DIABETES Flashcards
• What triggers the development of Type 1 diabetes?
Autoimmune destruction of the pancreatic beta cells, resulting in inability to produce insulin. Immune system identifies these cells as foreign accidentally and destroys them. Some are born with genetic susceptibility to it. Then later an environmental trigger such as virus activates the genetic susceptibility to bring immune response that produce type 1 diabetes.
• Name three (3) symptoms of Type 1 diabetes.
Nausea, Weight loss, vomiting, acetone smell.
• Name three (3) symptoms of Type 2 diabetes and characteristics.
Blurred vision. Polyuria. Polydipsia. Characteristics of T2D = insulin resistance, and insulin secretion deficit.
• State three (3) risk factors for Type 2 diabetes.
Obesity, Aging, Minorities [NZ Maori, Pacific].
• Name one (1) test used to diagnose Type 2 diabetes.
HBA1C. Oral glucose tolerance test. To monitor – urine, HbA1c
• State three (3) symptoms of hyperglycaemia.
Polyuria [excessive urination], Polydipsia [Excessive thirst], Polyphagia [Excessive hunger], dry mouth, fatigue.
• What is hypoglycaemia and possible causes?
Hypoglycemia occurs when the level of glucose in the blood falls below 3.5mmol/l, usually as a result of an imbalance between food, physical activity and medication. Overdose of insulin, inadequate food intake, vomiting, frequent simple carbohydrate intake, strenuous exercise, infection
• State three (3) symptoms of hypoglycaemia. early and late
Early – sweating, shaking, dizziness, hunger.
Late – double vision, unusual behaviour, confusion.
• Describe the treatment of hypoglycaemia.
1 Check BGL [blood glucose level] and treat immediately
2 If unconscious treat with glucagon injection
3 When conscious administer 5 jelly beans
4 Check BGL and repeat treatment in 5-10 minutes if no affect
5 Once BGL rises, follow with longer acting carb food like 1 sandwich or fruit.
6 Repeat BGL test to ensure levels have improved.
• Develop a teaching plan that identifies three (3) ways that Type 2 diabetes can be managed.
Healthy diet Exercise Weight loss Oral hypo glycaemics BP and lipid monitoring
Management of T2D and T1D?
Management T2D – Healthy diet, exercise, weight loss.
Management T1D – Insulin, different types – short acting, long acting, fast acting
• People with serious mental illness are more at risk of developing diabetes, HOW?
Atypical antipsychotic medications cause weight gain, hyperlipidaemia and insulin resistance causing diabetes
Atypical antipsychotic medications are associated with significant increases in fasting glucose concentrations
• Develop a teaching plan that identifies three (3) ways that Type 2 diabetes can be managed.
Healthy diet Exercise Weight loss Oral hypo glycaemics e.g. metformin = reduce glucose produced in liver BP and lipid monitoring
• How does metformin work to reduce glucose levels in the blood?
Oral hypo glycaemics e.g. metformin = reduce glucose produced in liver
• What blood glucose levels should people aim to sit within?
Blood glucose levels 4-8 mmol/l
Ideally 4-6mmol/l on waking
Ideally 4-8mmol/l rest of day
Elderly may be 5-10 mmol/l
• Interventions for diabetics
Retinal screening
Foot screening
Clinical measurements: Blood pressure, Weight and BMI, HbA1c, Cholesterol, Creatinine, Electrolytes.
Other services to offer:
Advice and information on nutritional and lifestyle modification
Smoking cessation
Appetite for life
Diabetes group education classes
Green prescription
Health info
Identify high needs and high risk patients
Many factors can contribute to hyperglycaemia, including:
- Insufficient insulin or oral diabetes medication
- Not injecting insulin properly or using expired insulin
- Diet
- Being inactive
- Illness or infection
- Certain medications, eg steroids, beta blockers
- Injury or surgery
- Experiencing emotional stress, such as family conflict or workplace challenges
What to do if someone has Hypoglycemia
• Always a medical emergency
• Consequences
– Sympathetic arousal, collapse, confusion, seizure, coma, death.
• Needs IMMEDIATE treatment
• Once patient stabilised, consider the cause and try to prevent recurrence.
Hypoglycaemia prevention
Frequent BSL monitoring
Monitor and encourage food intake
Anticipate changes in insulin requirements eg. fasting, changes in activity level
Give dextrose with insulin infusions*
Educate about symptoms of hypoglycaemia and encourage them to report these promptly.
Ask patients on insulin about their experience of hypoglycaemia and awareness threshold.
Hypoglycaemia management and specify mmol’s
Patient conscious, and able to swallow safely
– Give 15-20g quick acting carbohydrate
– Test BSL after 10min
– If still <3.5mmol/L, repeat up to 3 times
– If still low, call for help, consider IV glucose or IM glucagon.
– Once BSL>3.5 give a snack or next meal if available
Metabolic Syndrome / Defined as 3 or more of the following:
- Abdominal or visceral obesity(>102cm M, >88cm F)
- High triglycerides(ugly cholesterol)
- Low HDL(good) cholesterol
- High BP >130/80 (EPA SMI without DM 140/90)
- High fasting blood glucose
Managing Type 2 Diabetes
- Healthy diet
- Exercise
- Weight loss
- Oral hypo glycaemics
- BP and lipid monitoring
Hypoglycaemic Agents - state two
Biguanides / Metformin / REDUCE GLUCOSE IN LIVER
Sulphonylureas / Glipizide / Stimulate pancreas to release more insulin
Insulin resistance what is it
- term used to describe the detrimental effect fat has on blocking available insulins ability to work properly
- fat blocks insulins ability to work effectively and efficiently
- High levels of insulin (that cant be utilised effectively) called insulinaemia
- Multi faceted, complicated mechanism/s and is a feature of the ‘metabolic syndrome’
Barriers to preventitive care with patients who have mental illnesses [in diabetic care]
Less compliant with treatment, Severity of mental illness, Lack of social skills and communicating needs, migrant status or cultural ethnicity
