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Pathophysiology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

How many people in the world are living with Diabetes?

A
  • 425 million adults are living with diabetes
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2
Q

Factors contributing to the increase in the number of people with type II Diabetes

A
  • Aging population
  • Sedentary lifestyle
  • Aboriginal ethnicity
  • Asian/South Asian/African (immigration)
  • Increasing obesity rates
  • Longer life expectancy
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3
Q

What is Diabetes Mellitus (DM)?

A
  • DM is a metabolic disorder characterized by the presentation of hyperglycaemia due to defective insulin secretion, defective insulin action, or both
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4
Q

Types of Diabetes - Classifications

A
  1. Prediabetes
  2. Type 1 Diabetes
    3/ Type 2 Diabetes
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5
Q

Prediabetes

A
  • impaired glucose tolerance (IGT) - the body is no longer responding to the insulin the body is producing so the blood sugar remains high
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6
Q

Lab values for Prediabetes

  • 2-hour glucose level
  • Fasting glucose (IFG - impaired fasting glucose)
A

2-hour glucose levels between 7.8 and 11.1

IFG (impaired fasting glucose) 6.1-6.9 mmol/L

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7
Q

Type 1 Diabetes

A

pancreatic beta cell destruction

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8
Q

Type 2 DM

A

pancreas produces insufficient insulin and the body is not responding sufficiently to the insulin

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9
Q

Normal Blood Glucose Range

A

4-6mmol/L

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10
Q

What is Gestational Diabetes

A

Diabetes in pregnant women. Screen women at risk. Usually no longer present after the delivery.

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11
Q

Metabolic Syndrome - a collection of risk factors that increase an individuals chance of developing cardiovascular disease and diabetes mellitus (5)

A
  1. Abdominal obesity
  2. Hypertension
  3. Dyslipidemia
  4. Insulin resistance
  5. Dysglycemia
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12
Q

Modifiable Risk Factors of Type 2 Diabetes Mellitus (4)

A
  1. Obesity
  2. Physical inactivity
  3. Hypertension
  4. Abdominal cholesterol levels and dyslipidemia
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13
Q

Non-modifiable Risk factors for Type 2 DM (4)

A
  1. Age
  2. History of gestational diabetes
  3. Family history
  4. Race/ethnic background
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14
Q

Function of Beta cells of the pancreas

A
  • regulate the hormone insulin
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15
Q

Function of Alpha cells of the pancreas

A

Regulate the hormone glucagon

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16
Q

Function of insulin

A

increases cellular uptake of glucose

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17
Q

Function of Glucagon

A

increases release of glucose by the liver

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18
Q

Effect of increased glucose on insulin and glucagon

A

Increase insulin and decreased glucagon

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19
Q

Effect of decreased glucose on insulin and glucagon

A

Decreased insulin and increased glucagon

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20
Q

Pathophysiology of Type 1 DM

A
  • Lack of insulin secretion
  • destruction of beta-cells resulting in decreased or absent insulin secretion
  • Manifestations seen when 80-90% of normal beta-cell function is destroyed
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21
Q

Pathophysiology of Type 2 DM

A
  • Insulin resistance
  • Body tissues do not respond to action of insulin
  • Decreased responsiveness of beta cells to hyperglycaemia
  • Decrease in ability to produce insulin
  • Inappropriate glucose production by liver
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22
Q
  1. Diagnosis of Type 1 DM is…
  2. Typical onset at ….
  3. Cachexic appearance…
  4. Insulin …
  5. Often difficult to control …
  6. Often diagnosis is precipitated by …
A
  1. Abrupt
  2. younger age (<30) (Juvenile Diabetes)
  3. gaunt
  4. Insulin dependent for survival
  5. Blood sugar
  6. Stress or illness
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23
Q
  1. Typical onset at …
  2. Onset is …
  3. Combination of …
  4. Oral hyperglycaemic agents or insulin …
  5. Relatively stable …
A
  1. older age
  2. slow and gradual
  3. genetic and environmental factors
  4. may be necessary
  5. Blood sugar
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24
Q 
Lab Values: 
Symptoms of diabetes + 
1. random plasma glucose value
2. plasma glucose value in 2-hr sample
3. A1c
4. Fasting plasma glucose (FPG)
A
  1. Random plasma glucose value > 11.1 mmol/L (normal values: 4-6mmol/L)
  2. Plasma glucose value in a 2-hr sample > 11.1 mmol/L
  3. A1c > 6.5%
  4. FPG >7.0 mmol/L
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25
Q

