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Adult Health > Diabetes > Flashcards

Diabetes Flashcards

1
Q

define diabetes

A

is a chronic multisystem disease related to abnormal insulin production or impaired insulin utilization or both

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2
Q

diabetes is the leading cause of what?

diabetes is a major risk factors for what other health problems

A

Adult blindness
End-stage renal dx
Nontraumatic lower limb amputations

Heart disease and stroke

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3
Q

Theories link cause to single/combination of these factors

A

Autoimmune
Genetic
Environmental
Viral

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4
Q

insulin decreases ____in the bloodstream

type 1 diabetes mellitus peak onset occur b/w __ and __.

type 1 diabetes is a result of progressive destruction of________ by body’s own ____

Autoantibodies cause reduction of 80 to 90% of normal __ __function.

A

glucose

11 , 13

pancreatic B cells

T cells

B cell

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5
Q

What are the most known causes of Type I diabetes?

Type 1 has a cause of genetic predisposition due to what?

A

Genetic predisposition
Exposure to a virus

Human leukocyte antigens

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6
Q

What are the three classic symptoms of Type 1 Diabetes?

A

Polydipsia
Polyuria
Polyphagia

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7
Q

what do type 1 diabetes patients require?

DKA is a life threatening condition that occurs during absence _____ ______that resulting from metabolic ____

A

exogenous insulin

exogenous insulin

acidosis

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8
Q

Prediabetes known as impaired ____ ___ (igt) or impaired ___ ____ (ift)

IGT: fasting glucose levels higher than normal

IFG: 2-hr plasma glucose higher than normal

A

glucose tolerance

fasting glucose

> 100 mg/dl, but <126 mg/dl

(between 140-199 mg/dl)

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9
Q

in prediabetes long-term damage already occuring in?

prediabetes can present with no symptoms and also have symptoms of ?

A

heart, blood vessels

polyphagia, polydipsia, and polyuria

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10
Q

most prevalent type of diabetes is type?

A

type 2

over 90% of patients with diabetes and 80-90 are overweight

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11
Q

type II diabetes is greater in which ethnic groups?

Which two ethnic groups have the highest rate of type II diabetes in the world

A

african americans, asian americans, hispanic americans, and native americans.

Native american and Alaskan Natives.

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12
Q

With type 2 diabetes pancreas continues to produce ___ ____ however, insulin is either insufficient or poorly utilized by tissues due to decreased sensitivity/response of cells to insulin.

A

endogenous insulin

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13
Q

Largest risk factor of type 2 diabetes mellitus?

genetic mutations lead to what two factors that affect the likelihood of obtaining type 2?

A

obesity

insulin resistance and increased risk for obesity

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14
Q

Gestational diabetes increases risk for ?

therapy for gestational diabetes include

A

perinatal death, c-section, neonate complications

using nutrition first then utilize insulin therapy second

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15
Q

Secondary diabetes results from another medical condition such as?

A

Cushing syndrome Hyperthyroidism Pancreatitis
Parenteral nutrition
Cystic fibrosis
Hematochromatosis

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16
Q

Name a few clinical manifestations of type 2 Diabetes?

A
  • Recurrent yeast infections
  • Visual changes
  • Prolonged wound healing
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17
Q

What are the 4 ways to diagnose someone with type II diabetes

  1. A1C of __ or higher.
  2. Fasting plasma glucose (FPG) level greater than or equal to ___
  3. Two-hour plasma glucose level greater than or equal to4. In a patient with classic symptoms of hyperglycemia
    (polyuria, polydipsia, unexplained weight loss) or hyperglycemic
    crisis, random

4.In a patient with classic symptoms of hyperglycemia
(polyuria, polydipsia, unexplained weight loss) or hyperglycemic
crisis, a

A
  1. A1C of 6.5% or higher.
  2. Fasting plasma glucose (FPG) level greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no
    caloric intake for at least 8 hours.
  3. Two-hour plasma glucose level greater than or equal to
    200 mg/dL (11.1 mmol/L) during an OGTT, using a glucose load of 75 g.
  4. a random plasma glucose greater than or
    equal to 200 mg/dL (11.1 mmol/L).
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18
Q

Hemoglobin A1c test shows amount of glucose attached to hemoglobin molecules over rbc life span of __ to ___ days.

