Diabetes Mellitus Flashcards by Kelsey Grunwaldt

Hormonal Factors of Glucose Metabolism

Insulin: secreted by beta cells of pancreas due to increased blood sugar

Glucagon: secreted by alpha cells of pancreas due to decreased blood sugar; converts glycogen to glucose in the liver

ACTH and Glucocorticoids: turn fat and protein into glucose in times of stress or due to decreased blood sugar

Epinephrine: converts glycogen to glucose

Thyroid Hormone: promotes utilization of glucose for energy

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Insulin

Controls metabolism and cellular uptake of carbohydrates

Rate of secretion is dependent on the glucose level

In order to produce you need a healthy pancreas, a diet with protein, and normal potassium levels

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Functions of Insulin

Transports and metabolizes glucose for energy

Stores glucose in the liver and muscle

Signals liver to stop release of glucose

Enhances storage of fat

Accelerates transport of amino acids

Influences metabolism of fats and proteins

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Diabetes Mellitus Pathophysiology

Chronic, systemic, metabolic disorders

Caused by increased levels of glucose, insulin deficiency, insulin resistance

Affects every cell in the body

Hyperglycemia is principal clinical manifestation

Leading cause of amputations, blindness, and kidney disease

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Type I Diabetes

Insulin-Dependent, autoimmune

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Type II Diabetes

Most common, non-insulin-dependent, resistance to insulin action

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Other Causes of Diabetes

Acute pancreatitis

Cushing’s Syndrome

Pancreatic tumors

Increased need for insulin such as hyperthyroidism, pregnancy

Long-term stress which leads to increased cortisol and increased blood sugars

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Risk Factors of Diabetes

Heredity
Obesity (BMI > 30)
Race/Ethnicity (African American, Hispanic, Asian, Pacific, Native American)
Age (>45)
Health history of HTN, insulin resistance, low HDL, high triglycerides, baby weighing > 9 pounds
Viruses contribute to Type I (rubella, measles, cocksacky, mumps)

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Signs and Symptoms of Diabetes Mellitus

Polyuria
Polydipsia
Polyphagia
Weakness and fatigue
Sudden vision changes
Headaches
Cold extremities
Dry skin, lesions slow to heal, recurrent infections

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Fasting Blood Glucose

Must fast for 8 hours
Normal range is 69-99
Greater than 126 twice is diabetes

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Casual Plasma Glucose

Can be taken at any time of the day whether you have eaten or not

Greater than 200 is diabetes

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2-Hour Postprandial Blood Sugar

Taken 2 hours after a meal

Greater than 160 is diabetes

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Serum Insulin Level

For Type I, there would be no insulin

For Type II, there could be high, low, or normal insulin

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C-Peptide Test

Normal values are 0.5-2 ng/mL

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HBA1C

Glycosylated hemoglobin

Measures how much glucose has been in the blood over 120 days

Normal is 4-6% of total hemoglobin

Good diabetic control is < 7%

Poor control is 8-12%

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Features of Type I Diabetes

Sudden onset
Any age at onset (mostly young)
Thin or normal body
Ketoacidosis is common
Autoantibodies are present
Low or absent endogenous insulin

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Features of Type II Diabetes

Gradual onset
Mostly adults during onset
Obese body
Ketoacidosis is rare
Autoantibodies are absent
Normal, increased, or decreased endogenous insulin

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Pre-Diabetes

Decreased response to insulin

Labs include blood glucose, serum insulin

Treatment includes oral hyperglycemic agents, diet, exercise

Goal is to maintain normal insulin and glucose levels

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Risk Factors for Type II

Obesity, inactivity, older age

History of gestational diabetes

Family history of diabetes

Race

Goals of Diabetes Management

Normalize insulin activity

Prevent complications

Ingest adequate calories

Acute Complications of Diabetes

Hypoglycemia, renal disease, neuropathy, hypertension, cardiovascular disease

Components of Diabetes Management

Nutritional therapy, exercise, monitoring, pharmacologic therapy, education

Quantitative Diet

Stressing moderation, selection of foods, and reducing the use of simple carbohydrates

Three regular meals with snacks in between and at bedtime to help maintain constant glucose levels

Alcohol Consumption with Diabetes

Can decrease the normal reaction in the body that produces glucose; increases the likelihood of hypoglycemia

Choose alcohol that is low in sugar

Self Monitoring of Blood Glucose

Perform before meals and before bedtime (A.C. and H.S.)

Sick Day Rules

Stress increases the amount of sugar in the body Extra insulin may be required Increased risk of ketoacidosis

Rapid Acting Insulin

Lispro (Humalog) and Aspart (NovoLog) Onset: 5-15 minutes Duration: 2-4 hours

Short Acting Insulin

Regular (Humulin R, Novolin R) Onset: 30-60 minutes Duration: 4-6 hours

Intermediate Acting Insulin

Lente and NPH (Humulin N, Novolin N) Onset: 2-4 hours Duration: 16-20 hours

Long Acting Insulin

Ultralente Onset: 4-6 hours Duration: 28-36 hours

Very Long Acting Insulin

Peakless basal insulin Given once a day

Conventional Insulin Therapy

Simplifies insulin administration Involves short and intermediate acting insulin If you have variability in your diet with this, you will not have good glucose control

Intensive Insulin Therapy

Three to four injections a day or an insulin pump Allows for changes/flexibility in lifestyle

Insulin Storage and Use

Store one month at room temperature after opening Vials not in use should be stored in the refrigerator Syringes should be U-100 insulin Needle should be 27-29 gauge If insulin is cloudy, roll it in your hand

Treatment of Diabetes Mellitus

Oral hypoglycemic agents (for Type II) Glucagon for hypoglycemia Pancreas transplant

Sulfonylureas

Stimulate insulin secretion and insulin action

Thiazolidinedione

Reduces insulin resistance in target tissues and help enhance insulin action, but does not directly stimulate insulin action

Acute Complications of Diabetes

Hypoglycemia, Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar Syndrome

Hypoglycemia

Blood sugar less than 70 (severe when less than 40) Caused by excessive insulin/oral hypoglycemic agent, diet, occurs before meals

Diabetic Ketoacidosis

Occurs in Type I Carbs are not used properly, so fats and proteins are broken down instead Causes excess ketones in the blood which makes the blood acidic and increases blood sugar S/S include low BP, hot flushed skin, fruity breath, Kussmaul's respirations, serum hyperkalemia

Hyperglycemic Hyperosmolar Syndrome

No ketone problem, occurs in Type II Blood sugar is increased which leads the blood to become hyperosmolar Body has a lot of diuresis which leads to dehydration S/S include diuresis, hypotension, dehydration, alteration in consciousness, tachycardia

Treatment of Hypoglycemia

Juice if awake If unconscious, 1 mg Glucagon subcu or IM In hospital: D50W injection, 25-50 mL IV

Treatment of Diabetic Ketoacidosis

Rehydration Restoring electrolytes Reversing acidosis

Hyperglycemic Hyperosmolar Syndrome Treatment

Fluid replacement Electrolyte imbalance correction Insulin administration

Long-Term Complications of Diabetes Mellitus

Diabetic retinopathy Cardiovascular problems Renal failure (nephropathy, NEUROGENIC BLADDER) Risk for infection Neuropathy Sexual dysfunction

Diabetes Insipidus

Metabolic disorder related to deficiency of ADH, caused by head injuries S/S include polyuria, polydipsia, dehydration, hypovolemic shock