Diabetes Flashcards
What is Diabetes mellitus?
A Chronic Multisystem Disease that’s characterized by Hyperglycemia resulting from Abnormal Insulin Production and/or Impaired Insulin Use
What are the different types of diabetes? How many are there?
Type 1 + Type 2 + Gestational + Other
What is the typical age of onset for Type 1 DM?
Any Age, but mostly in young people (Those under 40)
What is the typical age of onset for Type 2 DM?
Any Age, but mostly in Adults
What is the type of onset for Type 1 DM?
Abrupt but may have been Malignant for many years
What is the type of onset for Type 2 DM?
Insidious (Gradual)
What % of people with DM have got T1DM?
5-10%
What % of people with DM have got T2DM?
90-95%
What are the environmental factors for T1DM?
Virus + Toxins
What are the environmental factors for T2DM?
Obesity + Lack of Exercise
What is the primary defect of T1DM?
Absent Insulin Production
What is the primary defect of T2DM?
Insulin Resistance + Less Production of Insulin + Altered Adopopkines
When are Islet Cell Antibodies present for T1DM?
At Onset
When are Islet Cell Antibodies present for T2DM?
Absent
What is Endogenous Insulin production for T2DM?
It’s initially increased, then secretion decreases
How is nutritional status different between T2DM and T1DM?
T1DM = May be Thin, Normal, or Obese
T2DM = Frequently Overweight or Obese, May be Normal
Symptoms of T1DM?
3 P’s (Polydipsia = Extreme Thirst, Polyuria, Polyphagia = Excessive Hunger)
Fatigue + Weight Loss + DKA + Weakness
Slow Wound Healing + Diabetic Retinopathy
Symptoms of T2DM?
Fatigue + 3 P’s
Recurrent Infection (Vaginal Yeast Infection, Candida Infection, etc.)
Prolonged Wound Healing
Visual Problems (Diabetic Retinopathy)
T2DM is mostly Asymptomatic until it becomes deadly
When does Ketosis occur with T1DM?
During Onset or During Insulin Insufficiency
When does Ketosis occur with T2DM?
It’s resistant to it unless you have an infection or are regularly stressed
T1DM and T2DM pt’s all require at least some Exogenous Insulin.
True or false?
False.
Although all T1DM pt’s require it, not all T2DM pt’s require it. It’s important to remember that they may progress into needing it though.
What happens with the Autoimmune System if an Autoimmune Disorder causes the pt to get T1DM?
Body develops Antibodies to Insulin and/or Pancreatic Beta Cells. This results in there not being enough Insulin for the body to rely on
So what do Pancreatic Beta Cells do?
Produce Insulin
What is Idiopathic Diabetes?
Diabetes that is inherited. This is a kind of T1DM
What kind of T1DM is slow and progressive?
Latent Autoimmune Diabetes (LADA)
If you have T1DM, do your symptoms ever leave?
The pt may have a temporary remission after starting treatment
If you have Prediabetes, you are at an increased risk for which type of DM?
T2DM
Is it possible to have both Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG) at the same time?
Yes
What lab can be used to determine if you have IGT?
OGTT range of 140-199 is the normal range
What lab result can be used to determine if you have IFG?
Fasting Glucose of 100-125 is the normal range
What are the symptoms of Prediabetes?
Asymptomatic but Long Term may already be occurring
Why might T2DM occur in a kid?
Obesity
Between T1DM and T2DM, which one has a higher prevalence depending on the ethnic group?
T2DM
What is the pancreas doing during T2DM?
It’s making Insulin but it may not be enough or it may be that it’s not being used by the body effectively
What are the 3 main distinctions between T1DM and T2DM?
T2DM is more controllable than T1DM in terms of preventing yourself from getting it
T1DM = No Insulin Production at all, T2DM = Insulin Production still occurs
T1DM = Weight Loss, T2DM = No Weight Loss
T1DM and T2DM both have genetic links. True or false?
True
What problems caused by genetics can lead to T2DM?
Insulin Resistance
Low Insulin Production by the Liver
High Hepatic Glucose Production
High Production of Hormones & Cytokines via Adipose Tissue (Adipokines)
The Brain + Kidneys + Gut all have roles in developing T2DM
Metabolic Syndrome increases the risk for-
T2DM
What components come together to make up a Metabolic Syndrome? At least how many of these components do you need to experience at once for it to be a considered a Metabolic Syndrome?
