Diabetes Flashcards
Functions of insulin
- Transport and metabolize glucose for energy
- stimulate storage of glucose in the liver and muscle as glycogen
- signals liver to stop the release of glucose
- enhances storage of dietary fat in adipose tissue
- accelerates transport of Amino acids from protein into cells
- inhibits breakdown of stored glucose, protein, and fat
Prediabetes
- impaired fasting glucose or impaired glucose tolerance
- high risk for developing type 2
- teach s/s
- start modifications asap
Type 1
- manifestation do not appear for months to years until beta cells destruction is severe
- acute onset
- need insulin to survive
- honeymoon phase
Destruction of beta cells results in
- decreased insulin production
- increased glucose from liver
- hyperglycemia
- DKA
- ketones produced
Type 2
- gradual onset
- complications may be present before diagnosis
- at risk for HHNS
- decreased production of insulin
- insulin resistance
Type 2 risk factors
- family history
- obesity
- race
- age (over 40)
- BP (over 140/90)
- hx of gestation DM or baby born over 9lbs
- metabolic syndrome
Metabolic syndrome
- central obesity
- high blood pressure
- high triglycerides
- low HDL cholesterol
- insulin resistance
Manifestations of type 1
- rapid onset
- 3Ps
- weight loss
- weakness, fatigue
- later, possible ketoacidosis
Manifestations of type 2
- insidious onset
- may experience 3Ps
- fatigue
- recurrent infections
- recurrent vaginal yeast infections
- prolonged wound healing
- visual changes
Diagnosis of DM
- positive if meets one of four criteria
- A1C over 6.5
- FPG over 126 on 2 separate days
- OGTT over 200
- random glucose over 200
5 components of diabetic management
- nutrition/weight management
- exercise
- self monitoring glucose
- pharmacological therapy
- education
Diet teaching
- fiber decreases insulin requirements
- sugar free not really sugar free
- sweeteners in moderation
- limit saturated fats
- limit alcohol
Exercise management
- lowers glucose
- in areas uptake of glucose by muscles
- improves insulin utilization
- if at risk for hypoglycemia then CHO snack before or after exercise
- avoid vigors activity if BS over 250 with ketones
Diabetic vital signs
- normal serum glucose 70-100
- ADA target 70-130 or 180 after meals
Ketone testing
- tests in urine
- warning of a deteriorating control of BS
When to test for ketones
- BS persistently elevated (over 240 two times in a row)
- during illness
- pregnancy
- glycosuria is present
Pt education
- s/s of hyper and hypoglycemia, ranges, how to monitor
- how to admin injections, store insulin, pump insulin, take meds
- diet, exercise, risk factor management
- foot care
Sick Day Rules
S (sugar) check glucose every 2-3 hours
I (insulin) always take insulin even when sick
C (carbs) take in enough carbs and fluids
K (ketones) check blood or urine levels every 4 hours
When to call MD
- BS over 240
- vomit persistency
- temp over 102 with Tylenol
- persistent diarrhea
- disorientation/confusion
- unable to tolerate liquids
- rapid breathing (Kussmaul)
- illness lasts longer than 2 days
Acute care treatment
- blood glucose target range of 140-180
- insulin is preferred over oral meds to bring down BS
- insulin protocols are crucial for insistence and effectiveness
- scheduled glucose checks, meals, and insulin doses to encourage stability of levels
Which patients get glucose checks
- all pts with DM
- certain meds (steroids)
- pts on TPN
- pts with tube feedings
- pts excessively stressed from illness/surgery
Hospitalize patient challenges
- increase in hyperglycemia
- diet changes (npo, clear liquids, parenteral nutrition, enteral tube feeding)
- stress
Common complications of hyperglycemia caused by
- illness
- injury
- surgery
- stress
- non compliance
Common complications of hypoglycemia caused by
- alcohol
- exercise
- increase fiber
- diabetes meds
Hypoglycemia implications mild
- shaky/tremors
- pounding heart
- diaphoresis
- anxious
- chills
- hungry
Hypoglycemia implications moderate
- tingling
- blurred vision
- weakness
- slurred speech
- confusion
- irriational
- drowsiness
Hypoglycemia implications severe
- disorientation
- seizure
- stupor
- coma
- death
What to do for hypoglycemia if able to swallow
- 15 to 20 gym of simply CHO PO if able to swallow get a snack
- recheck in 15 min
- if less than 70 repeat snack
- if over 7- give high protein snack with starch or meal
What to do for hypoglycemia if not able to swallow
- if no IV give glucagon 1mg SQ or IM (roll on side for vomit)
- if IV present amp of D50W 25 or 50 IVP
- usually standing order
Hypoglycemia pt teaching
- know s/s
- carry simple sugar at all times*
- educate family, co-workers, ID bracelet
- medication interactions (beta blockers)
- when to call HCP
Macrovascular complications
- cardiovascular (pain, MI)
- cerebrovascular (increased risk of TIA/CVA, more like to die, hyperglycemia may mimic sx of CVA
- peripheral vascular (intermittent claudication, decreased pulses, decreased wound healing
Microvascular complications
- unique to DM
- affects micro circulation and retina
- diabetic retinopathy (no cure)
- can prevent it if not then slow progression
Nephropathy (microvascular)
- earliest sign is microalbuminuria (monitor urine)
- closely manage HTN (it will cause acceleration)
Diabetic neuropathy (microvascular)
- sensory: affects the peripheral nervous system often lower extremity
- s/s: numb, pain, burning, loss of sensitivity to touch and temp
- high risk for injury
- chariot’s joints: joint changes and foot drop
Diabetic neuropathies complications
- autonomic neuropathy: affect almost all of body
- can cause: orthostatic hypotension, ED/low libido, gastroparesis, GERD, urinary retention, diarrhea
Foot and leg problems
- 3 diabetic complications contribute
- neuropathy, PVD, immunocompromise
- always asses skin and pulses
- neuropathy, ischemia, sepsis, gangrene , amputation
Diabetic foot care
- proper bathing
- lubricate
- daily inspection
- check inside shoes
- closed toed and well fitting shoes
- clean socks
- avoid high risk behavior
- careful toenail cutting
- podiatrist as needed
- prompt HCP evaluation
