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Diabetes Flashcards

1
Q

What are the risks associated with Gestational diabetes

A

Risk remains elevated for mom later in life that she will get T2D again

Increases risk for large size delivery for infant, bigger heads and differences in the way the liver functions at birth

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2
Q

What are the risk factors for Metabolic Syndrome?

A

Fasting Blood glucose ≥ 6.1 mmol/L
Blood pressure ≥ 130/85 mmHg
Triglyceride ≥ 1.7 mmol/L
HDL: Men < 1.0 mmol/L women < 1.3 mmol/L

Abdominal Obesity - waist circumference
men > 102 cm
Women > 88cm

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3
Q

What is polyphagia?

A

The body feels as though it is starving because lack of insulin function prevents transfer of glucose from the blood - strong desire to over eat

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4
Q

What is polyuria?

A

Hyperglycemia above the renal threshold of ~13.5 mmol/L causes glucose to be lost in the urine. Increased glucose in the urine leads to an increased urine production

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5
Q

What is polydypsia?

A

Increased urine production leads to water loss which leads to increased thirst

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6
Q

Why would diabetic patients experience weight loss?

A

their inability to utilize blood glucose leads to catabolism to provide energy

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7
Q

Why would diabetic patients experience fatigue?

A

The stress of starvation and inability to utilize blood glucose for energy

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8
Q

Why would diabetic patients experience poor wound healing and increased infections?

A

Hyperglycemia provides the ideal media for bacteria

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9
Q

Why would diabetic patients experience blurred vision?

A

Lens change due to hyperglycemia

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10
Q

Why would diabetic patients experience tingling/numbness in the extremities?

A

Neuropathy of diabetes - may happen if extended period prior to diagnosis

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11
Q

Why would diabetic patients develop ketoacidosis?

A

The body cannot utilize sugar for fuel so the liver starts to break down fats instead. Ketone bodies are a byproduct of this process, which leads to their breath smelling of acetone. High levels of ketones in the blood can impact pH and can be life threatening - although DKA is more common in type 1 diabetes.

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12
Q

Why might ketoacidosis cause labored respiration?

A

If the blood pH decreases, there is an increase in CO2 production
Respiratory rate increases to decrease CO2 production

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13
Q

What is Ketonemia?

A

presence of ketones in the blood

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14
Q

What is ketnuria?

A

ketones in the urine

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15
Q

What is Lipemia?

A

Increased lipids in the blood, specifically Non Esterified Fatty acids which are metabolized for energy - producing ketone bodies

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16
Q

What is the diagnostic criteria for Diabetes?

A

Hemoglobin A1c ≥ 6.5%
Fasting Blood Glucose ≥ 7.0 mmol/L
Random Glucose ≥ 11.1 mmol/L
2 hour post prandial OGTT ≥ 11.1 mmol/L
diagnosis requires a second positive lab test on a subsequent day (T2D only)

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17
Q

What leads to a diabetic coma?

A

Result of ketoacidosis and dehydration caused by hyperglycemia which leads to decreased circulation and decreased oxygen to the brain

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18
Q

What does HBA1c tell us?

A

Indicator of long term glucose control over 3 months
Normal is 4-5%
Desirable to be below 7% as having a level above 7% is associated with increased risk

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19
Q

How often should people with Diabetes monitor their blood?

A

Type 1 - at least 3x per day
Type 2 - can be variable but at least once per day is recommended

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20
Q

What are the recommended targets for glycemic control?

A

to reach an HbA1C level of <7%:

fasting plasma glucose target of 4-7 mmol/L
2 hr post prandial glucose target of 5-10 mmol/L

Further lowering of 5-8 mmol/L might be considered if the above does not reach the target

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21
Q

What are the complications of Diabetes?

A

Microvascular:
Retinopathy - damage to the retina
Nephropathy - kidney disease
Neuropathy - nerve damage

Macrovascular:
Coronary Artery Disease
Cerebrovascular Disease
Peripheral Vascular Disease

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22
Q

What are risk factors that can contribute to complications of Diabetes?

A
  • Smoking - not causative but nicotine makes arteries more stiff and oxidative stress impacts organs
  • Hypertension - not causative but clustered together
  • Elevated serum lipids - not causative
  • Duration of the disease
  • Genetic predisposition
  • Blood glucose control
23
Q

What are the Main symptoms of Diabetes?

A

Polydipsia
Polyphagia
Blurred Vision
Polyuria/Glycosuria

In Type 1 Diabetes patients:
Weight loss
Lethargy, stupor
Breath smells of acetone
Hyperventilation
Nausea
Vomiting

24
Q

What are the key messages for diabetic patients regarding fibre?

