Diabetes Flashcards
Diabetes Mellitus is the leading cause of?
- End-stage renal disease
- Adult blindness
- Nontraumatic lower limb amputations
Diabetes is a major contributing factor for?
- Heart disease (2-4x higher)
- Stroke (risk is 2-4x higer)
Type 1 Diabetes Mellitus most often occurs in people what age?
younger than 40 years of age
Classic symptoms of T1DM?
- Polyuria (frequent urination)
- Polydipsia (excessive thirst)
- Polyphagia (excessive hunger)
Type 1 Diabetes Mellitus symptoms?
- Rapid onset
- Classic symptoms
- Polyuria
- Polydipsia)
- Polyphagia
- Weight loss
- Weakness
- Fatigue
Management of Type 1
Insulin (REQUIRED)
Type 2 Diabetes Mellitus Usually occurs in people what age?
over 35 years of age
Risk Factors for Type 2 Diabetes Mellitus?
- overweight
- Family history
- African American
Major difference between type 1 & 2
Type 2: Pancreas continues to produce some endogenous insulin
Type 2 Diabetes Mellitus
- Pancreas continues to produce some endogenous insulin
- Insulin produced is insufficient or is poorly utilized by tissues
Hyperosmolar coma
caused by osmotic fluid/electrolyte loss from hyperglycemia
Symptoms of Type 2 Diabetes Mellitus?
- Nonspecific symptoms
- May have classic symptoms of type 1
- Fatigue
- Recurrent infection
- Recurrent vaginal yeast or monilia infection
- Prolonged wound healing
- Visual changes
Diabetes Mellitus:Diagnostic Studies?
- AIC ≥ 6.5%
- Fasting plasma glucose level >126 mg/dL
- Two-hour OGTT level ≥200 mg/dL when a glucose load of 75 g is used
- Random or casual plasma glucose measurement ≥200 mg/dL plus symptoms
Diabetes Mellitus: Diagnostic Studies (Fasting plasma glucose level)
> 126 mg/dL
Diabetes Mellitus: Diagnostic Studies (Two-hour OGTT level)
≥200 mg/dL when a glucose load of 75 g is used
Diabetes Mellitus: Diagnostic Studies (Random or casual plasma glucose measurement)
≥200 mg/dL plus symptoms
preferred method of diagnosis for Diabetes Mellitus?
The fasting plasma glucose (FPG) test, confirmed by repeat testing on another day
Prediabetes:
- Fasting glucose levels
- 2-Hour plasma glucose levels
- AIC is in range of
- 100 to 125 mg/dL
- between 140 and 199 mg/dL
- 5.7% to 6.4%.
Prediabetes:
1) symptoms
2) Teaching
1) Long-term damage already occurring
- Heart, blood vessels
- Usually present with no symptoms
2) diet, exercise, weight loss, and patient to watch for classic symptoms
Gestational Diabetes detected?
at 24 - 28 weeks of gestation
Risk factors for Gestational Diabetes detected?
- Obese
- Advanced maternal age
- Family history
When does Gestational Diabetes glucose levels usually return to normal?
6 weeks post partum
Therapy for Gestational Diabetes?
First nutritional, second insulin
Causes of Secondary Diabetes?
- Cushings syndrome
- Hyperthyroidism
- Pancreatitis
- Parenteral nutrition
- Long term steroid treatments
- Cystic fibrosis
Therapy for Secondary Diabetes?
- Usually resolves when underlying condition is treated
- Usually treated with sliding scale insulin
Nutritional Therapy for diabetes (carbohydrates)?
- Minimum of 130 g/day
- Fruits, vegetables, whole grains, legumes, low-fat dairy
- All benefit from including dietary fiber
- Nutritive and nonnutritive sweeteners may be used in moderation
Nutritional Therapy for diabetes (Protein)?
- Should make up 15% to 20% of total calories
- High-protein diets not recommended
Nutritional Therapy for diabetes (Alcohol)?
- 1 drink/day for women; 2 drinks/day for men
- Inhibits gluconeogenesis by liver and can cause severe hypoglycemia
- Blood glucose levels must be monitored
Nutritional Therapy for diabetes (Fats)?
- Limit saturated fats to < 7% of total calories
- Limit cholesterol to < 200 mg/day
- Minimize trans fat
- Healthy fats come from plants (Olives, nuts, avocados)
Amount of carbs per meal for a diabetic patient?
