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Nursing Therapeutics (Diabetes) > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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1
Q

Type 1: __________ onset, Autoimmune __________ destruction, ___________ insulin deficiency
Type 2: ___________ onset, _____________ loss of adequate ___________ insulin secretion

A

abrupt; beta-cell; absolute; insidious; progressive; beta-cell

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2
Q

What is gestational DM?

A

Diabetes diagnosed in 2nd/ 3rd trimester of pregnancy, usually disappears after giving birth

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3
Q

Normal range of (random) blood glucose for:
1. adults
2. elderly
3. adults fasting
4. HbA1C

A
  1. 5.0-8.0 mmol/L
  2. 4.4-8.3 mmol/L
  3. =<5.6mmol/L
  4. 4-6%
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4
Q

Prediabetes diagnostic criteria (fasting, 2hr pp & HBA1C)

A

Fasting: 5.6-6.9mmol/L
2hr plasma glucose: 7.8-11.0mmol/L
HBA1C: 5.7-6.4%

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5
Q

Diabetes diagnostic criteria (fasting, 2hr pp & HbA1C)

A

Fasting: >=7.0mmol/L
2hr pp: >=11.1mmol/L
HbA1C: >=6.5%

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6
Q

Definition of fasting plasma glucose?

A

no caloric intake for 8 hrs

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7
Q

What is glycated haemoglobin (HbA1C) & contraindications?

A

It determines glycaemic control over 3 months through irreversible attachment of glucose to RBC, average RBC life span is 120 days and result is not affected by recent change in diet/ medication
contraindications: anaemia patients

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8
Q

Hyperglycemia 4 classic signs & symptoms

A

Polyuria - frequent urination
Polydipsia - increased fluid intake & thirst
Polyphagia - increased food intake & hunger
Unexplained weight loss
(others: dry mouth & skin, blurred vision, glycosuria, ketouria)

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9
Q

2 complications of Hyperglycemia + their main S/S

A

Diabetic Ketoacidosis: occurs primarily in DM1; severe insulin deficiency w/ severe hyper, ketouria & acidosis
*s/s: kussmaul breathing, acetone breath, dysrhythmias
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNKS): affects DM2, ketone bodies usually absent
*s/s: dry mucous membrane, sunken eyeballs, poor skin turgor

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10
Q

Chronic complications of Hyperglycemia (list 4/7)

A
  1. Macroangiopathy (coronary artery disease & cerbrovascular disease; peripheral vascular disease)
  2. Microangiopathy (retinopathy, nephropathy)
  3. Neuropathy (autonomic & peripheral; early manifestation - albuminuria),
  4. Orthostatic hypotension
  5. Impaired immune function
  6. Diarrhoea
  7. Sexual dysfunction/ impotence
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11
Q

3 levels of Hypoglycemia

A

Lev1: 3.0-3.9mmol/L
Lev2: <3.0mmol/L
Lev3: altered mental/ physical state

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12
Q

Glycemic target for hyperglycemic patients
(HbA1C, Preprandial, 2hr pp, BP)

A

HbA1C: <7%
Preprandial: 4.4-7.2 mmol/L
2hrpp (peak postprandial): <10mmol/L
BP - Systolic: <140 mmHg; Diastolic: <90 mmHg

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13
Q

3 main principles of diet management for diabetic patients

A
  1. Energy balance & weight management
  2. Carbohydrate amount & quality
  3. Eating pattern & nutrient distribution
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14
Q

4 diet choices for diabetic patients (out of 6)

A
  1. High fibre, non-starchy veggies
  2. Carbohydrate counting (for flexible insulin dose)
  3. Consistent carbohydrate intake (for fixed insulin dose)
  4. Avoid carbs high in protein
  5. Cardiovascular: diet shd be rich in monounsaturated, polyunsaturated fats
  6. Alcohol: <1 for adult women; <2 for adult men
    *check glucose 3hrs after eating, determine if additional insulin adjustments are required
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15
Q

4 aims of physical activities for diabetic patients

A
  1. Improve blood glucose control
  2. Lower insulin resistance
  3. Lower cardiovascular system (CVS) risks
  4. Lower weight
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16
Q

4 eg of physical activities for diabetic patients (out of 7)

A
  1. Aerobic activity - 30min/ day; 75min/ week
  2. Break up prolonged sedentary time, eg stand up every 30mins
  3. Resistance exercise - free weights/ machines with >= 5 repetitive ex motions involving large muscles
  4. Higher frequency of regular leisure-time physical activities
  5. Flexibility & balance training (older adults)
  6. Tech assistance to deliver lifestyle interventions
  7. Customise ex to individual needs
17
Q