A

Aim for 30-50g per day
10-20g as viscous soluble fibre as viscous soluble fibre can decrease A1c, fasting BG, and decrease LDL

25
What is the balanced food plate for diabetics?
Fill 1/2 plate with non starchy veg and fruit Fill 1/4 with protein foods Fill 1/4 with whole grains and starchy vegetables
26
Compare the Plate/hand method to carb counting
Plate is an easier concept and doesn't require math, but it can be challenging to apply to some meals/cultures and is less flexible Carb counting can allow for some flexibility and a better understanding about how food impacts blood glucose response
27
What are best practices regarding WHEN to eat?
Space eating out over the day Eating earlier in the day is beneficial for glycemic management Individualize snack recommendations fasting may be done safely using a coordinated approach
28
What considerations should be made regarding when to eat?
Lifestyle weight management and metabolic goals Culture, religious practices, health beliefs regarding fasting Physical activity Diabetes medications
29
When are snacks helpful to blood sugar?
Meals are more than 4-6 hours apart When an individual is more active than usual and is at risk of hypoglycemia When an individual has better fasting/morning blood sugars as a result of including an evening snack If they experience better portion control at meals as a result of a midday snack Bedtime snacks: may or may not be needed and depends on previously mentioned factors - for people with insulin treated diabetes, a bedtime snack with carb and protein can help prevent hypoglycemia when blood glucose is less than 7.0 mmol/L
30
How does weight loss impact T2D?
5-10% of initial weight loss can improve insulin sensitivity, glycemic management, blood pressure and dyslipidemia 15% or more loss can send T2D into remission
31
What are the four main types of T2D pharmacotherapies?
1st line of therapies - metformin, SGLY-2 inhibitors (end in flozin) and DPP-4 inhibitors (end in liptin) Second group - GLP-1 receptor agonists (semaglutide - end in tide) Third group - Sulfonylureas and meglitinides - becoming less comon --> these have a hypoglycemia risk Thiazolinidone and a-glucosidase inhibitors - less common
32
Where does metformin (biguanide) target and what are its actions?
Targets liver, muscle/fat cells Increases insulin sensitivity, decreases liver glucose and increases glucose uptake
33
Where do SGLT2-inhibtors target and what are its actions?
Sodium glucose cotransport 2 inhibitor targets SGLT-2 in the kidney and increases excretion of glucose
34
What does DPP4 -inhibitor target and what are its actions?
Targets DPP-4 enzyme that impacts gut hormone and increases incretin effect
35
Where does GLP-1 target and what are its actions?
Targets: gut, pancreas (alpha and beta cells), brain Actions: decreases gastric emptying, decreases glucagon, increases insulin secretion and satiety very effective for weight reduction
36
What are the side effects of GLP1-RA and how can they be managed?
Side effects: Nausea, vomiting, constipation, diarrhea, GERD Dietary modifications: eat smaller meals mindfulness to stop when full avoid eating when not hungry avoid fatty, spicy foods may need to reduce fibre temporarily
37
Where do secretagogues target and what are their actions?
Target pancreas, increase insulin secretion
38
Where do a-glucosidase inhibitors target and what are their actions?
target small intestine, decrease carbohydrate absorption
39
Where do Thiazolidinediones (TZD) target and what are their actions?
target muscle/fat cells, increase insulin sensitivity
40
Briefly outline the guidelines for CHO Choices - i.e. how many choices/what food groups should the patient aim to eat from?
Aim for 7 or more sweet vegetables and fruit Aim for 6 servings of grain Aim for 2-3 milk and alternatives limit sweet foods, snacks and "other" foods
41
How many grams of Carbohydrate does 1 CHO choice contain? How many grams of protein and fat?
12-18g - average of 15g/serving MUST be less than 5g of fat MUST be less than 6g of protein
42
Describe dairy according to AHS choices
4-6g/serving 15g CHO 1% = 1g fat 2% = 2g fat
43
How much CHO do free veggies contain?
<4g
44
Describe fat choices according to AHS choices
One choice = 5g of fat
45
Describe protein choices according to AHS choices. Describe high fat protein choices.
One choice = 7g protein AND 3g of fat High fat protein choice = 8g fat may not contain more than 7g protein
46
Describe legumes according to choices
1 protein + 1 CHO 7g protein, 3g fat, 15g CHO
47
What are the CHO choices recommendations for women?
Meals: 3-4 choices CHO Snacks: 1-2 choices CHO Over the day total: CHO: 13-18 choices Protein: 5-7 Fat 5-6
48
What are the CHO choices recommendations for men?
Meals: 4-5 choices CHO Snacks: 1-3 choices CHO Over the day total: CHO: 15-24 Protein: 6-9 Fat: 5-8
49
What is the Somogyi Effect?
Low blood sugar overnight = glucagon and catecholamine secretion Results in increased rates of gluconeogenesis resulting in higher blood sugars - increase in over all blood sugars Often occurs in patients taking longer lasting insulin, can be prevented by consuming a late night snack
50
What is an insulin reaction?
More common in Type 1 Diabetes Hypoglycemia resulting from either too much insulin, too much exercise/stress or not enough food
51
What are the symptoms of insulin reaction?
Pale skin Confused Weak, shaky Cold sweat Possibly irritable
52
What are the treatments for Insulin Reaction?
IV Glucose (extreme cases) Glucose tablets Glucagon injections Juice/cola Candy/dextrose tablets
53
What are the key features of Ketoacidosis?
Red, flushed appearance Fruity smell on breath (from ketones) Dehydration Dry Skin Hyperglycemic
54
How is ketoacidosis treated?
Insulin Rest Monitor fluids and electrolytes

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