Diabetes Flashcards
Risk factors for DM
x
Signs and Symptoms of
1) Hyperglycemia
2) Hypoglycemia
Hyperglycemia: BG > 7.0 mmol/L Polyuria – excessive urination Polyphagia – increased hunger Polydipsia – increased thirst Glucosuria – high levels of glucose in the urine Weight loss Fatigue
Hypoglycemia:
BG
Labs key to DM
B.G. (blood glucose) FBG (fasting blood glucose) GGT (glucose tolerance test) A1C Cholesterol Urine - Ketones
BP
Glucose TOlerance test =
Glucose Tolerance Test – done after FBG – the patient drinks a standard solution of glucose to challenge his/her system – followed by a second BG test at specific intervals to track ‘glucose challenge’
Blood glucose monitoring
- How do errors typically occur?
- Important considerations for self monitoring?
Errors d/t:
- Blood amount too small
- Improper maintenance of machine
- Damaged monitor strips
Dependent on skill level, cognitive ability, visual acuity, technology, comfort, cost…teaching and eval critical!
Microalbuminuria (Proteinuria)
Albumin found in urine
r/t damage to kidneys in which filtering is impaired and proteins escape into urine
Hgb A1C
x
Pharmacological interventions for DM?
**Typically see polypharmacy!!
In order to reach A1C, BP and lipid targets, people with diabetes typically require many medications:
- To lower blood glucose: 1-3 pills and/or insulin
- To lower cholesterol: 1 or 2 pills
- To lower blood pressure: 2 or 3 pills
- For general vascular protection: aspirin
** Adherence to complex drug regimens can be a challenge for patients.
Glycemic Index
x
What occurs in severe metabolic acidosis?
Long term effects?
When blood glucose reaches 150mg/100ml (normal = 80-120), glycosuria begins…large fluid quantity excreted as well (polyuria) → dehydration occurs → blood vol dec → blood flow dec → less O2 → anaerobic resp → lactic acid poors out of muscles into bloodstream
- Lipids utilized → acidic ketone bodies enter bloodstream
- Protein also metabolized
- As cells die, release Na+ and K+, lost in excessive polyuria
-Long term effects = vascular narrowing leading to kidney, heart + retinal dysfx
Which people with DM need extra close monitoring because may not experience the initial symptoms of hypo/hyperglycemia?
Those with autonomic neuropathy or those on Beta blockers may not experience initial symptoms (adrenergic)
All with diabetes should wear?
BRacelet or tag
Important consideration for family when teaching about DM?
•Family members need to know symptoms of hypoglycemia, esp any change in behavior
Key nutritional aspects of managing diabetes?
Nutrition, diet, weight control + exercise = foundation for DM management
What is the most important objective with regard to DM and diet?
• Most important objective is caloric intake to attain or maintain reasonable body weight + control of blood glucose levels
Nutritional management goals for DM?
o Providing all essential food constituents (vitamins, minerals, etc.) for optimal nutrition
o Meeting energy needs
o Achieving & maintaining reasonable weight
o Preventing wide daily fluctuations in blood glucose levels
o Dec serum lipid levels (if elevated) to reduce risk for macrovascular disease
What aspect of DM is obestity r/t?
Inc insulin resistance
How important is weight loss with DM?
• Weight loss alone can eliminate need for medication in Type 2 with diabetics with obesity (loss as small as 5-10% may sig improve glucose levels, insulin sensitivity, pretension, and dyslipidemia)
How is weight distribution important for DM?
•Location of adipose tissue critical – check waist circ
Is skipping meals a good way to reduce caloric intake in DM?
• Reduce calories but DON’T skip meals! Easier on pancreas if pacing food throughout day
• 3 major acute complications r/t short-term imbalances in blood glucose levels:
hypoglycemia, DKA and HHNS
DKA =
Diabetic Ketoacidosis
*Deficit of insulin results in disorders in metabolism of CHO, proteins, and fat
HHNS =
hyperglycemic hyperosmolar nonketotic coma or hyperglycemic hyperosmolar syndrome
Normal range for blood glucose?
3.9-11 mmol/L
VIHA
Hypoglycemia = ?
•Glucose level
What is hypoglycermia d/t?
•D/t too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity
When can hypoglycemia occur (day or night?) and when does it often occur?
• May occur day or night; often before meals (esp if meals delayed or snacks missed)
How does an NPH insulin cause hypoglycemia in the middle of the night?
•Delay in NPH insulin’s associated with peak causing hypoglycemia a while after taking (middle of the night hypoglycemia may occur d/t pre-dinner NPH
2 groups of clinical manifestations of hypoglycemia?
1) Adrenergic symptoms = sympathetic system stimulated in early stage of hypoglycemia → surge of NorE and E → sweating, tremor, tachycardia, palpitation, nervousness and hunger
2) CNS symptoms: in moderate hypo, brain cells deprived of energy → inability to concentrate, headache, light-headedness, confusion, memory lapses, numbness of lips and tongue, slurred speech, impaired coordination, emotional changes, drowsiness (adrenergic symptoms continue)
SYmptoms of severe hypoglycemia?
Severe hypoglycemia: CNS fx so impaired that will require aid from another person – disoriented behavior, seizures, difficulty arousing from sleep, loss of consciousness
Difference between type1 and type 2 diabetes?
Type 1 diabetes (5-10%)
Body’s own immune system attacks the cells in the pancreas that produce insulin
Type 2 diabetes (90 - 95%)
The pancreas does not produce enough insulin and/or the bodies’ tissues do not respond properly to the actions of insulin – insulin resistant
What is gestational diabetes?
Diabetes with first onset or recognition during pregnancy
Puts women and the child at higher risk for type 2 DM later in life
WHat is pre- diabetes?
When a persons blood sugar levels are higher than normal but not enough to be diagnosed with Type 2