Increases Glucose Levels + Abdominal Obesity + HTN + High Triglyceride Levels + Decreased HDL Levels
At least 3/5 of these components are needed to come together to be considered a Metabolic Syndrome
With T2DM, about what percentage of Beta Cells are no longer secreting Insulin at the time of diagnosis?
50-80%
What are the ABC’s of Diabetes?
A1C Level + HTN + Cholesterol
Keeping these under control lowers risk of MI
At the time of diagnosis, how long have they had DM for on average?
~6.5 Years
What is A1C short for?
Hemoglobin A1C
With T2DM, it is expected for which labs to be high?
High Glucose, A1C, LDL, Triglycerides, etc.
A1C Level, Fasting Plasma Glucose Level, and Random Plasma Glucose (RPG) Levels are all indicative of DM if they are how high?
A1C = 6.5% +
FPG = 126 +
RPG = 200 +
When is Insulin given to T2DM pt’s?
During times of stress or if it progresses to the point to where glucose levels can’t be managed with previous therapies
What temps can make Insulin less effective?
Less than 32 F (0 C)
Greater than 86 F (30 C)
How long can vials and pens of Insulin be left at room temperature?
Up to 4 Weeks
Insulin shouldn’t be exposed to sunlight.
True or false?
True
In a regular climate, Insulin should be stored in a refrigerator, but what about a hot climate?
Use a Thermos or Cooler
How should Prefilled Syringes be stored?
Upright
Why shouldn’t a IM injection be used for Insulin?
It could cause Hypoglycemia
What kind of Insulin may be given via IV?
Regular Insulin
Why can’t Insulin be taken PO?
It’s Inactivated by Gastric Fluids
Is the user of self injected insulin allowed to recap a syringe?
Yes, but only the user
A pt has a self injectable Insulin injection, but no alcohol swabs. What should they do?
Use soap and water in place of alcohol swabs
What kinds of patient’s can benefit from an Insulin Pen?
Those with in tact vision
What’s an Insulin Pump? What kind of Insulin does it continuously administer?
Small device connected to a catheter that’s inserted into the SUBQ Tissue of the abdominal wall
Gives a continuous SUBQ infusion of Rapid-Acting Insulin
How often should the site of an Insulin Pump be changed?
Every 2-3 Days
What things can make you have to change the doses of Insulin via an Insulin Pump?
Carb Intake + Activity + Illness
How often should your glucose level be checked if you have an insulin pump?
4 to 8 times a day
What is the major advantage with Insulin Pumps?
They keep glucose in a tighter range, thus avoiding highs and lows
Gives more flexibility with meals and activity
What are the potential concerns of an Insulin Pump?
Infection of the Insertion Site + DKA Risk + Cost of Pump & Supplies + Attached to a device
How does alcohol impact diabetes?
It inhibits Gluconeogenesis via the Liver
What is Gluconeogenesis?
The creating of new Glucose
What should alcohol be taken with whenever you have DM?
Eat carbs when drinking unless the drinks have sweetened mixers
What should alcohol intake be limited to for diabetics with no risk of any other alcohol interactions?
1 for Women, 2 for Men
What is Insulin dosage based on?
The amount of carbohydrates (CHO) consumed
Give 1 unit per 15 g of carbs
How much exercise is recommended weekly by the ADA?
150 min / week of Moderate Intensity Aerobic Activity
Resistance Training 3x a week
What are the benefits of exercise for diabetic pt’s?
Lowers Insulin Endurance & Glucose + Weight Loss + Reduces need for T2DM Drugs
Reduces triglycerides + LDL + Increases HDL
Decreases BP + Improves Circulation
What meds should be avoided prior to excessive exercising? Why?
Insulin, Sulfonylureas, Meglitinides + Physical Activity = Hypoglycemia
The glucose lowering effect of exercise may last for up to how long?
At least up to 2 days
How should the risk for hypoglycemia when exercising be handled?
Carry fast acting carbs + If this frequently occurs, talk to HCP to lower the dosing of the meds
What might the body perceive as stress?
Strenuous Exercise
T1DM pt’s should delay any strenuous activity is greater or equal to what? Why?
250 and if there are Ketones in the urine (It makes the hyperglycemia worse because the body detects the exercise as stress which equals more glucose production)
Is continuous glucose monitoring used for T1DM or T2DM?
