Diabetes Flashcards
Type 1 DM
NO INSULIN
- beta cells have stopped making insulin
- onset
Type 1 DM cause
autoimmune attack on beta cells
-body perceives beta cells as foreign and form antibodies against them
How long does it take for symptoms to show in Type 1 DM? Why do symptoms start?
- long time to show up
- show up when pancreas can no longer produce insulin
- rapid onset of symptoms
- show up at ER with ketoacidosis
Classic symptoms of Type 1 DM
- recent and sudden weight loss
- polydipsia: patient becomes dry and dehydrated
- polyuria: increase urine due to increased glucose in urine due to glucose being an osmotic force and pulling fluid out of bloodstream.
- polyphagia: cells starve because cells require insulin to unlock them so glucose can come into cell for energy. No insulin means no glucose uptake and pt eats for more energy further increasing glucose
Illnesses and Type 1 DM diagnosis
patients under the impression that the illness (ex: flu) brings on type 1 DM, but actually the illness is causing acute stress pushing the patient into stress mode which increases the glucose.
Patient is unable to produce enough insulin to bring glucose down the normal like a normal patient and they are diagnosed with type 1 DM
Type 2 DM
- combination of insulin resistance and inadequate insulin secretion
- still makes insulin, just not enough or body doesn’t listen to it
- 90% of PWD
–onset >35 yo
- typically overweight
- prevalence increases with age
ethnic and Type 2
Native Americans and Alaskan Natives
ethnic and Type 1
non-hispanic AA
hispanics
Asian Americans
non-hispanic whites
Symptoms of Type 2
non-specific
- takes a long time
- tired
- recurrent infections
- prolonged wound healing
- visual changes
Powerful risk factor of Type 2 DM
obesity
-specifically abdominal/visceral fat
Insulin resistance
associated with type 2
- body tissues don’t respond to insulin: insulin receptors either unresponsive or insufficient in number. Results in hyperglycemia. (cells won’t unlock when the insulin asks and glucose can’t get in)
- Liver won’t listen either: continues to release glucose even after meals
- Pancreas loses ability to produce insulin: beta cells fatigued from compensating, but continue to make it
Treatment for Type 1
-must have insulin to live
Treatment for Type 2
- insulin
- oral medications
- mealplanning
Oral medications for Type 2
- increase sensitivity
2. tells pancreas to make more insulin
Type 2 mealplanning
- emphasis on achieving glucose, lipid, blood pressure goals
- calorie reduction
- carb counting
Exercise and diabetes
-improves sensitivity to insulin
Rule of 15’s
- 70 continue to next meal or test again in 45-60 minutes
Relationship with illness and hyperglycemia
- Stress to body increases BS
- Lack of insulin because they do not take their insulin because they aren’t eating due to not feeling well
Diabetic ketoacidosis
- untreated Type 1 DM
- continues to insulin deficit which causes fat stores to break down
- results in hyperglycemia and mobilization of fatty acids with a subsequent ketosis
**develops when there is an absolute deficiency of insulin and an increase in the insulin counter-regulatory hormones
-Causes: MIGS (MI, Infection, GI bleed*, Sepsis)
HHS
metabolic problem that occurs in individuals who have type 2 DM and is characterized by a plasma osmolarity of 340 or greater, greatly elevated BS, and altered LOC.
- mortality is high, life threatening and even more than DKA
- initiated by hyperglycemia
Treatment of DKA and HHS
What comes first? Impaired perfusion and aggressive rehydration
And then? monitoring and replacement of electrolytes
And finally….correction of hyperglycemia with insulin
And don’t forget…what caused it?
Chronic Complications of Diabetes
- hyperglycemia
- hyperlipidemia
- hypertension
Macrovascular dz
Microvascular dz
Sulonylureas
- “mides/zides/rides”
- stimulates pancreas to release more insulin
- only for Type 2 DM
- yes, can cause hypoglycemia
- not for type 1
Biguanides
Metformin
- insulin sensitizer
- yes, can cause hypoglycemia
