Diabetes

Question 1

Is type 1 or type 2 more common in Canada?

Answer 1

Type 2 (90%), Type 1 (10%)

Question 2

3 factors for why the prevalence of diabetes is increasing

Answer 2

1. Obesity from poor diets
2. Population is aging
3. More sedentary lifestyles

Question 3

When was an insulin injection first used and who discovered it?

Answer 3

1922 - Banting

Question 4

Describe DM

Answer 4

A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, action, or both.

Question 5

How long do you fast before taking a FPG (fasting plasma glucose)?

Answer 5

8 hours

Question 6

Describe gestational diabetes

Answer 6

Effects the growth of babies, larger because they are getting too much sugar. 1st recognized during pregnancy.

Question 7

Describe secondary diabetes

Answer 7

Health conditions or medications bring on secondary diabetes. ex, pancreatic or endocrine diseases

*not the same as Type 2 diabetes which is caused by lifestyle factors

Question 8

Primary prevention for type 2 diabetes

Answer 8

Diet (leads to insulin resistance), exercise, HTN, dyslipidemia

Question 9

What cells secrete insulin in the pancreas?

Answer 9

Beta cells

Question 10

What cells secrete glucagon in the pancreas? Function of glucagon?

Answer 10

Alpha cells. Glucagon increases stored glucose release by the liver when there is low glucose.

Question 11

3 other hormones that increase blood glucose

Answer 11

Stress hormones increase blood glucose:
1. EP
2. Cortisol
3. Growth hormones

Question 12

When are manifestations of type 1 diabetes seen?

Answer 12

When 80-90% of normal beta-cell function is destroyed

Question 13

Describe Type 1 Diabetes and 2 possible causes

Answer 13

• lack of insulin secretion
• autoimmune process as the body destroys its own beta cells
• possible causes: genetic predisposition of the immune disorder, virus

Question 14

Describe Type 2 Diabetes

Answer 14

• insulin resistance
• desensitization
• often inherited defect in insulin receptors
• adipokines from adipose tissue cause altered glucose and fat metabolism

Question 15

What does desensitization mean in regards to type 2 diabetes?

Answer 15

Decreased responsiveness of beta cells to hyperglycemia

Question 16

Describe how cachexic can appear in diabetes?

Answer 16

Glucose is not getting to any cells, so the body breaks down carbs and fats instead

Question 17

Compare the onset of diagnosis between DM1 and DM2

Answer 17

DM1 - younger age < 30, abrupt diagnosis
DM2 - older age, slow gradual onset

Question 18

Compare the insulin requirements and blood sugar maintenance between DM1 and DM2

Answer 18

DM1 - insulin required for survival, often difficult to control BS
DM2 - oral hypoglycemic agents or insulin may be necessary, relatively stable BS

Question 19

Compare the precipitated causes of DM1 and DM2

Answer 19

DM1 - often stress or illness
DM2 - often a combination of genetic and environmental factors

Question 20

4 ways diabetes can be diagnosed. MUST MEMORIZE!

Answer 20

1. Symptoms of DM + random (any time of the day) plasma glucose value ≥ 11.1 mmol/L

OR

2. Fasting plasma glucose (FPG) ≥ 7.0 mmol/L

OR

3. Plasma glucose value in the 2-h sample (2hPG) of a 75g oral glucose tolerance test (OGTT) ≥ 11.1 mmol/L

OR

4. A1C ≥ 6.5% (in adults)

Question 21

What is an A1C test?

Answer 21

A measurement of blood sugar serum over 3 months to show how much glucose is binding to hemoglobin.

Question 22

3 ways prediabetes can be diagnosed

Answer 22

1. FPG of 6.1-6.9

OR

2. 2hPG in a 75g OGTT of 7.8-11.0

OR

3. A1C of 6.0-6.4%

Question 23

Clinical Manifestations of Type 1 DM

Answer 23

3 Ps: polyuria (getting rid of glucose), polydipsia (excessive thirst), polyphagia (excessive hunger)

2 Ws: Weight LOSS, weakness/fatigue

2 Ks: Ketonuria (pee), ketoacidosis (blood)
- causes fruity breath

2GU: N&V, ab pain

Question 24

Clinical Manifestations of Type 2 DM

Answer 24

Often fatigue is the only symptom

Some S&S associated w/ prolonged hyperglycemia:
- chronic blurred vision
- recurrent infections
- slow wound healing
- neuropathic pain
- Weight GAIN

Question 25

4 goals for management of DM

Answer 25

1. Reduce symptoms 2. Prevent & manage acute complications 3. Prevent & manage long term complications 4. Attain a desirable body weight

Question 26

Describe sick day management of DM

Answer 26

- stress hormones increase blood glucose, so may need more insulin - assess blood glucose Q3-4H - check urine for ketones if CBG > 14 mmol/L - assess for dehydration and hold SADMANS meds if dehydrated

Question 27

Effects of exercise on glucose uptake and insulin resistance

Answer 27

↑ glucose uptake into cells ↓ insulin resistance

Question 28

Effects of stress on glucose levels and insulin resistance

Answer 28

↑ glucose levels in blood ↑ insulin resistance

Question 29

What percent of people with DM will die of heart disease or stroke?

Answer 29

65-80%

Question 30

What races are most at risk for diabetes?