Ideal goal for glycosylated hemoglobin A1C

Normal A1c reduces risk of retinopathy, nephropathy, some of the most common microvascular complications

A

90 to 120

ADA less than or equal to 7.0 american college of endocrinology

Normal A1C reduces

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19
Q

What are the different types of insulin?

A

short-acting, rapid acting, intermediate acting, & long acting

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20
Q

Rapid-acting:

Short-acting:

Intermediate-acting:

Long-acting:

A

Lispro (Humalog), Aspart (Novolog), and glulisine (Apidra), Exubera

Regular

NPH

Glargine (Lantus), detemir (Levemir)

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21
Q

what regimen closely mimics endogenous insulin production

long-acting basal is used how often

rapid/short-acting (bolus) are used when?

A

basal bolus

once a day

before meals using a sliding scale to cover blood sugar levels

22
Q

Rapid-acting (bolus)

Short-acting (bolus)

Intermediate-acting

A

Humalog, Novolog, Apidra
injected 0-15 min ac Onset of action 15 min; Peak 60-90 min; Duration 3-4 hours

Regular (Humulin R, Novolin R)
Injected 30 to 45 minutes ac
Onset of action 30 to 60 minutes; Peak 2-3 hours; Duration 3-6 hours

Acting (NPH (Humulin N, Novolin N
Onset 24- hours; Peak 4-10; duration 10-16

23
Q

what do you know about long-acting (basal)

A

injected once a day at bedtime or in the morning.
released steadily and continuously
No peak action
Cannot mixed with any other insulin stands alone since it is basal

24
Q

what are the two ways you can receive insulin

A

iv and subcutaneous injections

25
Q

insulin is usually available as U100 and 1 ml contains how many units of insulin?

A

100 units of insulin

26
Q

problems with insulin therapy are

A

Hypoglycemia

Allergic reactions

Lipodystrophy

Somogyi effect (occur during hrs of sleep which produce a decline in bs level due to too much insulin) response is gluconeogenesis and glycogenolysis producing rebound hyperglycemia in the morning often associated with morning headache, nightsweats, and nightmares. have to get bs checked b/w 2-4A to detect hypoglycemia.

Dawn phenomenon characterized by hyperglycemia present on awakening the morning. Due to release of counterregulatory hormones in predawn hours
Treatment will include an adjustment in the timing of insulin administration or an increase in insulin dose Measurement of the blood sugars should include pre-bedtime, predawn (2-4 AM) and morning. if predawn levels are less than 60 mg/dL insulin dose is reduced.

27
Q

oral agents drug therapy used for diabetes is not insulin and work to improve the mechanisms of which three defects of type 2 diabetes

A

insulin resistance

decreased insulin production

Increased hepatic glucose production

28
Q

name a few oral agents that are used as drug therapies for diabetes

A 
Sulfonylureas
Meglitinides
Biguanides
a-Glucosidase inhibitors
Thiazolidinediones
29
Q

sulfonylureas stimulate the production of ____ and decrease _____ and ____. name a few examples

A

insulin from the pancreas

Decrease glycogenolysis and gluconeogenesis.

Glipizide, glyburide, and glimepride

30
Q

meglitinides

name two examples

A

Stimulate a rapid and short-lived release of insulin
from the pancreas
(starlix and prandin).

31
Q

Biguanides

name example

A

Reduce glucose production by liver
Enhance insulin sensitivity at tissues
Improve glucose transport into cells
Do not promote weight gain

ex. metformin

32
Q

α-Glucosidase inhibitors
“Starch blockers”
do what?

name an example

A

Slow down absorption of carbohydrate in small intestine

precose, glyset

33
Q

thiazolidinediones are most effective in? and also improves?

name a few ex,

A

those with insulin resistance.
insulin sensitivity, transport, and utilization at target tissues

actos, avandia,

34
Q

amylin analog

give example of one

A

Slows gastric empyting, reduces postprandial glucagon secretion, increases satiety (fullness)

symlin

35
Q

Exercise
Essential part of diabetes management
↑ __ ___ ___, lowers ___ ___ __. contribute to ___ loss.