A1c Test

A

Determines the presence of glucose on hemoglobin cells

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26
Q

Impaired Fasting Glucose

A

Test: Fasting Plasma Glucose
Results: 6.1-6.9

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27
Q

Impaired Glucose Tolerance

A

Test: 2-hr Plasma Glucose in 75-g Oral Glucose tolerance test
Results: 7.8-11.0

28
Q

Prediabetes

A

Test: Glycated Hemoglobin (A1c)
Results: 6.0-6.4

29
Q

Clinical Manifestations of Type 1 DM

A 
Polyuria
polydipsia
polyphagia 
weight loss 
Ketonuria 
weakness and fatigue 
visual changes
30
Q

Polyuria

A

Too much urine

31
Q

Polydipsia

A

Excessive thirst and drinking a lot

32
Q

Polyphagia

A

Excessive hunger and eating a lot

33
Q

Ketonuria

A

spilling ketones into the urine from the burning of fat and protein

  • Fruity breath. N & V, Abdominal pain
  • Very ill person.
34
Q

Clinical Manifestations of Type 2

A
  • Gradual onset
  • may have classic manifestations
  • chronic blurred vision
  • recurrent infections (skin, vaginal yeast), slow-healing wounds
  • Neuropathic pain
  • Weight gain.
  • Fatigue (may be only symptom)
35
Q

Medications associated with Type 2 DM

A
  • Statins –> cholesterol lowering
  • ACE inhibitors –> lower BP
  • Aspirin
36
Q

Goals for management of diabetes (4)

A
  1. Reduce symptoms
  2. prevent and manage acute complications
  3. delay onset and progression of long-term complications
  4. Attaining desirable weight
37
Q

Glycogen

A

Stored glucose in the liver and muscle

38
Q

Glucose

A

Source of energy in the body

39
Q

Glucagon

A

strongly opposed the action of insulin. Stimulates conversion of glycogen to glucose

40
Q

Gluconeogenesis

A

making glucose from non-carbohydrate sources

41
Q

Gycogenolysis

A

Glycogen breakdown to make glucose

42
Q

Endogenous insulin

A

insulin the body/pancreas makes

43
Q

Exogenous insulin

A

Externally made insulin

44
Q

Hypoglycaemia

A

Too much insulin in proportion to available glucose in blood.

45
Q

Causes of Hypogycemia (4)

A
  1. mismatch in the timing of food intake and the intake of insulin or an oral hyperglycemic agent.
  2. Excessive insulin, or oral hyperglycemic agents
  3. Ingestion of insufficient carbohydrates
  4. Excessive exercise
46
Q

Adrenergic Signs and Symptoms of Hypoglycemia

A

Epinephrine release (fight or flight)
body is in stress state which causes:
- diaphoresis, tremors, hunger, nervousness, anxiety, pallor & palpitations

47
Q

Neuroglycopenic Symptoms of Hypoglycemia

A

Brain is not getting enough glucose.

- irritability, visual disturbances, difficulty speaking, confusion & coma

48
Q

What happens if hypoglycemia is left untreated?

A

loss of consciousness, coma, seizure

49
Q

What to do in the case of hypoglycemia

A
  • check blood sugar: threat is BS < 4mmol/L
  • administer 15-20g simple carbohydrate
  • check BS in 15 minutes & give more CHO prn
    Once BS > 4 mmol/L give longer-acting starch & protein (cereal and milk) (peanut butter sandwich)
50
Q

Diabetic Ketoacidosis (DKA)

A
  • Profound deficiency of insulin. hyperglycemia & dehydration.
  • Fats are metabolized in absence of insulin –> ketosis & acidosis
51
Q

what type of DM is most likely to get DKA?