Answer 30

Hispanic, Asian, South Asian, African, Indigenous

Question 31

3 Acute Complications of DM

Answer 31

1. Hypoglycemia 2. Diabetic ketoacidosis 3. Hyperosmolar hyperglycemic nonketotic syndrome (HHS)

Question 32

Explain how electrolyte abnormalities occur in patients with DKA

Answer 32

Body pulls H+ into the cells but K+ are already in the cells so the K+ ions are pulled out. Hyperglycemia causes intracellular potassium depletion and K+ goes into the bloodstream (intracellular hypokalemia)

Question 33

How are ketones tested?

Answer 33

Through beta hydroxybutyrate which releases H+ that circulates and contributes to metabolic acidosis

Question 34

Describe DKA

Answer 34

Diabetic Ketoacidosis: FATS METABOLIZED in absence of insulin -> ketosis, acidosis - most likely seen in type 1 - profound deficiency of insulin -> hyperglycemia and dehydration

Question 35

Describe HHNS

Answer 35

Hyperosmolar hyperglycemic nonketotic syndrome: Has enough insulin to prevent DKA Not enough insulin to prevent: 1. Severe hyperglycemia 2. Osmotic diuresis (increased urine) 3. Extracellular fluid depletion - primarily a type 2 problem - less common than DKA - higher mortality rate than DKA - mostly to older adults who lose thirst protective mechanism

Question 36

4 Causes of hypoglycemia

Answer 36

1. Mismatch timing of intake and peak of insulin 2. Excessive insulin 3. Insufficient carb intake 4. Excessive exercise

Question 37

S&S of hypoglycemia

Answer 37

SNS is triggered releasing EP which causes: - diaphoresis - tremors - hunger - anxiety - pallor - palpitations When the CNS is not getting enough glucose - irritability - visual disturbances - dysarthria (difficulty speaking)

Question 38

How does asymptomatic hypoglycemia occur?

Answer 38

When there is autonomic neuropathy -> impaired secretion of the counter regulatory hormones (EP) Needs BG managed more

Question 39

Tx of hypoglycemia

Answer 39

If BG < 4: Administer 15-20g of simple carbs Check BG in 15 mins If BG > 4: Administer longer-acting starch & protein Check BG in an hour

Question 40

What is the response of the liver and kidneys to hyperglycemia?

Answer 40

Liver tries to make more glucose for the CELL and converts glucagon to glucose. Fat is broken down into ketones. Kidneys recognize glucose pulling fluid into vascular space as too much volume causing polyuria. The glomerulus filters more glucose than the proximal tubule can reabsorb causing glycosuria.

Question 41

6 Causes of DKA

Answer 41

1. Illness 2. Infection 3. Insulin Omission 4. Inappropriate management or undiagnosed T1DM

Question 42

S&S of DKA

Answer 42

[ BG > 14 and pH < 7.35 ] - Tachycardia - Hypotension - Kussmaul RR (rapid to get rid of acid) 3 Ps: polyuria (getting rid of glucose), polydipsia (excessive thirst), polyphagia (excessive hunger) 2 Ws: Weight LOSS, weakness/fatigue 2 Ks: Ketonuria (pee), ketoacidosis (blood) - causes fruity breath 2GU: N&V, ab pain

Question 43

Tx of DKA

Answer 43

- ABCDs, blood work - Need NS bolus dose of 1-2L before insulin because it could cause fluid and electrolyte shifts like a severe serum potassium drop - NS lowers BG through dilution - Once BG is at 14, give dextrose to prevent hypoglycemia - Fluid resuscitation until urine output > 30 ml/hr

Question 44

Explain Osmotic Diuresis

Answer 44

Glucose in the blood creates osmosis of water from the interstitial spaces in cells to dilute the intravascular hypertonic hyperglycemia. This leads to dehydration and increased urine output.

Question 45

S&S of HHNS

Answer 45

Fewer symptoms cause late recognition - Increased serum osmolality (glucose > serum) - BG > 34 !!! - ketone bodies absent in blood and urine - coma, seizures, aphasia

Question 46

How does DM affect the vascular system?

Answer 46

Prolonged high blood sugar can damage blood vessels and the nerves that control your heart. Diabetics often have comorbidities that increase the risk of CVD. that raise the risk for heart disease: High BP increases the force of blood through arteries and can damage artery walls.

Question 47

Why are diabetics more prone to infection?

Answer 47

Increased glucose is a breeding ground for more bacteria.

Question 48

Chronic complications of DM

Answer 48

Infections, macrovascular (CAD, MI, HTNL, PVD) and microvascular (retinopathy, nephropathy, neuropathy) complications

Question 49

What is the most common form of diabetic sensory neuropathy?

Answer 49

Distal symmetrical neuropathy. Risk for foot ulcers, reduced BF due to atherosclerosis, slow wound healing.

Question 50

What are the only two ways to treat diabetic neuropathy?

Answer 50

1. Control of BG 2. Foot care

Question 51

ABCDESSS of Diabetes Care

Answer 51

A - A1C (<7% optimal glycemic control) B - BP (<130/80) C - Cholesterol (<2.9 mmol/L) D - Drugs (statin, ACE inhibitors) E - Exercise and eating healthy S - Screening for complications S - smoking cessation S - self management

Question 52

How to give pt education for foot care

Answer 52

Keep feet dry Wear proper shoes Inspect foot daily Recognize and treat wounds promptly If ulceration occurs: debride wound, give antibiotics, bed rest, prevent edema

Question 53

Relationship between obesity and diabetes

Answer 53

1. Obesity-linked inflammation contributes to insulin resistance: cells resist letting insulin move glucose into them. 2. The area of your liver where excess glucose is usually stored is filled with fat. Therefore, glucose staying in the blood.