Diabetes Flashcards
How many Americans have diabetes ?
29.1 million
1 out of 4 do not know that they have diabetes
How many Americans have prediabetes
86 million americans 20 years or older - more than 1 out of 3 adults have prediabetes
9 out of 10 do not know that they have prediabetes
Without weight loss and moderate physical activity ,
15-30% of people will develop type 2 diabetes within 5 years
How much higher is the risk of death for those with diabetes than those without diabetes ?
50% higher
What does type 1 diabetes do physiologically ?
There is the destruction of beta cells of pancreas
and there is absolute insulin deficiency
What does type 2 diabetes do ?
Progressive loss of beta cells of pancreas
Preceded or Accompanied by insulin resistance
Gestational diabetes
develops during the 2nd or 3rd trimester of pregnancy
disease is not present prior to gestation
Risk factors
Strong family hx of type 2 DM
Obesity
Glycosuria (glucose in urine),
Prior hx of GDM or previous large-for-gestation infant
What are the three P’s of diabetes mellitus?
Polydipsia
Polyuria
Polyphagia
What is polydipsia ?
Excessive thirst - as glucose levels are raised in the blood, water is pulled out of the cells and this results in dehydration and thirst stimulation
What is polyuria ?
Excessive urination
Glucose filtered by glomeruli exceed water reabsorption in renal tubules
Results in glycosuria and large water loss in the urine
What is polyphagia ?
Excessive hunger
Depletion of cellular storage of carbs, fats, and proteins
Results in cell starvation with corresponding increased hunger
What are signs and symptoms of diabetes Type 1 ?
Rapid onset 3 “Ps” - polydipsia, polyuria, polyphagia Weight Loss Fatigue Blurred Vision Nocturnal Enuresis (children) (wetting the bed) Ketosis Hyperglycemia
Type 2 diabetes signs and symptoms
Gradual onset 3 ”Ps” not as pronounced Symptoms of neuropathy Fatigue Blurred Vision Poor wound healing Prone to infections
What is neuropathy ?
Weakness, numbness, and pain from nerve damage, usually in the hands and feet.
A patient with type 2 diabetes asks the nurse what “type 2” means. The nurse explains which pathophysiologic features?
The liver is producing glucose abnormally during times of fasting
Over time the pancreas loses its ability to produce insulin.
There is decreased muscle and fat cell sensitivity to insulin.
Who are the pancreatic cells involved in diabetes ?
Alpha cells, beta cells and delta cells
Alpha cells
produce glucagon, which increases blood sugar levels
What is glycogenolysis ? What pancreatic cell stimulates this ?
The transformation of glycogen to glucose.
Done by the alpha cells
What is gluconeogenesis??
The transport of amino acids into the liver. This is done by the alpha cells
Beta cells
Produce insulin and amylin
What does amylin do ?
It increases satiety and suppresses glucagon release
What does insulin do ?
Lowers serum glucose
Stimulates cellular metabolism
Promotes glucose transport
Stimulates storage of glycogen in liver and muscle
Enhances fat deposition
Inhibits protein degradation
Accelerates amino acid transport into cells and protein synthesis
What do delta cells do ?
Produce gastrin and somatostatin
What does gastrin do ?
Stimulates secretion of gastric juice
Response to the presence of food
What does somatostatin do ?
Secreted in response to food intake, high levels of blood glucose and amino acids
Inhibits the secretion of insulin and glucagon
What is a priority nursing action when a patient’s blood glucose level is 50?
Administer 15 gm of carbohydrates (orange juice, soda, milk)
IV dextrose
IM glucagon
Long term complications of Diabetes
Macrovascular Damage - cardiovascular disease, hypertension and stroke
Microvascular damage - directly related to the degree and duration of hyperglycemia- retinopathy, nephropathy, sensory and motor neuropathy, autonomic neuropathy such as gastroparesis, amputations second to infections,
What are the different types of insulin categories?
Short Duration: Rapid Action
Short Duration Slower Acting
Intermediate Duration
Long Duration
What kind of insulin is Lispro(Humalog)
What is its onset, peak and duration of effect ?
short duration; rapid acting
Onset is 15-30 minutes
Peak is 0.5-2 hours
Duration is 3-6 hours
What kind of insulin is regular insulin ?
Short Duration; slower acting This is unmodified human insulin Onset is 30-60 minutes Peak is 1-5 hours Duration is 6-10 hours
What kind of insulin is NPH insulin?
Intermittent duration
NPH = Neutral Protamine Hagedorn
Onset is 60 -120 minutes
Peak is 6-14 hours
Duration is 16-24 hours
What kind of insulin is Insulin Glargine (Lantus)
Long Duration Insulin
Onset is 70 minutes
No Discernible Peak
Duration is up to 24 hours
