Diabetes Mellitus

Question 1

Type 1 DM

Answer 1

insulin dependent: pancreas doesn’t produce insulin
- diagnosed mostly as child
- symptoms: polydipsia, polyuria, polyphagia
-weightloss>10lbs
-ketoacidosis (body burns fat as fuel which starts making acids=ketone bodies=life threatening
- blurred vision
- dehydration

Question 2

polyuria

Answer 2

increased urination

Question 3

polydipsia

Answer 3

increased thirst

Question 4

polyphagia

Answer 4

increased hunger

Question 5

type 2 DM

Answer 5

• insulin resistant: body keeps making insulin but body’s tissues stop accepting insulin, which is why blood glucose increases
• secondary to other dysfunction: due to hypertension, inactivity, obesity
• symptoms similar to type 1 without ketoacidosis: polydipsia, polyuria, polyphagia

Question 6

DM diagnosis criteria

Answer 6

fasting blood glucose: >126 mg/dL
resting blood glucose: >200 mg/dL
HbA1C: >10% (requires immediate insulin therapy
(normal is 4-6%)
- most accurate, taken over 3 months

Question 7

hyperglycemia

Answer 7

BG >300dg/mL
early signs:
- hot and dry sugar, 3 Ps
- dry mouth
- frequent/scant urination
- extreme thirst
- kussmaul breathing (deep, and shallow)
- weakess
- decreased senses, diminished reflexes, confusion
late signs:
- fruity odor (acetone) breath
- hyperglycemic coma

Question 8

hypoglycemia

Answer 8

BG <70dg/mL
cold and clammy, give a candy!
early signs:
- pallor, sweating
- shakiness
- unsteady gait, dizziness, decreased coordination
- extreme hunger
- fainting
-tachycardia, heart palpitations
late signs:
- confusion, drowsiness, slurred speech
- LOC, coma

Question 9

relationship between blood glucose and insulin

Answer 9

-BG is high when tissues dont let in insulin
-when tissues let in insulin, BG decreases

Question 10

what can exercise result in for patients with type 2 diabetes - recommendations to avoid this

Answer 10

hypoglycemia - because exercise increases insulin sensitivity and lets more insulin into tissues. This leads to decreased blood glucose
recs:
- avoid exercise during peak insulin hours (2-4hrs after taken) (because insulin is at peak so BG will drop even further)
- apply insulin in abdomen/non-active extremity because insulin is absorbed much more quickly in active extremity
- insulin dosage should be decreased after exercise

Question 11

exercise recs for type 1 and 2 DM

Answer 11

-exercise in morning to avoid insulin fluctuations which happen more at night
-Do not exercise in extreme hot or cold
-Pt should be well hydrated

Question 12

Random BG levels relating to exercise

Answer 12

100-250mg/dl: safest
250-300mg/dl: proceed with caution
70-100mg/dl: give 15g of carb, wait 15min, proceed if ok
<70: contra, give candy or juice
>300: contra, send to MD (not emergency)
ketone bodies (fruity odor): contra

Question 13

diabetic foot care

Answer 13

• cut toenails
• skin checks regularly
• do not soak feet, just wash/rinse
• white socks so you can see bleeding
• do not moisturize between toes
• alternate which shoes you wear
• buy shoes in evening because feet swell
  -snug shoes to avoid blisters

Question 13

FITT for DM
frequency

Answer 13

3-7 days/wk (more freq is bettter)

Question 14

FITT for DM
intensity

Answer 14

11-13 on RPE scale (can go up to 17

Question 15

FITT for DM
time

Answer 15

min of 150mins/wk, can be progressed to 300 mins/wk

Question 16

FITT for DM
type

Answer 16

moderate intensity aerobic exercise involving larger m groups