Diabetes Flashcards
Diabetes Mellitus
secreted by:
of the :
INSULIN- from pancreas a hormone secreted by the BETA CELLS of the ISLETS OF LANGERHANS in the PANCREAS in response to an INCREASE
How much units
40-60 units secreted by pancreas
Normal blood glucose range
74-106 mg/dl
Insulin
AIDS in transport and metabolism glucose for energy
Glucagon
Glucose in liver storage
Insulin role (5)
Stimulates storage of glucose in the liver as glycogen
*Signals the liver to stop the release of glucose
*Enhances the storage of dietary fat in adipose tissue
*Accelerates protein synthesis into cells of the muscles
*Facilitates the release of stored glucose, protein from muscle and fat from adipose tissue
Polyphagia
Increase hunger
Polydypsia
Increased thirst
Glycouria
Sugar in urine
3 p’s in db type 1
s/s (4)
Polyuria, Polydipsia, Polyphagia
quick onset/ less than 30/ normal or under BMI/ ketones
type 1 vs type 2
type 1: insulin deficiency. autoimmune. Requires insulin therapy.
type 2: (lifestyle) insulin resistant. receptor cells are resistant to insulin. Can be genetic.
type 2 s/s (6)
Chronic
Frequent infections (yeast infections)
-prolonged wound healing
Numbness+ tingling in hands and feet
Fatigue (harder to diagnosis)
Blurred vision
risk for type 2:
waist
triglycerides
HDL
BP
Fasting Glucose ( state normal)
waist: men greater than 37 inches
women greater than 33
triglycerides greater than 150
men less than 40
women less than 50
greater than 130/85
greater than 106 (Normal is
74-106mg/dl)
RISK FACTORS FOR TYPE II
DM (9)
- Obesity- 25 lbs. above ideal weight (abdominal
fat) - Hereditary
- Age >45 years
- Stress
- Race: African American, Native American, Hispanic,
Asian American and Pacific Islanders - Sedentary lifestyle
- Dx of Prediabetes or gestational DM
- Hypertension
- High Cholesterol
GESTATIONAL DIABETES (4)
whenare moms screened/risk factors 3
Occurs in 2 -10%
pregnancies in US
Increases the risk of C-
section delivery,
Preeclampsia and fetal
macrosomia
Risk factors include obesity,
advanced maternal age,
family hx of DM
Moms screened at 24-28
wks with OGTT (oral glucose
tolerance test)
SECONDARY DIABETES ( 3)
Associated with pancreatic & endocrine
disorders such as Cushings syndrome,
acromegaly
Use of certain medications such as
corticosteroids (prednisone), estrogen,
thiazides
Contribute to diabetes d/t damages to the B-
cell functioning in the pancreas
PREDIABETES
(define/ IFG/ IGT/interventions *2)
Blood sugar levels elevated but not high enough to be classified as diabetic- most
likely will progress to type 2
- IFG: Fasting blood glucose levels 106-
125mg/dl - IGT: Glucose tolerance test 140-199mg/dl
Interventions :
a. Losing weight and increase activity may prevent or delay DM
b. Monitor blood glucose levels, HgA1C levels,
assess for s/s DM
**DIAGNOSIS OF DM **
Fasting Plasma Glucose=
Confirmed by:
A1C= * remember what professor d said*
Fasting=
2hr =
Glucose Tolerance =
- Fasting plasma glucose > 126
- Confirmed by repeat test on another day:
preferred - A1C lab result 6.5% or higher !
