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N232 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Complications of diabetes?

A

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

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2
Q

type 1 diabetes:

A

Body’s own immune system attacks the cells in the pancreas that produce insulin

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3
Q

type 2 diabetes

A

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.

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4
Q

Gestational diabetes

A

o Diabetes with first onset or recognition during pregnancy.

o Puts women at higher risk for type 2 DM later in life.

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5
Q

why is ageing population at inc. risk for diabetes:

A 
o	Changes in carbohydrate metabolism.
o	Poor diet.
o	Decreased activity.
o	Decreased lean body mass.
o	Altered insulin secretion.
o	Increased fat tissue.
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6
Q

non-modifiable risk factors of diabetes:

A

o Genetics
o Age
o Ethnicity
- gender

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7
Q

modifiable risk factors of diabetes:

A 
o	Diet
o	Exercise
o	Smoking
o	Alcohol use
o	Hypertension
o	Increased cholesterol (hyperlipidemia)
o	Abdominal obesity
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8
Q

macrovascular complications of diabetes

A

o Stroke.
o Heart disease and hypertension.
o Peripheral vascular disease.
o Ulcers and amputation.

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9
Q

microvascular complications of diabetes

A

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)

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10
Q

Diabetic Foot Care Patient Education:

A
  • 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.
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11
Q

Nephropathy - damage to the kidneys:

A

• 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.

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12
Q

Signs and symptoms of hypoglycemia:

A 
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
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13
Q

signs and symptoms of Hyperglycemia:

A 
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
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14
Q

Management of diabetes:

A
  • PCC
  • exercise
  • nurtrition
  • monitoring
  • pharmacologic therapy
  • education
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15
Q

Diagnostics for diabetes:

A 
o	Blood glucose (BG)
o	Fasting blood glucose (FBG)
o	Glucose tolerance test (GTT)
o	A1C
o	BP
o	Cholesterol
o	Microalbuminuria (proteinuria)
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16
Q

Blood glucose monitoring:

A

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.”

17
Q

What is diabetic A1C:

A
  • 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
18
Q

What is A1C used for?

A
  • 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.
19
Q

what is Microalbuminuria

A
  • 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
20
Q

Ketones in urine:

A
  • 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)
21
Q

What are the main targets/goals for pharmacological therapy?

A

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

22
Q

HumaLOG (Lispro) insulin:

A
  • 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
23
Q

Glargine (Lantus):

A
  • Long acting
  • onset: 90min
  • peak: none
  • duration: 24hr
  • comes in 10mL vial
  • *
  • do not give IV
  • do not mix with other insulins
  • not interchangeable
24
Q

PO Anti-hyperglycemics - type 2

List the kinds we’re studying

A
  • 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
25
Q

Biguanides - metformin: mechanism of action and adverse side effects

A

o Mechanism of action:

  • Decreases hepatic glucose production
  • Decreases interstitial glucose absorption
  • Increases sensitivity to insulin

o Adverse effects:
- Contraindicated with patients with renal impairment, HF,
and recent MI and stroke.
- Monitor creatinine, >133 men, >112 women

26
Q

Sulfonylures - Glypizide: mechanism of action and adverse side effects

A

o Mechanism of action:

  • Stimulates the pancreas to secrete insulin
  • Improves insulin action at receptor site
  • May decrease hepatic insulin metabolism (break down)

o Adverse effects:

  • Hypoglycemia
  • Mild nausea
  • Diarrhea, constipation
  • Dizziness, drowsiness
  • Skin rash, redness, itching

N232 (15 decks)

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