Diabetes Flashcards
define diabetes
is a chronic multisystem disease related to abnormal insulin production or impaired insulin utilization or both
diabetes is the leading cause of what?
diabetes is a major risk factors for what other health problems
Adult blindness
End-stage renal dx
Nontraumatic lower limb amputations
Heart disease and stroke
Theories link cause to single/combination of these factors
Autoimmune
Genetic
Environmental
Viral
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.
glucose
11 , 13
pancreatic B cells
T cells
B cell
What are the most known causes of Type I diabetes?
Type 1 has a cause of genetic predisposition due to what?
Genetic predisposition
Exposure to a virus
Human leukocyte antigens
What are the three classic symptoms of Type 1 Diabetes?
Polydipsia
Polyuria
Polyphagia
what do type 1 diabetes patients require?
DKA is a life threatening condition that occurs during absence _____ ______that resulting from metabolic ____
exogenous insulin
exogenous insulin
acidosis
Prediabetes known as impaired ____ ___ (igt) or impaired ___ ____ (ift)
IGT: fasting glucose levels higher than normal
IFG: 2-hr plasma glucose higher than normal
glucose tolerance
fasting glucose
> 100 mg/dl, but <126 mg/dl
(between 140-199 mg/dl)
in prediabetes long-term damage already occuring in?
prediabetes can present with no symptoms and also have symptoms of ?
heart, blood vessels
polyphagia, polydipsia, and polyuria
most prevalent type of diabetes is type?
type 2
over 90% of patients with diabetes and 80-90 are overweight
type II diabetes is greater in which ethnic groups?
Which two ethnic groups have the highest rate of type II diabetes in the world
african americans, asian americans, hispanic americans, and native americans.
Native american and Alaskan Natives.
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.
endogenous insulin
Largest risk factor of type 2 diabetes mellitus?
genetic mutations lead to what two factors that affect the likelihood of obtaining type 2?
obesity
insulin resistance and increased risk for obesity
Gestational diabetes increases risk for ?
therapy for gestational diabetes include
perinatal death, c-section, neonate complications
using nutrition first then utilize insulin therapy second
Secondary diabetes results from another medical condition such as?
Cushing syndrome Hyperthyroidism Pancreatitis
Parenteral nutrition
Cystic fibrosis
Hematochromatosis
Name a few clinical manifestations of type 2 Diabetes?
- Recurrent yeast infections
- Visual changes
- Prolonged wound healing
What are the 4 ways to diagnose someone with type II diabetes
- A1C of __ or higher.
- Fasting plasma glucose (FPG) level greater than or equal to ___
- 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
- A1C of 6.5% or higher.
- 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. - 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. - a random plasma glucose greater than or
equal to 200 mg/dL (11.1 mmol/L).
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
90 to 120
ADA less than or equal to 7.0 american college of endocrinology
Normal A1C reduces
What are the different types of insulin?
short-acting, rapid acting, intermediate acting, & long acting
Rapid-acting:
Short-acting:
Intermediate-acting:
Long-acting:
Lispro (Humalog), Aspart (Novolog), and glulisine (Apidra), Exubera
Regular
NPH
Glargine (Lantus), detemir (Levemir)
what regimen closely mimics endogenous insulin production
long-acting basal is used how often
rapid/short-acting (bolus) are used when?
basal bolus
once a day
before meals using a sliding scale to cover blood sugar levels
Rapid-acting (bolus)
Short-acting (bolus)
Intermediate-acting
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
what do you know about long-acting (basal)
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
what are the two ways you can receive insulin
iv and subcutaneous injections
insulin is usually available as U100 and 1 ml contains how many units of insulin?
100 units of insulin
problems with insulin therapy are
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.
oral agents drug therapy used for diabetes is not insulin and work to improve the mechanisms of which three defects of type 2 diabetes
insulin resistance
decreased insulin production
Increased hepatic glucose production
name a few oral agents that are used as drug therapies for diabetes
Sulfonylureas Meglitinides Biguanides a-Glucosidase inhibitors Thiazolidinediones
sulfonylureas stimulate the production of ____ and decrease _____ and ____. name a few examples
insulin from the pancreas
Decrease glycogenolysis and gluconeogenesis.
Glipizide, glyburide, and glimepride
meglitinides
name two examples
Stimulate a rapid and short-lived release of insulin
from the pancreas
(starlix and prandin).
Biguanides
name example
Reduce glucose production by liver
Enhance insulin sensitivity at tissues
Improve glucose transport into cells
Do not promote weight gain
ex. metformin
α-Glucosidase inhibitors
“Starch blockers”
do what?
name an example
Slow down absorption of carbohydrate in small intestine
precose, glyset
thiazolidinediones are most effective in? and also improves?
name a few ex,
those with insulin resistance.
insulin sensitivity, transport, and utilization at target tissues
actos, avandia,
amylin analog
give example of one
Slows gastric empyting, reduces postprandial glucagon secretion, increases satiety (fullness)
symlin
Exercise
Essential part of diabetes management
↑ __ ___ ___, lowers ___ ___ __. contribute to ___ loss.
Insulin receptor sites
Lowers blood glucose levels
Contributes to weight loss
always monitor blood glucose levels when during exercise?
before, during, and after exercise
Acute interventions are seen with what conditions?
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic nonketotic syndrome
Stress of illness and surgery
DKA is caused by what
Characterized by:
DKA most likely occurs in
Caused by profound deficiency of insulin
Hyperglycemia Ketosis Acidosis Dehydration Illness Infection Inadequate insulin dosage Undiagnosed type 1 Poor self-management Neglect
Type 1
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
glucose cannot be properly used for energy
what are signs and symptoms of DKA
lethargy/weakness are early symptoms
dehydration orthostatic hypotension
tachycardia
dry mucous membranes
poor skin turgor
DKA what type of respirations will you see?
Kussmaul respiration which is seen in rapid deep breathing, attempt to reserve metabolic acidosis, and sweet fruity odor.
What are the lab finding you will see with a pt who has DKA
Blood glucose > 300 mg/dl
Arterial blood pH below 7.30
Serum bicarbonate level <15 mEq/L
Ketones in blood and urine
What would you prepare to do with a patient who has DKA?
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
Insulin therapy for DKA wittheld until?
what is given first and second medication wise for those affected by DKA
fluid resuscitation has begun
Bolus followed by insulin drip
What are the common manifestations of hypoglycemia?
Confusion Irritability Diaphoresis Tremors Hunger Weakness Visual disturbances Can mimic alcohol intoxication
What is hypoglycemic unawareness
Person does not experience warning signs/symptoms, increasing risk for decreased blood glucose levels
Related to autonomic neuropathy
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?
15 to 20
4 to 6
Fat
15 minutes after treatment.
70 mg/dl
If person hypoglycemia don’t improve after 2 to 3 doses of simple carbs or patient ain’t alert to swallow administer what?
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
angiopathy microvascular changes occur as a result from?
thickening of vessel membranes in capillaries and arterioles in response of chronic hyperglycemia is specific to diabetes unlike macrovascular
angiopathy
macrovascular is defined as what?
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
microvascular angiopathy areas most notably affected are?
clinical manifestations usually occur
eyes (retinopathy)
kidneys (nephropathy)
skin (dermopathy)
10-20 years
Diabetic neuropathy consist of nerve damage due to
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