A

Insulin receptor sites
Lowers blood glucose levels
Contributes to weight loss

36
Q

always monitor blood glucose levels when during exercise?

A

before, during, and after exercise

37
Q

Acute interventions are seen with what conditions?

A

Hypoglycemia

Diabetic ketoacidosis

Hyperosmolar hyperglycemic nonketotic syndrome

Stress of illness and surgery

38
Q

DKA is caused by what

Characterized by:

DKA most likely occurs in

A

Caused by profound deficiency of insulin

Hyperglycemia
Ketosis
Acidosis
Dehydration
Illness
Infection
Inadequate insulin dosage
Undiagnosed type 1 Poor self-management
Neglect

Type 1

39
Q

When supply of insulin is insufficient that means?

Body breaks down fats stores
Ketones are by-products of fat metabolism
Alters pH balance, causing metabolic acidosis
Ketone bodies excreted in urine
Electrolytes become depleted

A

glucose cannot be properly used for energy

40
Q

what are signs and symptoms of DKA

A

lethargy/weakness are early symptoms

dehydration orthostatic hypotension
tachycardia
dry mucous membranes
poor skin turgor

41
Q

DKA what type of respirations will you see?

A

Kussmaul respiration which is seen in rapid deep breathing, attempt to reserve metabolic acidosis, and sweet fruity odor.

42
Q

What are the lab finding you will see with a pt who has DKA

A

Blood glucose > 300 mg/dl
Arterial blood pH below 7.30
Serum bicarbonate level <15 mEq/L
Ketones in blood and urine

43
Q

What would you prepare to do with a patient who has DKA?

A 
Airway management oxygen administration?
Correct fluid/electrolyte imbalance
IV infusion 0.45% or 0.9% NaCl
Restore urine output
Raise blood pressure
When blood glucose levels approach 250 mg/dl 
5% dextrose added to regimen
Prevent hypoglycemia 
Potassium replacement sn big deal
Sodium bicarbonate 
If pH <7
44
Q

Insulin therapy for DKA wittheld until?

what is given first and second medication wise for those affected by DKA

A

fluid resuscitation has begun

Bolus followed by insulin drip

45
Q

What are the common manifestations of hypoglycemia?

A 
Confusion
Irritability
Diaphoresis
Tremors
Hunger
Weakness
Visual disturbances
Can mimic alcohol intoxication
46
Q

What is hypoglycemic unawareness

A

Person does not experience warning signs/symptoms, increasing risk for decreased blood glucose levels
Related to autonomic neuropathy

47
Q

hypoglycemia treatment should consist of __ to __ g of a simple carb and _ to _ oz of fruit juice. you also want to avoid foods with ___ because they decrease absorption of sugar..

When should you recheck blood sugar?

Repeat until blood sugar is at what range?

A

15 to 20

4 to 6

Fat

15 minutes after treatment.

70 mg/dl

48
Q

If person hypoglycemia don’t improve after 2 to 3 doses of simple carbs or patient ain’t alert to swallow administer what?

A

1 mg of glucagon IM or subcut

side effect rebound hypoglycemia

in acute care settings they administer 20 to 50 ml of 50% dextrose IV push

49
Q

angiopathy microvascular changes occur as a result from?

A

thickening of vessel membranes in capillaries and arterioles in response of chronic hyperglycemia is specific to diabetes unlike macrovascular

50
Q

angiopathy

macrovascular is defined as what?

A

Disease of large and medium-size blood vessels

Occur with greater frequency and with an earlier onset in diabetics

Results in peripheral arterial disorders and amputations

51
Q

microvascular angiopathy areas most notably affected are?

clinical manifestations usually occur

A

eyes (retinopathy)
kidneys (nephropathy)
skin (dermopathy)

10-20 years

52
Q

Diabetic neuropathy consist of nerve damage due to

A

metabolic derangements of diabetes

Sensory neuropathy
Distal symmetric 
Most common form 
Affects hands and/or feet bilaterally
Characteristics include
Loss of sensation, abnormal sensations, pain, and paresthesias

Adult Health (3 decks)

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