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patho nursing > diabetes mellitus > Flashcards

diabetes mellitus Flashcards

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1
Q

what is diabetes mellitus

A

systemic metabolic disorder in which there is chronic hyperglycemia

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2
Q

what are the two reasons for diabetes mellitus

A
  1. decrease in production/secretion of insulin (t1)

2. a decrease in the cells ability to utilize the insulin-receptor problem (t2)

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3
Q

insulin deficiency results in

A

impaired use of CHO, fats and proteins

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4
Q

chronic hyperglycemia causes

A

structural abnormalities in the vasculature of many organs

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5
Q

in the lock and key concept, insulin is which

A

key

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6
Q

where does insulin come from

A

pancreas (beta cells)

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7
Q

what is glute 4

A

glucose transporter protein

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8
Q

where does insulin and glucose bind on a cell?

A

to the tyrosine kinase receptors

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9
Q

glute 4 allows glucose and insulin to ender cells by what

A

facilitated diffusion

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10
Q

type one is also called what

A

juvenile onset

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11
Q

type two is also called what

A

adult onset

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12
Q

which type of DM is most common

A

type 2 (85-90%)

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13
Q

what is the age of onset for type one

A

usually before 30 (abrupt)

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14
Q

why does type one happen?

A

theory is that beta cells are destroyed by an inappropriate autoimmune response supported by the presence of islet cell antibities

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15
Q

what is the cause of type two

A

resistance to insulin in the cell membrane receptors or a decrease in the number of receptors

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16
Q

what are the risk factors for type two

A

age
obesity
heredity

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17
Q

what are the manifestations of type one

A 
polyuria
polydyspia (thirst)
polyphagia (hunger)
weight loss (gluconeogenisis)
weakness/fatigue
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18
Q

what are the clinical manifestations of type two

A

same as type one or may be asymptomatic

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19
Q

what is the management of type one

A

insulin

diet/exercise

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20
Q

what is the management of type two

A

diet/exercise
oral hypoglycemic meds
insulin possibly

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21
Q

which DM type is easy to control

A

type two if adhere to diet

22
Q

how do they diagnose DM

A

FBS > 126
presence of islet cell antibodies
glycosylated hemoglobin >5.5%
glucose tolerance test

23
Q

What is the criteria for good DM control

A
  1. maintain optimal weight
  2. glycosylated hgb <7%
  3. FBS under 140
    4, Postprandial bs no higher than 180
24
Q

What is diabetic ketoacidosis (diabetic coma)

A

hyperglycemia of 300-800 with ketonuria

25
Q

what is the patho of diabetic ketoacidosis

A

marked decrease in insulin
not enough insulin
illness
psychologic stress

26
Q

what is the patho chain for diabetic ketoacidosis

A

body senses lack of cellular fuel-> glycogenolysis and gluconeogenisis-> makes things worse because we don’t need more glucose

27
Q

what happens due to the high blood sugar in DK

A

osmotic diruesis

28
Q

what does osmotic diuresis in DK

A

fluid moves toward glucose causing increase in BV

leads to dehydration as kidneys pee out extra BS

29
Q

what is increased lipolysis (breakdown of lipids) in DK

A

ketone production and accumulation of acids leads to ketonuria and acidosis when then leads to hyperkalemia via ion switch

30
Q

what is the breakdown product of lipolysis

A

ketones

31
Q

how does the body in DK get rid of ketones

A

excretion of ketone acids by lungs (hard, deep, fast)

32
Q

what kind of breathing is seen with those in DK

A

kussmaul’s
hard, deep, fast
gets rid of excess ketone acids

33
Q

what is increased proteolysis in DK

A

increase in gluconeogenisis

34
Q

what are the clinical manifestations of DK

A 
hyperglycemia
ketonurea
polyuria, polydipsia, polyphagia
N/V, abdominal pain,
kussmauls respirations
osmotic diuresis (tachy, hypot, shock, cardiac arrhythmias)
35
Q

what is the management of someone in DK

A
  1. shift from fat catabolism to CHO catabolism
  2. Correct fluid and electrolyte imbalances
  3. correct the cause
36
Q

what is hypoglycemia

A

BS level less than 60

37
Q

how does hypoglycemia happen

A

OD of insulin
inadequate food intake
increased amts of exercise

38
Q

what are the 2 clinical manifestations of hypoglycemia

A
  1. neurogenic reaction when the hypothalamus senses decreased glucose levels
  2. cellular malnutrition
39
Q

what is the neurogenic reaction when the hypothalamus sensies decreased glucose levels in hypoglycemia

A 
increaded HR and RR
diaphoresis
palor
tremors
cool skin
40
Q

what happens due to cellular malnutrition in hypoglycemia

A

(mostly brain things)

HA, dizziness, irritability, confusion, fatigue, vision changes, hunger, seizures, coma

41
Q

what is the management with a hypoglycemic person

A

give glucose
correct fluid and electrolyte imbalance
correct cause

42
Q

What are the 4 chronic complications of DM

A
  1. microvascular degenerative changes
  2. microvascular disease (degenerative change)
  3. neuropathy
  4. Infection
43
Q

What is macrovascular degenerative change

A

In the major vessels

Lipolysis-> hyperlipidmia->atherosclerosis-> CAD/DVD/CVA

44
Q

what is microvascular disease

A

Affects the Capillary

thickening of the basement membrane leading to vascular cell proliferation of cap wall

45
Q

what two things cause microvascular disease

A
  1. glycoslation of protein/collagen (glucose binds with no enzyme) forms/deposits advanced glycosylation end product in vessel walls
  2. Protein kinase c (enzyme) is inappropriately activated by high BS
46
Q

what is the patho chain of microvascular disease

A

vascular cell prolif-> thickens basement membrane of caps-> decreased perfusion-> hypoxia/ischemia

47
Q

what does microvascular disease mainly affect

A

retina (diabetic retinopathy)
kidney (nephropathy, renal failure)
also affects extremities

48
Q

what is neuropathy related to

A

microvascular disease

49
Q

what causes neuropathy in DM

A

vascular ischemia-> nerve endings are destroyed in the ischemic areas

50
Q

what is peripheral neuropathy mani in DM

A

pain and tingling in extremities

decreased sensation

51
Q

what is autonomic nervous system mani of nuropathy in DM

A 
gastropanesis (delayed emptying of GI)
neurogenic bladder (decreased bladder emptying)
sexual dysfunction
CV- no HR variability
52
Q

why does infection occur with DM

A

glucose is a good media for growth
decreased sensation/decreased possible prevention
hypoxia/ischemia causes poor wound healing

patho nursing (4 decks)

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