Diabetes Flashcards
What are the most common signs of diabetes?
Urinary frequency and excessive thirst
What does diabetes stand for?
What does mellitus stand for?
Diabetes - siphon
Mellitus - sweet
Diabetes - Stats
- the majority (80%) of people with diabetes will die as a result of ______ _____ or _______
How does peripheral vascular disease occur as a result of diabetes?
heart disease, stroke
small arterioles in the lower leg calcify leaving to PVD and often amputations
What is type I diabetes?
What proportion of diabetics are type I?
When are most cases diagnosed?
What used to be another name for type I diabetes?
Occurs when the pancreas does not produce insulin (autoimmune disorder where the Beta cells of the islets of Langerhans are attacked)
Accounts for 10% of all diabetics
Most cases Dx before age 30
Juvenile diabetes - name no longer used
Who discovered insulin?
Where was early insulin extracted from?
What do we use now?
Dr. Frederick Banting
Pigs and cattle
Now use synthetic (many ppl are allergic to porcine/bovine insulin)
Describe Type II diabetes.
What proportion of diabetics are type II?
How are the majority (75%) of cases diagnosed?
Type II diabetes is either due to the pancreas not producing enough insulin, or the body does not effectively use the insulin that is produced
90%
Incidentally through routine/incidental testing
Type II diabetes is developing in children at an alarming rate, why?
Obesity epidemic
- especially in latin immigrants, but also home grown children
What is needed to prevent children from developing type II diabetes?
Lifestyle changes - exercise and weight reduction
How is sugar consumption related to obesity (at least according to her slides).
Sugar consumption can lead to a fatty liver and consequently to metabolic disorders
Type II - Who is at risk?
- Over ___ years old
- High risk ethnic groups - basically everyone but?
- number one risk factor
- Family Hx
- Birth related?
- high ______ or high _______ ______
40 everyone but Europeans and Caucasians Obesity - number one risk factor Hx of gestational diabetes or giving birth to a high birth weight baby High cholesterol or BP
What is a special population to consider when thinking about type II diabetes risk in Canada?
Canadian Aboriginal people
Type II and Aboriginal people:
- - x more likely than the general population to have type 2
- Estimated that ___% of individuals in First Nations communities over 45 have DM
3-5x
25%
Diabetes that is a temporary condition that occurs during pregnancy.
Gestational diabetes
Gestational diabetes:
- Placenta produces _____ and ______ - this allows more sugar to the get to the baby, causing a larger birth weight baby
- When this occurs, women are not as healthy during pregnancy, often need bedrest later on
- after the baby is delivered, the mother and child should be fine, but carry around a high risk of developing this disease
cortisol, estrogen
high risk of developing type II diabetes
How are women screened for gestational diabetes?
Glucose tolerance test
Glucose intolerance
Secretion of placental hormones
What are the most important modifiable risk factors for the development of type II diabetes:?
Diet, exercise and weight
- managing these can lead to reversal of type 2
What are the three most important non-modifiable risk factors for type II diabetes?
age, genetics, ethnicity
number associated with a particular type of food that indicates the food’s effect on a person’s blood glucose level.
Indicates how quickly food glucose is absorbed.
Glycemic index - GI
Frequent or recurring infections, cuts or bruises that are slow to heal, tingling or numbness in the hands or feet, and trouble getting or maintaining an erection are all _____ signs of uncontrolled blood sugar.
later
excessive thirst due to hypovolemia
polydypsia
If glucose is not being taken up by the cells, what will start accumulating in their blood and urine?
Ketone bodies
Why does diabetes often precipitate infections or cause recurring infections?
Hypoglycemia –> increase glucose in the fluid of the tissues (But not in the cells) = favourable medium for bacteria
What is the physiological mechanism for polydypsia?
Glucosuria pulls water from the body, increasing thirst
How can keto acidosis contribute to gallstones?
Increased ketone bodies in the blood –> hyperlipidemia –> build up in the gallbladder and produces gallstones
Blood glucose targets:
- For individuals with diabetes
- Fasting?
- 2 hours post-prandial
- Normal values
- fasting?
- -2 hours post-prandial
Diabetics
- fasting - 4-7 mmol/L
- 2 hours post meal - 5-10 mmol/L
Normal:
- fasting - 4-6 mmol/L
- 2 hours post meal - 5-8 mmol/L
Glucometer testing:
- Frequency of testing is variable - could be as frequent as ______ ______ or as infrequent as ______ _ ______.