45-60g
Patient Teaching for a diabetic?
- Insulin
- Self-monitoring of blood glucose
- Prep & admin
- Exercise
- At least 150 minutes/week aerobic
- Strength training 2 days/week
- Avoid Alcohol
- Hygiene
- Avoid Stress
Exercise ________ insulin receptor sites and ________ blood glucose levels?
- increases
- lowers
Rapid-acting (bolus) insulin
Lispro, aspart, glulisine
Lispro
- Rapid-acting (bolus) insulin
- onset of action 15 minutes
- Injected 0 to 15 minutes before meal
aspart
- Rapid-acting (bolus) insulin
- onset of action 15 minutes
- Injected 0 to 15 minutes before meal
glulisine
- Rapid-acting (bolus) insulin
- onset of action 15 minutes
- Injected 0 to 15 minutes before meal
Short-acting (bolus) Insulin
Regular
Regular insulin onset and time given?
- Short-acting (bolus)
- Injected 30 to 45 minutes before meal
- Onset of action 30 to 60 minutes
Intermediate Insulin?
NPH
NPH
- Intermediate insulin
- Injected twice daily
- 24 H coverage
- cloudy, needs to be agitated (not shaken)
- Must adhere to meal plan
Long-acting Insulin?
Lantus, Glargine
Lantus
- Injected once a day at bedtime or in the morning
- Released steadily and continuously
- No peak action
- Cannot be mixed with any other insulin or solution
Glargine
- Injected once a day at bedtime or in the morning
- Released steadily and continuously
- No peak action
- Cannot be mixed with any other insulin or solution
Administration of Insulin
- Fastest absorption from abdomen, followed by arm, thigh, and buttock
- Rotate injections
Preferred site of injection for insulin?
abdomen
Complications from Insulin Therapy?
- Hypoglycemia
- Allergic reaction
- Infection at insertion site
- Lipodystrophy-atrophy of sub q tissue
- Somogyi effect-hypoglycemia
- Dawn phenomenon
Somogyi effect-hypoglycemia info?
- 02-04am
- May sleep through it
- Provide HS snack, decrease insulin dose
Dawn phenomenon-
- hyperglycemia upon awakening
- Have headache, night sweats, nightmares
- Assess HS, BS and BS at 02-04am
- Increase insulin dose or adjust times
Inhaled Insulin?
Afrezza
Afrezza
- Rapid-acting inhaled insulin
- Administered at beginning of each meal or within 20 minutes after starting a meal
- Not a substitute for long-acting insulin
Type 2 Oral Medications
- Sulfonylureas (Amaryl)
- Meglitinides (Prandin)
- Biguanides (Metformin)
- α-Glucosidase inhibitors (Precose)
- Thiazolidinediones (Actos)
Sulfonylureas
- Glucotrol,
- Glucotrol XL
- glyburide (Micronase, DiaBeta, Glynase)
- glimepiride (Amaryl).
Meglitinides
- repaglinide (Prandin)
- nateglinide (Starlix).
Sulfonylureas and Meglitinides receptor sites are located?
pancreas
biguanides and thiazolidinediones receptor sites are located?
adipose tissue and muscle
Sulfonylureas and Meglitinides action?
increases insulin production
biguanides and thiazolidinediones action in adipose tissue and muscle?
Adipose tissue and muscle: - increases insulin uptake - decreases insulin resistance Liver: - decreases glucose production
α-Glucosidase inhibitors (Precose) action ?
delays absorption of starches in the stomach and small instestines
DDP-4 Inhibitor action?
- increases activity of incretins in the small intestine and stomach
- decreases hepatic glucose production
GLP-1 and amylin action?
decreases gastric emptying in the stomach and small intestine
Complications-S/S of Hyperglycemia?
- Increased urination
- Increased appetite followed by lack of appetite
- Weakness, fatigue
- Blurred vision
- Headache
- N/V
- May progress to DKA
Complications-S/S of Hypoglycemia?
- BG < 60 or 70 (varies)
- Cold, Clammy skin
- Numbness
- Tachycardia
- Headache, Nervous
Dizzy, Slurred speech, Lethargy - May be a asymptomatic
Causes of hyperglycemia?
- Infection
- Steroids
- Too much food
- Not enough medication
- Stress
Causes of hypoglycemia?
- Alcohol
- Not enough food
- Too much exercise
- Too much medication
- Weight loss
Tx of hyperglycemia?
