
Short acting insulin example
NPH
Intermediate acting insulin example
Lantis, levemir
Extended long acting insulin
SADMANS
Hold meds when dehydrated
Sulfonureas ACE inhibitors Diuretics and direct renin inhibitors Metformin Angiotensin receptor blockers Non-steroidal anti-inflammatories SGLT 2 Inhibitors
