Diabetes Flashcards
Complications of diabetes?
heart attack, stroke, blindness, amputation, kidney disease, sexual dysfunction, serious psychiatric illness, accelerated cognitive decline, arthritis and nerve damage.
• Skin infections.
• Digestive problems.
• Thyroid problems (hypothyroidism).
• Sexual dysfunction in men (50-70% of all male
diabetes patients suffer from erectile dysfunction).
• Urinary tract and vaginal infections.
- Carpal tunnel syndrome
type 1 diabetes:
Body’s own immune system attacks the cells in the pancreas that produce insulin
type 2 diabetes
o The pancreas does not produce enough insulin and/or the bodies’ tissues do not respond properly to the actions of insulin.
o Caused by both genetic and environmental factors.
Gestational diabetes
o Diabetes with first onset or recognition during pregnancy.
o Puts women at higher risk for type 2 DM later in life.
why is ageing population at inc. risk for diabetes:
o Changes in carbohydrate metabolism. o Poor diet. o Decreased activity. o Decreased lean body mass. o Altered insulin secretion. o Increased fat tissue.
non-modifiable risk factors of diabetes:
o Genetics
o Age
o Ethnicity
- gender
modifiable risk factors of diabetes:
o Diet o Exercise o Smoking o Alcohol use o Hypertension o Increased cholesterol (hyperlipidemia) o Abdominal obesity
macrovascular complications of diabetes
o Stroke.
o Heart disease and hypertension.
o Peripheral vascular disease.
o Ulcers and amputation.
microvascular complications of diabetes
o retinopathy: blindness and cataracts, macular edema, cataracts, glaucoma).
o Renal disease (kidney).
o Neuropathy (limb amputation and ulcers)
Foot problems (damaged sensory nerve fibers resulting in numbness and pain)
Diabetic Foot Care Patient Education:
- Careful daily assessments of the feet.
- Bathe, dry, and lubricate feet (avoid moisturizer between toes).
- Wear closed-toe, well-fitting shoes.
- Do not go barefoot, shave calluses, or soak the feet.
- Trim toenails straight across, file sharp corners.
Nephropathy - damage to the kidneys:
• Secondary to diabetic microvascular changes.
• Kidneys filtration is stressed.
• Leading cause of kidney failure (end-stage renal
disease).
• Assess/manage: Monitor for microalbuminuria (proteinuria: protein in urine), BP, UTIs.
Signs and symptoms of hypoglycemia:
o BG < 4.0 mmol/L o Confusion – change in LOC o Sweating o Rapid pulse o Tremors o Headache o Weak o Impaired vision o Ask your patient for their experience
signs and symptoms of Hyperglycemia:
o BG > 7.0 mmol/L. May only see symptoms when BG is much higher, like 16 3 P's o Polyuria – excessive urination o Polyphagia – increased hunger o Polydipsia – increased thirst o Glucosuria – high levels of glucose in urine o Weight loss o Fatigue
Management of diabetes:
- PCC
- exercise
- nurtrition
- monitoring
- pharmacologic therapy
- education
Diagnostics for diabetes:
o Blood glucose (BG) o Fasting blood glucose (FBG) o Glucose tolerance test (GTT) o A1C o BP o Cholesterol o Microalbuminuria (proteinuria)
Blood glucose monitoring:
o Self- detection/prevention of hyper/hypoglycemia
o Dependent on skill level, cognitive ability, visual acuity, technology, comfort cost.
o Errors occur:
♣ Blood amount too small.
♣ Improper maintenance of machine.
♣ Damaged monitor strips.
o Teaching and evaluation critical.
• Fasting blood glucose – To measure amount of glucose in blood after no caloric intake for 8 hours.
• Glucose tolerance test – done after FBG – the patient drinks a standard solution of glucose to challenge his/her system – followed by a second BG test at specific intervals to track “glucose challenge.”
What is diabetic A1C:
- A1C: <7.0% or less than or equal to 6.0%
- BP: less than or equal to 130/80 mmHg
- Cholesterol: LDL-C <2.5 mmol/L
What is A1C used for?
- A1C is a measurement of your average blood glucose control for the last 2-3 months and approximately 50% of that value comes from the last 30 days
- Healthy red blood cells have some glucose attached to the hemoglobin – A high A1C means that unhealthy amount of glucose are stuck to the cells.
what is Microalbuminuria
- proteinuria
• A screening test for the presence of proteins in the urine
o Albumin is one of the first proteins to pass through the kidney
o Secondary to microvascular changes in the kidney
o Indicates kidney damage
o More than 85% of diabetics with microalbuminuria develop neuropathy
Ketones in urine:
- No effective insulin available
- Body breaks down stored fat for energy
- Ketones are byproducts of fat metabolism
- Accumulate in blood and urine
- Puts patients at risk for diabetic ketoacidosis (DKA)
What are the main targets/goals for pharmacological therapy?
o To lower blood glucose: 1-3 pills and/or insulin
o To lower cholesterol: 1 or 2 pills
o To lower blood pressure: 2 or 3 pills
HumaLOG (Lispro) insulin:
- rapid acting (give when food is in front of them, right before they eat)
- onset: 10-15min
- peak: 60-90min
- duration: 3-5hrs
- comes in 3mL vial
- give immediately before meals
- may be mixed with NPH
- aspart and glulisine automatically substituted to lispro
Glargine (Lantus):
- Long acting
- onset: 90min
- peak: none
- duration: 24hr
- comes in 10mL vial
- *
- do not give IV
- do not mix with other insulins
- not interchangeable
PO Anti-hyperglycemics - type 2
List the kinds we’re studying
- Common action of lowering BG levels
- Classification based on chemical structure and mechanism of action
- Single, dual, or triple therapy may be used
- May require insulin
- Biguanides - metformin
- Sulfonylureas - Glypizide