Both
For diabetics, how often should glucose be assessed if they are ill?
Q4hrs
Blood sugar should normally be assessed when?
Before meals + 2 hrs after the first bite of a meal + before and after exercise + Anytime hypoglycemia is suspected
5-7% body weight reduction & 150 min exercise/week can lower the risk of T2DM by how much?
34-58%
Who should have routine diabetes screening? How often should they keep getting screened if their results are normal?
All overweight pt’s + Anyone over 45 with 1 or more risk factors
If the results are normal, repeat every 3 years
What acute situations can occur from DM?
DKA + Hypoglycemia + Hyperosmolar Hyperglycemic Syndrome (HHS)
What is HHS?
Extremely high glucose level without a presence of Ketones (May occur with T1DM or T2DM)
If glucose level is over 240, how often should Ketones be assessed for?
Every 3-4 Hrs
You have a sick diabetic pt who’s eating less than normal, what do you do?
Supplement with CHO Fluids
Sweating, Tachycardia, and Tremors are all indicators for-
Hypoglycemia
What is the difference between Retinopathy, Nephropathy, and Neuropathy?
The vessel membranes in capillaries and arterioles are thickened from Chronic Hyperglycemia:
Eyes = Retinopathy
Kidneys = Nephropathy
Nerves = Neuropathy
What are the 2 different classifications of Retinopathy?
Nonproliferative
Proliferative
What is Nonproliferative Retinopathy?
Partial occlusion of small blood vessels in the retina that causes Microaneurysms
Mild to Severe Vision Loss
What is Proliferative Retinopathy?
Retinal capillary occlusion that results in the compensation of new blood vessels being formed (Neovascularization)
Pt will have vision loss and/or see black or red spots or lines
May cause Retinal Detachment + Glaucoma + Cataracts
Retinopathy is initially Asymptomatic.
True or false?
True
What are the risk factors for Nephropathy?
HTN + Genetics + Smoking + Chronic Hyperglycemia
What annual screening should be done for Nephropathy?
Albuminuria + Albumin-To-Creatinine Ratio
Albumin in the blood =
Albuminuria
What is Albuminuria an indicator of?
Worsening Nephropathy
What meds can cause Nephropathy?
ACE Inhibitors + Angiotensin II Receptor Blockers
What’s the most common type of Neuropathy? What is it?
Sensory Neuropathy = Loss of protective sensation in lower extremities
What are some pharmacological treatments for Neuropathy?
Topical Creams + Tricyclic Antidepressants + SSRI’s + SNRI’s + Anti-seizure Meds + Pregobalin
What can Neuropathy cause?
Gastroparesis, Amputation, CV Abnormalities, Sexual Dysfunction, Neurogenic Bladder = Urinary Retention
What is Gastroparesis?
Delayed Gastric Emptying that causes Anorexia + Nausea + Vomiting + GERD + Feeling Full + Hypoglycemia
What CV abnormalities can Neuropathy cause?
Postural Hypotension / Falls (BP suddenly drops whenever you stand up or sit down) + Resting Tachycardia + Painless MI
How should you treat a Neurogenic Bladder?
Give Cholinergic Drugs
Self-Catheterization
Have bladder retention? Use the Crede’s Maneuver
What is Neuropathic Arthropathy?
Joint dysfunction that causes footdrop. Also called Charcot’s Foot
What does Charcot’s Foot leave you at risk for?
Falls + Ulcers
What diabetic skin condition is a manifestation of Insulin Resistance?
Acanthosis Nigricans
What is Acanthosis Nigricans?
Velvety light brown to black skin thickening; appears at Flexures, Axillae, and Neck
What is the most common diabetic skin condition?
Diabetic Neuropathy
What does Diabetic Neuropathy look like?
Red-Brown, Round, or Oval patches of skin + Scaly then Flat and Indented
Appears commonly on the Shins
What does Necrobiosis Lipoidica Diabeticorum look like?
Red-Yellow Skin + Atrophic Skin (Shiny & Transparent)
This diabetic skin condition is Uncommon
What does Necrobiosis Lipoidica Diabeticorum look like?
Red-Yellow Skin + Atrophic Skin (Shiny & Transparent)
What is the likelyhood of you getting DM after turning 65 or older?
1/4th of elderly pt’s have DM because of Decreased Beta Cell Function, Insulin Sensitivity + Altered Carb Metabolism
