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Pathophysiology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes Mellitus Type 1

A

Beta cells in islet of Langerhans (pancreas) do not work… destroyed… there is no more insulin produced +> must use insulin

 - NOT related to lifestyle, it is genetic or autoimmune (virus) 
 - Pts thin, young, + happen suddenly… ketones in urine
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2
Q

Diabetes Mellitus Type 2

A

Cells quit responding to insulin because of fatty deposits on receptors…’INSULIN RESISTANT’ glucose hangs in body… pancreas thinks you need insulin so it oversecretes insulin leading to hyperinsulinemia => metabolic syndrome

- Related to lifestyle…obese, sedentary, poor diet, genetic 
- Pts  overweight, happens over time, adult aged, rare to have ketones in urine
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3
Q

Gestational diabetes

A

Similar to type 2… `cells not receptive to glucose which occurs with pregnancy but usually goes away after birth

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4
Q

Insulin

A

“helps w/ high blood sugar levels”

Hormone: regulates amount of glucose in body

Secreted by BETA cells of pancreas (islet of Langerhans

Facilitates glucose into the cell

Stimulates liver to store glucose in the form glycogen

Signals to the liver to stop producing glucose

Enhances fat storage in adipose tissue

Promotes the transport of protein into the cell

Inhibits the breakdown of glucose, fats and proteins

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5
Q

Liver

A

Sensitive to insulin levels

Elevated blood sugar = elevated insulin in body absorb that extra glucose + store it as glycogen.

Low blood sugar = low insulin: release glycogen which turns into glucose to raise blood sugar

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6
Q

Glucose

A

“Sugar” body needs it to survive… fuels cells in your body BUT it cannot enter the cell without the help of INSULIN (stored in liver in the form glycogen)

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7
Q

Manifestations

A

Both type 1 & Type 2

“SUGAR”

  • Slow wound healing
  • BlUrry vision
  • Glycosuria
  • Acetone breath * (mainly in type 1)
  • Rashes on skin, Repeated yeast vaginal infection (yeasts love glucose)
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8
Q

Pathophysiology

A

• Body can NOT get access to the glucose you’re eating
- No insulin present or body is resistant to the insulin. There this leads to hyperglycemia

  • Glucose hangs out in the body + this affects major organs.
  • The body starts to metabolize FATS (TYPE 1) for energy OR there is just enough insulin so no fat metabolizing but carbs are not used (TYPE 2)
  • TYPE 1: Insulin inhibits glycogenesis from a protein source. Uncontrolled breakdown of fats which lead to ketone bodies
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9
Q

Complications

A

Hypoglycemia:
Organ problem
Diabetic ketoacidosis:
Hyperosmolar nonketotic syndrome:

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10
Q

Hypoglycemia

A

Blood glucose < 60 mg/dL
- Sweating, clammy, irritability, palpitations confused, lightheaded, dizzy, double vision… Remember: I’m sweaty, cold, clammy…give me candy!

  • Need SIMPLE carb (hard candies, fruit juice, graham crackers, honey) or if unconscious (can’t eat) IV D5OW
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11
Q

Organ problems

A

Atherosclerotic… glucose sticks to proteins of vessels… become hard + form plaques… heart disease, strokes, HDV, neuropathy, slow wound healing, eye trouble, infections

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12
Q

Diabetic ketoacidosis

A 
Type 1 (Rare in type 2) no insulin (no treating diabetes properly or 1st find out have diabetes) --> Burning ketones for energy --> acid enters blood --> acid/base imbalance  life threatening 
 	- Hyperglycemic, extreme thirst, * Kussmaul breathing, fruity breath
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13
Q

Hyperosmolar nonketotic syndrome

A

HNS: Type 2 ↑ BS w/o burning of ketones… just enough insulin… no fat burning
- Very dehydrated, thirsty, ↑ BS, mental status

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14
Q

Nursing Assessment

A

Polyuria: frequent urination
- ↑ glucose pulls H2O out of cells… “osmosis law” more H2O in blood… kidneys need to release… can’t cope w/ ↑ glucose (reabsorption) leaks out  glycosuria

Polydipsia: very thirsty… due to polyuria

Polyphagia: very hungry… body burning fats needs more energy

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15
Q

Nursing management

A

The Triangle of Diabetes Management

Diet, Medications, Exercise

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16
Q

Triangle of Diabetes Management: Diet

A

individualized based on activity level + medication treatment follow ADA (American Diabetic Association Diet)

  • Carbs (45% - 60%): grains, starchy vegetables (corn, potatoes), sweets, cookies, soda, dried beans, milk
  • Fats (<20%): limit saturated / trans fats = lard, gravies, whole milk, fatty meats (bologna/sausage), encourage healthy fats mono/poly saturated fats like avocados, olives, nuts
  • Proteins (15 – 20%): meats don’t ↑ glycemic index: meats = chicken, turkey, fish, plant-based brans, egg whites, low fat cheese
17
Q

Triangle of Diabetes Management: Exercise

A

Education: Check BS prior to exercising… <100 eat a small snack

  • Carry SIMPLE carbs (hard candy, fruit juice, honey)
    - S+S of low BS: swearing, clammy, confusion, lightheaded, double vision, tremors
    - If planning extended exercise check sugar prior, during _ after
    - If glucose > 250 w/ ketones in urine avoid exercising until normal
    - S+S of high BS (polyuria, polydipsia, polyphagia)
18
Q

Triangle of Diabetes Management: Medications

A

Oral medications (for type 2 diabetes when diet + exercise don’t work) and Insulin (for type 1)

Sulfonylureas “MOST COMMON”: Glyburide, Glipizide, Diabinese, Amaryl, Glucotrol, Diabeta

- These drugs end with “ides” 
- These stimulate beta cells to make insulin AVOID ETOH!!! Extreme hypoglycemia

Meglitinides: These ends with “glinide” e.g., Repaglinide.
- Stimulate beta cells. Take these w/ 1st bite of food

Biguanides: Metformin aka Glucophage

- Decreases liver's storage of glucose.
- Usually held 48 hrs. prior to surgery or heart Cath)… watch for renal function

Alpha-glucoside inhibitors: Precose, glyset
- lowers BS by breaking down starchy foods in gut * take w/ 1st bite of food

Thiazolidinedione (TEDs): “Glitazone, actos, avandia’
- Decreases glucose production in liver. Watch liver function, heart function ↑ risk of Mis

Referral: Ophthalmology, podiatry, dietician, diabetes educator

19
Q

Types of Insulin

A

Types of Insulin

“Ready Set Inject Love”

Rapid acting - Humalog, Novolog
Short acting - Humulin R, Novolin R
Intermittent acting - Humulin N, Novolin N
Long acting – Levemir, Lantus

20
Q

Peak duration of Rapid Acting Insulin

A

RAPID ACTING

“15 minutes feels like an hour during 3 rapid response”

onset: 15 mins
peak: 1 hours
duration 3 hours

21
Q

Peak Duration of Short Acting Insulin

A

SHORT ACTING

*Short - staffed nurses went from 30 patients 2 (to) 8 patients”

 onset: 30 mins
 peak: 2 hours
 duration 8 hours

22
Q

Peak Duration of Intermediate Acting Insulin

A 
INTERMEDIATE ACTING 
“Nurses play hero 2 (to) eight 16-year-old”
	onset: 2  hours
	peak: 8 hours 
	duration 16 hours
23
Q

Peak duration of Long Acting Insulin

A

LONG ACTING
“The two long nursing shifts never peaked but lasted 24 hours”

onset: 2 hours
peak: None
duration 24 hours

Pathophysiology (15 decks)

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