- 2 hr Oral glucose tolerance test (OGTT)
- Fasting at least 8hr, drink glucose liquid (75gm),
blood drawn before liquid and again at 60 mins
after and 120 mins after consumption. - 140-199 Prediabetes
urine = negative
- Glucose tolerance >200 confirms DM
FACTORS AFFECTING BLOOD
GLUCOSE LEVELS (RAISE) 7
- Food
- Stress
- Growth
- Meds(steroids, epinephrine)
- Menstrual cycle
- Fatigue
- Lack of exercise
FACTORS help BLOOD
GLUCOSE LEVELS (LOWER) 6
- Insulin
- Oral diabetic meds
- Exercise
- Fasting
alcohol - Medications
Tips( hint discharge chart) Treatment regimen (5)
Education
* Nutrition
* Exercise
* Medications
* Self-monitoring
4 GOALS OF DIETARY
MANAGEMENT
- Achieve and maintain reasonable body
weight - Maintain near normal blood sugars
- Reduce fat and salt intake
- Maintain proper nutrition
NUTRITION RECOMMENDATIONS (8)
* Adequate calories:
- Protein:
- CHO:
- FAT:
- Cholesterol:
- NA:
- Fiber:
- Alcohol:
- Adequate calories: (1800 – 2200
ADA) - Protein: 15-20% of calories
- CHO: 45 – 60gm/meal
- FAT: saturated fats 7% of total
calories - Cholesterol: < 200 mg/day
- NA: 2300 or less mg/day
- Fiber: 25-30 GM/day
- Alcohol: limit to 1 glass/day
Main Diet Points (6)
- Eat same time
- Eat from all food groups
- Maintain CHO control with each meal
(45-60gm/meal) - Limit fats and sugars
- Eat about same amounts (portion control)
- Include low CHO snacks between meals to
prevent low blood sugar & keep blood glucose
even
Lab Test/monitoring (5)
-Glucose levels can vary from
-Glucose levels can vary from 70 -400mg/dl in a single day
Log kept for self glucose monitoring
More accurate than urine testing
Rotate times for accurate picture of how diet and
exercise impact levels
Typical hospital monitoring: ac meals and at hs (using
a sliding insulin scale)
Typical hospital monitoring:( think of math class)
ac meals and at hs (using
a sliding insulin scale)
GLYCOSYLATED HEMOGLOBIN
(HGBA1C) 2
- Amount of HgB that has glucose
attached to it - Measures how the blood sugar has been
maintained over a three-month period
HGBA1C results (3) ( define state ideal)
measures how the blood sugar has maintained over three month period !~Ideal less than 7 % ( diabetic pts)
2-5% good control ( good glucose level)
6-8% fair control, greater
than 8 poor controls (need to review diabetic care)
exercise (6)
Increase the use of glucose at
muscle
- Increase insulin
sensitivity/reduction of insulin
resistance - May lead to low blood sugar
levels - 30mins/5xweek
- Promotes weight loss
- Monitor for s/s of hypoglycemia
Health teaching (6)
Control blood glucose levels
- Follow meal plan, Regular exercise
- Quit smoking
- Control blood pressure, Limit salt, Limit alcohol
- Insulin administration
- S/S hyper/hypoglycemia
-eye exams - dental
- doctors
-foot doctor (podratic)
-medical bracelets
TREATMENT FOR LOW BLOOD
SUGAR:
Check blood glucose level:
Rule 15 ( 2 )
In the hospital :
Check blood glucose level: less than 70 requires
immediate action
Use rule of 15:
-Give 15gm simple, fast-acting CHO (4-6oz regular
soda, 4-6oz OJ, 1TBS honey, 6 jellybeans, 2-3 glucose
tablets)
-Retest after 15 minutes: if BS still less than 70 give
additional 15gm CHO, then recheck in 15 mins. If no
improvement call MD
In the hospital, treat with 20-50ml 50% dextrose IV (50% glucose)
push, or administer Glucagon IM or SQ (use deltoid)
HYPOGLYCEMIA ( define state the number)
( causes)4 state the analogy
think of mall cop
LOW Blood glucose
Below 70mg/dl
Causes:
Too much medication
Too little food
Too much activity
Cool and Clammy = need some candy
SIGNS AND SYMPTOMS of Hypo (7)( TIRED)
- “cold and clammy get the candy”
- Shaking, Sweating
- Tachycardia
- Anxious/dizziness
- Impaired vision ( colors) ( pilsbury)
- Weakness, fatigue
- Headache, irritable, confusion
HYPERGLYCEMIA (9)
- “warm and dry sugar’s high” ( dry skin )
- Extreme thirst
- Increased urination
- Increase hunger
- Glycosuria
- Blurred vision
- Drowsiness, weakness, fatigue
- Nausea & vomiting, fruity breath
- LOC is loss
COMPLICATIONS OF DM (heart/eyes/kidney/body)
heart 5, eyes 5, kidney1 , Nervous system * 1* , body 2
Heart***
Stroke
* Coronary artery disease
* Atherosclerosis
* Hypertension
* Peripheral artery
disease
eyes
* Diabetic retinopathy
* Cataracts
* Glaucoma
* Blindness
Kidney
* Chronic kidney disease
* * Diabetic nephropathy
**Nervous system **
* Peripheral neuropathy
Body
* Infections
* Gangrene (tissue death)
A1C purpose
shows physicians how compliance with their diet. regardless how well they ate prior to testing this is the real test.
PT with type 1 requires
insulin to survive!!!
twice a day monitoring
diabetes 1
twice a week monitoring
diabtes 2
gestational diabetes FG ( when do we screen)
greater than 200
24-28 weeks
diabetes ( A1C / fasting blood glucose/ glucose tolerance test )
6.5 or greater
126 or greater
200 or greater ( drink the drink within a hour)
prediabetes ( A1C / fasting blood glucose/ glucose tolerance test )
5.7 - 6.4
100-125 mg/dl
140-199 md/dl
normal rates diabetes ( A1C / fasting blood glucose/ glucose tolerance test )
5.7 equal to or less
99( or 106) or less
140 equal to or less
obese rates
greater than 25
glucagon vs glycogen
when glucose is gone. released
glycogen stored in the liver