2 main types of oral antidiabetic agents (2 effects & 2 contraindications/ risks each)

A
  1. Biguanide - glucophage (Metformin)
    - Decrease hepatic glucose production & intestinal absorption of glucose
    - Increase muscle glucose uptake
    *contraindicate in lactic acidosis & hypoperfusion (less blood flow to organs)
    *withheld on day of surgery
  2. Sodium Glucose Co-Transporter 2 (SGLT2) inhibitors - dapagliflozin (Forxiga)/ canagliflozin(Invokana)/ empagliflozin (Jardiance)
    - Inhibits SGLT2 in proximal nephrons (insulin-dependent pathway) to produce glycosuria
    - Reduce glucose absorption in nephrons
    *may cause euglycemia DKA during fasting
    *discontinued 3-4days before surgery
18
Q

Rapid-acting insulin example? (onset, peak, duration)

A

Lispo/ Aspart (usually administer with meal)
Onset: 5-10mins
Peak: 30min-1hr
Duration: 2-4hrs

19
Q

Short-acting insulin example? (onset, peak, duration)

A

Actrapid HM (administer 30mins before meal) (basal prandial regimen)
Onset: 0.5hr
Peak: 1-3hrs
Duration: 8hrs

20
Q

Intermediate-acting insulin example? (onset, peak, duration)

A

Protaphane (administer at nighttime) (basal prandial regimen)
Onset: 1.5hrs
Peak: 4-12hrs
Duration: 24hrs

21
Q

Long-acting insulin example? (onset, peak, duration)

A

Insulin Glargine (Lantus)
Onset: 1-5hrs
Peak: Plateau
Duration: 24hrs

22
Q

Example of an injectable antidiabetic drug (2 effects & 2 adverse effects)

A

Glucagon-like peptide 1 receptor agonist (GLP-1-RA) - exenatide (Byetta)
- Increase endogenous incretin conc, glucose-dependent insulin secretion
- Glucagon suppression
- Delayed gastric emptying (increase satiety)
*Adverse effects: pancreatitis, gallstone
*potent glucose lowering actions, less weight gain & hypoglycemia when compared to intensified insulin regimen

23
Q

What is the rate of glucose reduction for critical diabetic cases? (what is the risk of reducing too fast)

A

3mmol/L per hour; cerebral oedema

24
Q

What are pancreas? Location?

A

A lobulated gland surrounded by extensive capillary network to transport hormones to target cells
it lies retroperitoneally in the posterior part of the upper abdomen

25
Q

In the pancreas, each lobule is composed of:

A

numerous acini (singular: acinus) secretes digestive enzymes &
Islets of Langerhans: hormones

26
Q

What r the 4 cells in the Islets of Langerhans? What r they responsible for?

A

Alpha cells: Glucagon
Beta cells: Insulin & amylin
Delta cells: Somatostatin
F cells: Pancreatic polypeptide

27
Q

2 Specific functions of alpha cells

A

Glycogenolysis: increase glycogen breakdown
Gluconeogenesis: increase glucose release by liver

28
Q

3 specific functions of beta cells

A

Insulin: decrease glucose levels
glycolysis - increase rate of glucose uptake & utilization in body cells
glycogenesis - increase glycogen synthesis

amylin: slow gastric emptying & suppresses postprandial glucagon secretion

29
Q

3 specific functions of delta cells

A

suppresses the release of glucagon & insulin
reduce rate of food absorption
reduce enzyme secretion

30
Q

What is Diabetes Mellitus?

A

a chronic metabolic illness characterized by high blood glucose due to inadequate insulin
(- requires ongoing multidisciplinary care & self-management)

31
Q

Etiology of Type 1 & 2 DM

A

type 1: autoimmune beta-cell destruction; absolute insulin deficiency
type 2: progressive loss of adequate beta cell insulin secretion frequently on the background of insulin resistance

32
Q

Adrenergic hypoglycemia clinical manifestations?

A

(release of adrenaline)
hunger, tremor, diaphoresis (excessive sweating), pallor, tachycardia, palpitations, nervousness

33
Q

Neurologic hypoglycemia clinical manifestations?

A

(depression of CNS)
light-headedness, headache, irritability, confusion, slurred speech, lack of coordination & staggering gait, seizure, LOC coma

Nursing Therapeutics (Diabetes) (1 decks)

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