Diabetes Mellitus Flashcards
Diabetes
group of metabolic diseases which result from:
- a combination of the defects and actions of insulin
- defects in the secretion of insulin
what does diabetes often present with
hyperglycemia
metabolism disruption
blood vessel damage
microvascular diabetes complications
small blood vessels
retinopathy
nephropathy
neuropathy
macrovascular diabetes complications
damage to arteries
CVD - 68%
stroke - 16% due from stroke
PVD
Autonomic Neuropathy
results when nerves become damaged that manage bodily functions including: heart rate, sweating, bowel and bladder emptying, blood pressure, digestion
Type 1
inadequate production of insulin
usually diagnosed at young age
Type 2
insulin-resistant
most commonly diagnosed in adulthood
Gestational
Altered glucose metabolism due to increased pregnancy hormone levels
Insulin-Dependent DM
Type 1
juvenile-onest
childhood-onset
Type 1 Factors
presence of type 1 in a first-degree relative
little to no secretion of insulin
5010% of diabetic cases in North America
What cells are destroyed in Type 1 DM
pancreatic B-Cells
Type 2 Factors
Most common type of diabetes can often be controlled by diet and exercise metabolic disorder tissue-wide insulin resistance reduced insulin levels
Type 2 Risk factors
ethnic origin (African American, Native American, Hispanic, Asian American, Pacific Islander)
Obesity Genetics Poor Diet PCOS >45 vascular disease smoking
When is a fasting glucose test given
24th-28th week pregnancy
How much does having gestational diabetes increase risk of future development
50%
GD effect on child:
delayed fine motor skills
delayed gross motor skills
inattention, hyperactivity
Diagnosis of DM
Urinalysis, glucose tolerance tests, thirst, itchy skin, familial tendency, decreased hair growth
Semmes-Weinstein Test
Monofilaments used to map sensory loss
Semmes-Weinstein 10g results
protective/some sensation
Semmes-Weinstein 75g results
absent sensation
Type 1 Symptoms
frequent urination
increased thirst
increased appetite
blurred vision
Polyuria
frequent urination
polydipsia
increased thirst
polyphagia
increased appetite
retinopathy
Blurred vision
underlying microvascular occlusion of the retina
progressive areas of retinal ischemia and tissue death
vision impairment
Type 2 symptoms
gradual onset blurred vision neuropathic complications inflections significant blood lipid abnormalities
Normal Fasting Plasma Glucose Test
<100 mg/dl
Prediabetes Fasting Plasma Glucose Test
100-125 mg/dl
Diabetes Fasting Plasa Glucose Test
> 125 mg/dl
Atherosclerosis Type 1
Begins earlier, more extensive
changes large blood vessels
Atherosclerosis Undiagnosed Type 2
significantly higher risk for CAD, CVA, PVD
smoking increases risk
Nephropathy
kidney failure requiring dialysis or transplantation
presence of small amounts of albumin in urine
What is the leading cause of end-stage renal disease
DM
Dialysis
helps when filtration of the blood is compromised
hemodialysis and peritoneal dialysis
considered if kidneys filtering ability reduces to 10%
Hemodialysis
use of a dialyzer to purify blood
treatment 4 hours, 3x a week
must be done until able to get a transplant
Advantages to Hemodialysis
not required everyday
disadvantages to hemodialysis
patients will need to check in with dialysis center to ensure opening
International travel can be costly
diet and fluid intake restrictions
Peritoneal Dialysis
continuous ambulatory peritoneal dialysis (4 per day)
automated (7-10 hours a day)
put insulin in dialysate
Peritoneal Dialysis Advantages
more convenient scheduling
travel is easier
fewer diet and fluid restrictions
Disadvantages of Peritoneal Dialysis
must be performed daily
infection of peritoneal
increased potential for lethargy
weight gain
Infection
chronic, poorly controlled DM
significant risk for infection
skin, urinary tract, vaginal infections
Motor Neuropathy
produced weakness and atrophy
diabetic amyotrophy
Sensory Polyneuropathy
usually affecting hand and feet
causing mild tingling, burning, numbness or pain or complete loss of sensation
Sensory Neuropathy
Diabetic peripheral neuropathic pain
charcot food
Wagner Ulceration Grade 0
no ulcer but high risk foot
Wagner Ulceration Grade 1
superficial ulcer of skin or subcutaneous tissue
Wagner Ulceration Grade 2
Deep Ulcer, no bony involvement or abscess
Wagner Ulceration Grade 3
Deep ulcer with osteomyelitis
Wagner Ulceration Grade 4
Localized gangrene (heel, toes, etc)
Wagner Ulceration Grade 5
extensive gangrene of entire foot