Diabetes Mellitus Flashcards
Chronic metabolic disorder characterized by high blood glucose (hyperglycemia)
diabetes mellitus
Describe Type 1 Diabetes
-B cell of pancreas that produces insulin are destroyed
-results in insulin dependence
commonly detected before 30 years old
Describe Type 2 Diabetes
-blood glucose levels rise due to:
1. insufficient insulin action (insulin resistance) followed by
2. declining insulin production
commonly detected after 40 years of age
effects >90% of DM pop eventually leads to B cell failure
What is normal fasting plasma glucose?
test that is cheap, fast
normal 70-100 mg/dl
pre-diabetic 100-125 mg/dl
diabetic >125 mg/dl
What is normal Hb A1c
normal <5.7% of Hb
what is the oral glucose tolerance test?
tested after 2 hours of glucose rich drink
140-199 mg/dl signals pre-diabetes
>200 mg/dl signals diabetes
what is the diagnostic criteria for diabetes
fasting plasma glucose >125 mg/dl
OR
2 hour plasma glucose during OGTT >200mg/dl
OR
A1C >6.1%
OR
classic diabetic symptoms + random plasma glucose >200 mg/dl
what are some complications of diabetes mellitus
cardiovascular disease
-CAD
-HTN
-peripheral vascular disease
-CVA
Retinopathy
Nephropathy
Neuropathy
Osteopathy
Immune dysfunction
In patients with DM assume what?
they have heart disease until proven otherwise
-CAD/MI is major cause of death in both types of DM (70%)
-increased HTN, CHF, CVA risk
-increased incidence of dysrhytmias
Explain the clinical manifestation of retinopathy in DM
early recognition of visual changes and treatment best option for preventing further damage
affect ~80% of patients with DM
-involves macular edema and formation of fragile blood vessels
Explain the clinical manifestations of diabetic peripheral neuropathy
loss of protective sensation distal>proximal
decreased vibration and proprioception
diminished reflexes
neuropathic pain
blood vessels are damaged that are supplying blood to the nerves
explain clinical manifestation of osteopathy
charcot disease- degeneration of a weight bearing joint
increased risk of skin breakdown
-varied pressure distribution
-if combined with DPN increased wound risk
what are common MSK manifestations for individuals with DM
-frozen shoulder
-carpal tunnel syndrome
-flexor tenosynovitis (trigger finger)
-spine osteoporosis
Do individual have and increased risk for infection
yes innate immunity is impaired
-decreased function of macrophages
-skin breakdown is common
-infections more rapidly enter body
hyperglycemia promotes bacterial growth and proliferation
-glucose feeds the infection
What is the most common acute hyperglycemic emergency
diabetic ketoacidosis- more common in type 1>type 2
results from a shortage of insulin
What happens in diabetic ketoacidosis
body switches to burning fatty acids and produces acidic ketone bodies
what are signs and symptoms of diabetic ketoacidosis
N/V
abdominal pain
polydipsia
polyuria
dehydration
what causes diabetic ketoacidosis
can be because of an infection, pneumonia, MI, CVA, drug abuse, poor DM management
What are the three major components of treatment for DM
diet and exercise
oral hypoglycemic therapy
insulin therapy
what should diet aim at in DM management
1.ensuring weight control
2.providing nutritional requirements
3.allowing good gycemic control with blood glucose levels as close to normal
4. correcting any associated blood lipid abnormalities
how does exercise help in DM management
promotes weight reduction and improves insulin sensitivity
lowers blood glucose levels
people should be educated on potential risk of hypoglycemia- know blood sugar before and afer
Does exercise have any impact on glucose control in type 1 diabetes?
no
does exercise have any impact on glucose control in type 2 diabetes
yes improves insulin sensitivity
increases glucose transporter
what do you need to do when exercising with a patient who has DM
monitor blood glucose before, during and after session
there is an increased risk of hypoglycemia
what are some symptoms of hypoglycemia
-headache
-confusion
-fatigue
-hunger
-tachycardia
-sweating
-anxiety
what is the 4 step treatment of hypoglycemia
- have at least 15-20 grams of fast acting carbohydrate (sports drink, soda)
- wait 15-20 min
- if still low repeat treatment
- eat regular meals and snacks as planned to keep blood glucose up
What if a patients blood glucose is >250 mg/dl at the start of exercise
postpone exercise
-may lead to induced hyperglycemia
-glucagon release combined with hyperglycemia can result in ketone bodies and ketoacidosis
If a patients blood sugar is less than 100 mg/dl prior to exercise
take a snack before beginning
Other insulin considerations for exercise
increased absorption if insulin is injected into exercising region
faster onset of action: increasing risk of hypoglycemia
patients are often instructed to rotate injection sites
Can lifestyle modifications change or prevent the onset of type2 diabetes in high risk adults?
yes
