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Clients with Health Challenges - N3600 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the most common signs of diabetes?

A

Urinary frequency and excessive thirst

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2
Q

What does diabetes stand for?

What does mellitus stand for?

A

Diabetes - siphon

Mellitus - sweet

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3
Q

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?

A

heart disease, stroke

small arterioles in the lower leg calcify leaving to PVD and often amputations

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4
Q

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?

A

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

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5
Q

Who discovered insulin?
Where was early insulin extracted from?
What do we use now?

A

Dr. Frederick Banting

Pigs and cattle
Now use synthetic (many ppl are allergic to porcine/bovine insulin)

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6
Q

Describe Type II diabetes.
What proportion of diabetics are type II?
How are the majority (75%) of cases diagnosed?

A

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

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7
Q

Type II diabetes is developing in children at an alarming rate, why?

A

Obesity epidemic

- especially in latin immigrants, but also home grown children

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8
Q

What is needed to prevent children from developing type II diabetes?

A

Lifestyle changes - exercise and weight reduction

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9
Q

How is sugar consumption related to obesity (at least according to her slides).

A

Sugar consumption can lead to a fatty liver and consequently to metabolic disorders

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10
Q

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 _______ ______
A 
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
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11
Q

What is a special population to consider when thinking about type II diabetes risk in Canada?

A

Canadian Aboriginal people

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12
Q

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
A

3-5x

25%

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13
Q

Diabetes that is a temporary condition that occurs during pregnancy.

A

Gestational diabetes

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14
Q

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
A

cortisol, estrogen

high risk of developing type II diabetes

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15
Q

How are women screened for gestational diabetes?

A

Glucose tolerance test
Glucose intolerance
Secretion of placental hormones

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16
Q

What are the most important modifiable risk factors for the development of type II diabetes:?

A

Diet, exercise and weight

- managing these can lead to reversal of type 2

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17
Q

What are the three most important non-modifiable risk factors for type II diabetes?

A

age, genetics, ethnicity

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18
Q

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.

A

Glycemic index - GI

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19
Q

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.

A

later

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20
Q

excessive thirst due to hypovolemia

A

polydypsia

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21
Q

If glucose is not being taken up by the cells, what will start accumulating in their blood and urine?

A

Ketone bodies

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22
Q

Why does diabetes often precipitate infections or cause recurring infections?

A

Hypoglycemia –> increase glucose in the fluid of the tissues (But not in the cells) = favourable medium for bacteria

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23
Q

What is the physiological mechanism for polydypsia?

A

Glucosuria pulls water from the body, increasing thirst

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24
Q

How can keto acidosis contribute to gallstones?

A

Increased ketone bodies in the blood –> hyperlipidemia –> build up in the gallbladder and produces gallstones

25
Q

Blood glucose targets:

  • For individuals with diabetes
    • Fasting?
    • 2 hours post-prandial
  • Normal values
    • fasting?
  • -2 hours post-prandial
A

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
26
Q

Glucometer testing:

  • Frequency of testing is variable - could be as frequent as ______ ______ or as infrequent as ______ _ ______.
  • where do we prick the finger? Why?
A

before meals; once a week

We prick the side of the finger, as it is less sensitive than the fat pad

27
Q

What is some teaching we can do about glucometer testing?

A

To not reuse the lancet when testing blood glucose

28
Q

What are the critical values for blood glucose?

A

< 2.8 or > 20

29
Q

If the blood glucose is 2.8 or less, what is done?

A

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)

30
Q

What do we do when the blood sugar is above 20?

A

Call physican and let them know - they will change the order for insulin

31
Q

Serves as a marker for average blood glucose levels over the previous 1-3 months prior to the blood test

A

Glycated hemoglobin

32
Q

What values of Hb1Ac do we look for to indicate good control of blood glucose?

A

< 0.065 (or less than 6.5%/7%)

33
Q

If someone has Hb1Ac over 6.5%, what is done?

A

Perform a glucose tolerance test

34
Q

How long does a RBC live?

A

4 months - ~120 days

35
Q

Describe the GTT

A

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
36
Q

A diagnostic test where glucose is given and blood samples are taken afterward to determine how quickly it is cleared from the blood.

A

GTT

37
Q

Diagnosis summary

  • Fasting blood glucose (no food for last 8 hours) of?
  • Casual plasma glucose of?
  • 2 hour post-prandial?
  • Hb1Ac of?
    • prediabetes value?
A 
FPG - 7+
Casual PG - 11.1+
2hPG OGTT - 11.1+
HbA1C > 6.5%
- pre = 6.0-6.4%
38
Q

Pre-diabetes can be modified by _____ alone.

A

diet

39
Q

The major complications of diabetes are?

A

Macrovascular, microvascular and neuropathic

40
Q

What are the most important hyperglycemia signs and symptoms?

A

Polyuria

Polydipsia

41
Q

How do we treat hyperglycemia?

A

Insulin, oral hypoglycemia agents, control diet

42
Q

Can the brain survive on ketone bodies?

A

No, the brain exclusively uses glucose

43
Q

What are the most important signs to look out for that may indicate hypoglycemia?

A

Mood changes - patient is irritable, unlike themselves; lose consciousness

sweating - profuse diaphoresis - sweating buckets from their forehead

44
Q

How do we treat hypoglycemia?

A

Give patient glucose = glucose tabs, orange juice, or glucagon

45
Q

What is the treatment for diabetic ketoacidosis?

A

Fluids and electolytes, insulin

46
Q

What are some signs that patients may recognize for diabetic ketoacidosis?

A

Fruity breath (acetone), blurred vision, extreme headaches and weakness

Very thirsty

Kausmal breathing

47
Q

What are Kussmal respsirations?

A

Increased rate and depth of respiration

48
Q

What are the 3 main causes of diabetic ketoacidosis?

A

Lack of insulin, illness, undiagnosed diabetes

49
Q

Although the person’s pH becomes acidic during diabetic ketoacidosis, why do we not give bicarbonate?

A

Can lower potassium levels and cause fatal arrhythmia

50
Q

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?>
A

15%
amputation
Neuropathy and PVD (calcification of the small arterioles in the lower leg and foot)

51
Q

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

A - motor

B - autonomic

C - sensory

52
Q

What is an easy way to test for autonomic neuropathy in diabetics?

A

See if they can perspire below the knee (if they cannot, they have advanced autonomic neuropathy)

53
Q

higher or lower than normal sensitivity to stimuli

A

hypo or hyper aesthesia (related to sensory neuropathy)

54
Q

Describe how autonomic neuropathy can lead to foot amputation.

A

No sweating, get cracked heels –> bacteria enter fissues and create an ulcer –> can lead to amputation

55
Q

How do we heal cracked feet?

A

Do not soak (removes essential oils), but wash feet

56
Q

How do we test neuropathy of the foot?

A

Test 10 spots on both feet with monofilament

57
Q

If someone does not have a monofilament, what can they use?

A

Plastic pricetag from new clothing.

58
Q

What are important considerations when doing monofilament testing?

A

Have patient close their eyes and tell you where they feel the sensation
test both feet

Clients with Health Challenges - N3600 (22 decks)

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