Diabetes Flashcards
diabetes mellitus
a disorder of glucose metabolism r/t absent or insufficient insulin supply or poor utilization of the insulin that is available
insulin
allows uptake of cells into liver, muscle, and fat and is converted to glycogen to make energy
insulin is required for
glucose to make energy and for glucose to get into cells
insulin prevents
utilization of fat as an energy source
insufficient insulin
increases protein catabolism, increases production of glucose, decreases use of glucose, increases fat catabolism
DM type 1
absolute lack of endogenous insulin
DM type 1 is caused by
destruction of pancreatic beta cells
origin of DM type 1
autoimmune or idiopathic of origin
DM type 1 is most common before age of
30 years
DM type 1 has 3 classic onset symptoms
polydypsia, polyuria, polyphagia
without exogenous insulin _____ occurs
ketoacidosis
DM type 2
insulin resistance, decreased ability of pancreas to produce insulin, inappropriate insulin production in liver
risk factors for DM type 2
obesity, pre diabetes, advanced age, race/ethnicity, physical inactivity
DM type 2 is a metabolic disorder characterized by
- varying degrees of insulin resistance
- impaired glucose production by the liver
- impaired insulin secretion by the pancreas
- alteration in the production of hormones and cytokines by adipose tissue
diagnosis of DM
- fasting glucose
- hmg A1C
- random plasma glucose
- 2 hr oral glucose tolerance test
diabetes would be diagnosed if fasting plasma glucose (fpg) value is
fpg >/= 7.0 mmol/L
diabetes would be diagnosed if hmg A1C is
hmg A1C >/= 6.5%
diabetes would be diagnosed if random plasma glucose is
> /= 11.1 mmol/L with “classic symptoms”
diabetes would be diagnosed if 2 hr glucose tolerance test is (OGTT)
OGTT >/= 11.1 mmol/L
prediabetes impaired fasting glucose (IFG) = ____ and impaired glucose tolerance (IGT) = _____
IFG = 6.1 - 6.9 mmol/L
IGT = >/= 7.8 mmol/L but less than 11.1 mmol/L
anti diabetic drugs include
metformin, glyburide, pioglitazone, sitagliptin
insulin types
novrapid, humulin N, humulin R, lantus, humulin 70/30
nutritional therapy for type 2
emphasis on achieving glucose, lipid, and bp goals
- calorie reduction
nutritional therapy for type 1
meal plan based on individuals usual food intake and is balanced with insulin and exercise patterns
carbohydrates should be
45-65% of total energy intake
low carb diets are ______ for diabetics
not recommended
glycemic index
term used to describe rise in bg levels after consuming carbohydrate containing food
fats should compromise no more than ______ of meal plans total calories
25-30%
protein should contribute ____% of total energy consumed
<10%
acute complications of DM
hypoglycemic crisis
hyperglycemic crisis - diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolarstate (HHS)
most common diabetic complication
hypoglycemic crisis
hypoglycemic crisis
abnormally low bg level of <4mmol/L
OR below pts normal when they start showing signs of hypoglycemia
common predisposing factors for hypoglycemia
- excessive medication
- increased activity level
- lack of dietary intake
- critical illness
clinical manifestations of hypoglycemia
cool, clammy, diaphoretic, shaky
if hypoglycemic and unresponsive give
dextrose 50% in 50ml IVP and then recheck bg in 15 min
goal of pt management with hypoglycemic
rapid restoration of intravascular fluid levels and normal serum glucose levels
DKA results from
an absolute or relative deficiency in insulin
characteristics of DKA
- uncontrolled hyperglycemia
- ketosis
- metabolic acidosis
DKA most often occurs in
type 1, sometimes type 2, <45 years
precipitating factors for DKA
- any condition or situation that increases insulin deficit
- infection is most common factor
- psychologic stress
clinical presentation DKA
- hyperglycemic; increase in glucose >17mmol/L, increase urine glucose
- ketosis; increase serum and urine ketones
- ketone “fruity” breath
- osmotic diuresis
osmotic diuresis
- hypotension
- polyuria and polydypsia
- dehydration - increase serum BUN and creatinine
- electrolyte alterations - increase serum osmolality
hyperosmolar hyperglycemic state (HHS)
results from insulin deficiency and insulin resistance
characteristics of HHS
- extreme hyperglycemia
- osmotic diuresis
- neurological alterations
- absence of ketosis
clinical manifestations HHS
- fewer symptoms than DKA
- bg levels high
- increase serum osmolality = increase neurological manifestations
precipitating factors DKA
- infection
- inadequate fluid intake
- impaired thirst sensation
- functional inability to replace fluids
- increasing mental depression and polyuria
usual bg in pt with DKA
> 13.9 mmol/L
usual bg in pt with HHS
> 33.3mmol/L
management of hyperglycemic crisis
1) restore intravascular fluid volume
2) correct electrolyte imbalances
3) clear ketones and correct acidosis
4) normalize serum glucose
5) monitor pts status
6) prevent further complications
7) identify precipitating cause
what is given to correct hydration status and serum Na level
IV fluids - 0.9% NaCl
what can high or low potassium levels cause
arrhythmias
what labs are looked at to assess kidney and electrolyte status
glucose, BUN, and creatinine, and all electrolytes
types of insulin therapy in management of hyperglycemic crisis
continuous low dose IV insulin infusion
- sc insulin
- sliding scale insulin
- intensive insulin therapy
Long term consequences of diabetic crisis’
- end-organ disease resulting from damage to the blood vessels - angiopathy
- macrovascular complications
- microvascular complications (retinopathy (eyes), nephropathy (kidneys), dermopathy (skin, shin spots))
