Diabetes Flashcards
Diabetes
A disease in which the body is unable to manufacture or utilize insulin thus resulting in a chronic state of hyperglycemia
Characterized by :
Disturbances of carbohydrate, lipid and protein metabolism
Beta-cell destruction leading to absolute insulin deficiency (Type 1)
OR
Insulin resistance with relative insulin deficiency (Type 2)
Secretory deficit with insulin resistance (Type 2)
Systemic organic changes as a result of vascular pathology
Facts about DM:
- Affects 7% of pop
- 7th leading cause of death in the US
- Leading cause of blindness, end-stage renal disease and amputations in the US
- 2-4x more likely to have heart disease
- **MI and CVA are leading cause of death for clients with DM
Pancreas: exocrine function
98% of pancreas is digestive enzymes
Pancreas: endocrine fumction
Islets of Langerhans…scattered through the organ most prominently found in the tail
Alpha, Beta, Delta
Secretion of hormones: Glucagon, Insulin and Somatostatin
Insulin
- A protein made up of amino acids
- Allows the glucose to move into the cells for energy
- Insulin reaches the liver first where it helps the liver produce and store glycogen and inhibits glycogen breakdown into glucose
- Increases protein and lipid synthesis
- Limits ketogeneisis (conversion of fats to acids) and gluconeogenesis (conversion of proteins to glucose)
- Keeps lipid levels in normal range and prevents glucose levels from being too high
Ketogenesis
conversion of fats to acids
Gluconeogenesis
conversion of protein to glucose
Lack of insulin
- Unable to store glucose
- Cells starve …fats break down for energy… ketones form
- Stored glucose dumps into bloodstream
- Glucose breaks down into CO2 +H2O
- Fluid and electrolyte imbalances
- Polyuria, polydipsia, polyphagia
Polyphagia
excessive hunger
Polydipsia
excessive thirst
Risk factors:
- Genetics
- Obesity > 20% IBW or BMI >25 kg/m2
- Body shape: apple v. pear
- Habitually inactive
- Ethnic group (AA, American Indian, Hispanic American, Asian American, Pacific Islander)
- HTN > 140/90
- HDL 250
- PMH Gestational diabetes or babies >9 pounds
- Polycystic ovary syndrome
- IFG or IGT on previous testing
Type 1 Diabetes
• Insulin dependent ◦ Absolute insulin deficiency ◦ Ketoacidosis (DKA) ◦ Usually younger than 30 y/o ◦ <10% of all DM
Type 2 Diabetes
• Non-insulin dependent ◦ Insulin resistance ◦ Abnormal secretion of insulin ◦ Impaired gluconeogenesis ◦ Obesity in 80% of clients ◦ 90% of DM
Treatment: Type 1
◦ Exogenous insulin
◦ Dietary control
Treatment: Type 2
◦ Lifestyle changes
Dietary control
Weight reduction
Exercise
◦ May require oral hypoglycemic therapy or exogenous insulin
– Insulin when oral hypoglycemic medications can no longer provide glycemic control
Diagnosis: health history
◦ Age ◦ Weight and weight changes ◦ Excessive hunger ◦ Excessive urination ◦ Excessive thirst ◦ Excessive fatigue ◦ Slow wound healing ◦ Infections ◦ Family hx DM
Diagnosis: blood glucose
◦ FBS > 126 (fasting = NPO x 8h)
◦ 2-hour plasma glucose > or = 200 mg/dL during an OGTT
◦ Symptoms of DM and random BG >200mg/dl
◦ The above 3 should be repeated to confirm Dx of DM
Diagnosis: HbA1C
◦ HbA1C > or = 6.5% (newly recognized as diagnostic criterion)
◦ Used to monitor glycemic control and predict risk for chronic complications
Target labs for diabetic patients:
- Blood Glucose
- Fasting: 90-130 (70-100 in non-diabetics)
- Bedtime: 100-140
- HbA1C: < or =7%
- Lipids
LDL: < 100 mg/ dL
HDL: >40 (men)
> 50 (women) ( with exercise and good fats)
Triglycerides: < 150 - Blood pressure: 130/80
Prevention of progression:
• Lifestyle changes Increase in physical activity Decrease in dietary fat Modification of food intake • Smoking cessation • Tx of HTN • Tx of hyperlipidemia • Tight control of blood glucose levels • Regular F/U with HCP or endocrinologist • Yearly vision testing Yearly urine microalbumin levels
Secondary diabetes
Pregnancy (Gestational diabetes) ◦ Weight gain, increased estrogen levels and placental hormones Pharmacological: ◦ Insulin antagonists ◦ Adrenal corticosteroids ◦ Contraceptives (po) ◦ Estrogen replacements ◦ Atypical antipsychotics Surgical removal of pancreas or pancreatitis Adrenal or pituitary gland disorders Viral infections ◦ CMV, rubella, mumps, adenovirus
Hyperglycemia: S/s
Hot, dry skin Dehydration Rapid, deep respirations; Kussmaul From alert to stuporous; coma N/V, cramps Tachycardia, orthostatic hypotension Positive ketonuria Notify HCP: BS >250 Cannot take food or fluids Ill more than 1-2 days Ketonuria lasts more than 24 hours
Sick Days:
Notify HCP of illness Monitor BG q4h Test urine for ketones Continue taking insulin or po antidiabetics Increase fluids, eat regular meals Get plenty of rest Treat symptoms as directed by HCP Know when to call HCP!