- where do we prick the finger? Why?
before meals; once a week
We prick the side of the finger, as it is less sensitive than the fat pad
What is some teaching we can do about glucometer testing?
To not reuse the lancet when testing blood glucose
What are the critical values for blood glucose?
< 2.8 or > 20
If the blood glucose is 2.8 or less, what is done?
Nurse will give a glass of orange juice or a tbsp of honey - if the person can swallow;
if the person cannot swallow, will draw sugar in syringe and give intravenously, or give glucagon
(do not need an order)
What do we do when the blood sugar is above 20?
Call physican and let them know - they will change the order for insulin
Serves as a marker for average blood glucose levels over the previous 1-3 months prior to the blood test
Glycated hemoglobin
What values of Hb1Ac do we look for to indicate good control of blood glucose?
< 0.065 (or less than 6.5%/7%)
If someone has Hb1Ac over 6.5%, what is done?
Perform a glucose tolerance test
How long does a RBC live?
4 months - ~120 days
Describe the GTT
Person shows up fasted, then is given a sugary solution to drink - do a blood test before and 2 hours later
- if the fasting glucose is 7 or higher - positive
- if it is 11.1 or higher after the 2 hours - positive
A diagnostic test where glucose is given and blood samples are taken afterward to determine how quickly it is cleared from the blood.
GTT
Diagnosis summary
- Fasting blood glucose (no food for last 8 hours) of?
- Casual plasma glucose of?
- 2 hour post-prandial?
- Hb1Ac of?
- prediabetes value?
FPG - 7+ Casual PG - 11.1+ 2hPG OGTT - 11.1+ HbA1C > 6.5% - pre = 6.0-6.4%
Pre-diabetes can be modified by _____ alone.
diet
The major complications of diabetes are?
Macrovascular, microvascular and neuropathic
What are the most important hyperglycemia signs and symptoms?
Polyuria
Polydipsia
How do we treat hyperglycemia?
Insulin, oral hypoglycemia agents, control diet
Can the brain survive on ketone bodies?
No, the brain exclusively uses glucose
What are the most important signs to look out for that may indicate hypoglycemia?
Mood changes - patient is irritable, unlike themselves; lose consciousness
sweating - profuse diaphoresis - sweating buckets from their forehead
How do we treat hypoglycemia?
Give patient glucose = glucose tabs, orange juice, or glucagon
What is the treatment for diabetic ketoacidosis?
Fluids and electolytes, insulin
What are some signs that patients may recognize for diabetic ketoacidosis?
Fruity breath (acetone), blurred vision, extreme headaches and weakness
Very thirsty
Kausmal breathing
What are Kussmal respsirations?
Increased rate and depth of respiration
What are the 3 main causes of diabetic ketoacidosis?
Lack of insulin, illness, undiagnosed diabetes
Although the person’s pH becomes acidic during diabetic ketoacidosis, why do we not give bicarbonate?
Can lower potassium levels and cause fatal arrhythmia
Diabetic foot ulcers:
- __% of people with diabetes will develop a foot ulcer in their lifetime
- 14-24% of those who have a foot ulcer will have what complication?
- What combination puts diabetics at risk for ulcer formation?>
15%
amputation
Neuropathy and PVD (calcification of the small arterioles in the lower leg and foot)
Name the neuropathy type based on the description:
A - changes in muscle/tendon anatomy, clawing of the toes, foot deformity, a change in gait = a change in pressure points = callous
B - Sympathetic nerve damage, no sweating, dry skin, cracks and fissures develop as a result
C - bilateral, progressive may have no pain, high risk for mechanical, thermal and chemical trauma
A - motor
B - autonomic
C - sensory
What is an easy way to test for autonomic neuropathy in diabetics?
See if they can perspire below the knee (if they cannot, they have advanced autonomic neuropathy)
higher or lower than normal sensitivity to stimuli
hypo or hyper aesthesia (related to sensory neuropathy)
Describe how autonomic neuropathy can lead to foot amputation.
No sweating, get cracked heels –> bacteria enter fissues and create an ulcer –> can lead to amputation
How do we heal cracked feet?
Do not soak (removes essential oils), but wash feet
How do we test neuropathy of the foot?
Test 10 spots on both feet with monofilament
If someone does not have a monofilament, what can they use?
Plastic pricetag from new clothing.
What are important considerations when doing monofilament testing?
Have patient close their eyes and tell you where they feel the sensation
test both feet