- Medication
- Check BG frequently
- Drink fluids
Tx of hypoglycemia if alert and can swallow?
- “Rule of 15”
- Give 15-20 g of simple carb (juice followed by bread/crackers/peanut butter)
- Recheck blood sugar 15 minutes after treatment
- Repeat until blood sugar >70 mg/dL.
- Patient should eat regularly scheduled meal/snack to prevent rebound hypoglycemia
- Check blood sugar again 45 minutes after treatment
Tx of hypoglycemia not alert enough to swallow (non-acute setting)?
- Administer 1 mg of glucagon IM or subcutaneously
- Side effect: Rebound hypoglycemia
- Have patient ingest a complex carbohydrate after recovery (starchy veg, whole grain bread)
Tx of hypoglycemia not alert enough to swallow (acute setting)?
- 20 to 50 mL of 50% dextrose IV push
- Followed by a continuous infusion D5W
Diabetic Ketoacidosis and Diabetic Coma are characterized by?
- Hyperglycemia
- Ketosis
- Acidosis
- Dehydration
- mostly occurs in type 1
Causes of DKA
- Severe illness
- Stress
- Infection
- Deficient pancreas
- Inadequate insulin
- Undiagnosed Type 1
- Poor self-management or neglect
DKA S/S early symptoms?
lethargy/weakness
DKA S/S ?
- Dehydration
- Abdominal pain
- Kussmaul respirations
S/S of dehydration?
- Poor skin turgor
- Dry mucous membranes
- Tachycardia
- Orthostatic hypotension
S/S of Kussmaul respirations?
- Rapid deep breathing
- Attempt to reverse metabolic acidosis
- Sweet fruity odor
DKA diagnostic results?
1) glucose
2) pH
3) HCO3
4) Ketones
1) > 250mg/dL
2) < 7.3
3) < 15 mEg/L
4) Moderate to large in urine
DKA Complications
- Renal failure
- Comatose
- Dehydration
- Electrolyte imbalance
- Acidosis
- Death
DKA Treatment?
- Manage Airway
- Correct fluid/electrolyte imbalance
- IV infusion
- Restore urine output
- Raise blood pressure
- 5% dextrose added
- Prevent hypoglycemia
- Potassium replacement (know K level before starting insulin gtt)
- Sodium bicarbonate
- IV infusion
DKA insulin Tx therapy?
begin with a bolus followed by a drip
Life threatening condition cause by severe hyperglycemia, but has enough insulin to prevent DKA?
Hyperosmolar Hyperglycemic syndrome (HHS)
Hyperosmolar Hyperglycemic syndrome (HHS)
- Life threatening condition cause by severe hyperglycemia, but has enough insulin to prevent DKA
- Occurs in pts > 65
Causes of HHS?
UTI, pneumonia, sepsis, acute illness, newly diagnosed type 2
High blood glucose in HHS can result in?
Seizures, hemiparesis, aphasia
Symptoms of HHS
May be asymptomatic with elevated blood sugar
What is need for a diagnosis of HHS?
- blood glucose > 600mg/dL
- increase serum osmolality
- absent or minimal ketones in serum and urine
HHS Treatment?
- Similar to DKA
- Manage Airway
- Correct fluid/electrolyte imbalance
How often should blood glucose be monitored?
hourly
Interventions for patients at home following acute illness, injury or surgery?
- heck blood glucose every 4 hours
- Report BG >300mg/dL x2
- Continue to eat, increase non-caloric fluids
- If unable to eat increase carb containing fluids
- Continue to take insulin or oral medications
- Notify MD if unable to keep food/fluids down
Interventions for the hospitalized patient
following acute illness, injury or surgery?
- IVF
- IV insulin
- Frequent blood glucose monitoring
- If patient is unconscious monitor for sweating, tachycardia, tremors
Chronic Complications of diabetes?
- Cardiovascular disease
- PAD
- Diabetic retinopathy
- Diabetic nephropathy
- Diabetic neuropathy
- infection
T1DM pts should have dilated exam within _____ of onset and repeated _____?
- 5 y/o
- annually
What is the leading cause of ESRF?
diabetic nephropathy
usually appears as red-yellow lesions, with atrophic skin that becomes shiny and transparent, revealing tiny blood vessels under the surface?
Necrobiosis Lipidoidica Diabeticorum
High incidence of diabetes in what population?
- Hispanics
- American Indians
- African Americans
- Asians and Pacific Islanders