A

Type 1

- happens when a person doesnt know they have type 1 diabetes

52
Q

In DKA the cells are starved for glucose. so the body…

A

breaks down fats to try and create energy for the body.

53
Q

Betahydroxybuterate

A

the ketone that is tested for in the blood to diagnose DKA. The one that is check to see if the patient is ketotic. As well as blood gas which will show the pH and the amount of acidosis.

54
Q

Precipitating Factors of DKA (6)

A
  1. Illness
  2. Infection
  3. Inadequate insulin dosage
  4. Insulin omission
  5. Undiagnosed type 1 diabetes
  6. Poor self-management
55
Q

Signs and Symptoms of DKA

A
  • polyuria, polydipsia, polyphagia
  • Dehydration
  • lethargy and weakness (early symptoms)
  • poor skin turgor, dry mucous membrane, tachycardia, orthostatic hypotension, sunken eyes.
  • N & V
  • Abdominal pain
  • Kussmauls respirations
  • Fruity odour to breath
  • Blood glucose > 14 mmol/L, pH < 7.35. HCO3 < 15 mmol/L
  • ketones in blood & urine
56
Q

Treatment of DKA

A
  • Ensuring airway
  • IV access
  • First step - hydrate them because their blood is hypertonic. Boluses of fluid - 1-2L. Until urine output is 30-60mL/hr.
  • Insulin infusion (slowly) 3-4 ml/hr
  • Electrolyte pannel Q4h
  • When glucose is around 14, D5W (5% dextrose in water) will start to be infused to prevent hypoglycemia
57
Q

Hyperosmolar Hyperglycemic nonketotic syndrome (HHS)

A
  • occurs in clients able to produce enough insulin to prevent DKA but not enough to prevent sever hyperglycemia, osmotic diuresis & ECF depletion
  • Ketoacidosis does not occur
  • Less common than DKA
  • Develops slowly over time until it gets to a dangerous place
58
Q

Who is HHS most common in?

A

Older adults with type 2 DM because of impaired thirst sensation, functional inability to replace fluids

59
Q

Signs and Symptoms of HHS

A
  • Somnolence, coma, seizure, hemiparesis, aphasia
  • BG > 35 mmol/L
  • Marked increase in serum osmolality
  • Tachycardic
  • Low BP
  • Severe dehydration
60
Q

Treatment

A
  • more fluid replacement
  • IV admin of insulin
  • Replacing electrolytes
  • monitoring repsonse to treatment
  • high mortality
  • Patients do not correct as well as in DKA
61
Q

Chronic Complications of DM

A

Macrovascular complications
Microvascular complications
Neuropathy

62
Q

Macrovascular complications

A
  • coronary artery disease, stroke, hypertension, atherosclerosis, peripheral vascular disease
  • 2-3x greater risk of heart disease
  • important to optimize their BS (control HTN, hyperglycemia and dyslipidemia)
63
Q

Microvascular complications

A

specific to diabetes patients. Secondary to thickening capillary beds and arteries.

  • retinopathy - issues with eyesight
  • nephropathy - chronic kidney disease
64
Q

Neuropathy

A

Nerve damage (peripheral vasculature)

  • sensory neuropathy - digestion, temp control, BP, heart
  • autonomic neuropathy, when the nerves that control involuntary bodily functions are damaged. Loss of autonomic innervation ot heart.
65
Q

Infections and DM

A
  • people with DM are at higher risk fo infections (infections of skin, osteomyelitis, vaginitis, peridontal infection)
  • hyperglycemic state leads to increased infection because of poor blood supply.
  • increase in glucose levels stimulate growth of microorganisms
  • Good wound care is essential nursing intervention

Pathophysiology (8 decks)

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