DM Flashcards
DM type 1 s&s
Poly uria
Polydipsia
Polyphagia
Weight loss
Fatigue
Increase frequency of infections
Rapid onset
Insulin dependent
Familial tendency
Peak incidence from 10 -15 years
What are the counter regulatory hormones to insulin?
Glucagon, epinephrine, growth hormone, cortisol
What should A1C% numbers look like for a pre diabetic?
6.0-6.5%
What test is gold standard for A1C?
HGB-A1C or A1C
Which test is mainly used for pregnant women?
2 hr postprandial oral glucose tolerance test
A pt is not feeling to well and goes to the doctor as a walk in. When describing his symptoms the doctor ordered labs to check his blood sugar. What is this test called?
Random blood glucose
How many times a day and when do you use self monitoring blood glucose?(SMBG)
4x a day before each meal and before bed time
DM 1 onset
Gradual onset
Autoantibodies are present for months to years before symptoms occur
Manifesting develop when pancreas can no longer produce insulin- then rapid onset with ketoacidosis
Necessitates insulin
Patient may have temporary remission after initial treatment
DM 2 onset
Gradual onset
Hyperglycemia may go many years without being detected
Often discovered with routine lab testing
At time of diagnosis
About 50-80% of beta cells are no longer secreting insulin
Average person has had diabetes for 6.5-8 years
What do we want our HDL levels to be at for men and women?
Over 50 for women
And over 40 for men
What Do we want our LDL numbers to be at
Under 100
Metabolic syndrome
Increase risk for type 2
Increase glucose levels
Abdominal obesity
Elevated bp
High levels or triglycerides
Decrease levels of HDL
Modifiable risk factors
BM >/= and risk increases > 30
Physical inactivity
HDL </= 35 MG/DL and or TG>/= 250 MG/DL
Metabolic syndrome
Non modifiable risk factors
First degree relative with DM
Members of high risk ethnic population
Women who delivered baby 9lb or greater or who had GDM
HTN
Women with pods
HGBA1C or greater
History of CVD
What labs are you going to draw for diabetic nephropathy?
BUN, creatine, GFR (tells me how well kidneys are functioning and a UA
Will also be started on a diuretic.. spirolactone or LASIX
What should your urine be free of for a UA
Free of albumin, protein, glucose, nitrates/bacteria, etc
What does albumin in the urine indicate ?
Kidneys are breaking down
If urine at uti and bacteria what do they have?
UTI
If there is glucose in the urine?
Spilling into urine- too much in the blood stream
What does protien in the urine indicate?
Break down of muscle
Keytones in the urine indicates?
Breaking down fat quickly
What should your GFR rate be ?
> 60
Bethanecol
The only drug that tells the bladder to contract in neurogenic bladder
DKA symptoms
Abd pain, anorexia, N/V
Kussmaul respirations
Sweet, fruity breath odor
Kussmaul respirations
Deep and rapid breathing
Use of accessory muscles
Lab work for DKA
BG level of 250 mg/dl or higher
Blood pH < than 7.30
Serum bicarbonate level < 16 mEq
Moderate to high ketone levels in urine or serum
DKA difference from hhs
Mostly seen in t1dm
Rapid onset
Big > 250 mg/dl
Ph > 7.3
Bicarb <15
Ketones urine and serum
Sweet breath
Kussmaul respirations
HHS difference from DKA
Occurs more in elderly
Gradual onset
BG>600 mg/dl
Ph >7.3
Bicarb >30
Negative Keytones
Still producing insulin so not breaking down fat (ketones)
Fewer symptoms
More severe
High mortality rate
Order of treatment for hhs and DKA
1 NS
2 o2
3 insulin drop with potassium ordered as well
4 replace with d5 eventually
What do you give someone who is going thru a hypoglycemic episode?
Check BS first if you can
Give them juice, or coke
Glucotabs (dissolve quickly)
If they go ack to normal then we can give them something with a fat and a protien (peanut butter and crackers or peanut butter and apples)
What is our biggest concer for hypokalemia?
Effects of the Corozon
Lipohypertrophy
Accumulation of sq fat when insulin is injected too frequently at same site
Diabetic dermopathy
Aka shin spots or pigmented pretibial applies
Most common cutaneous manifestation of diabetes
Benign asymptomatic red brown maculae’s on shins
No treatment needed
Hypoglycemia unawareness
More common in elderly
Do not know they are hypoglycemic
Acanthodii’s nigiricans
Feels like silk, soft, satin
More common in type 2
Goals of nutrition therapy of dm
Maintain BG levels
Lipid profiles and bp levels
Prevent/slow rate of chronic complications
Nutritional needs and personal cultural and economic needs
Maintain the pleasure of eating
15 grams equals
One carb
What kind of diets are not recommended for dm
A high protien diet will kill kidneys
Only 15-20% of total protein calories consumed
Hot and dry
Sugar high
Cold and clammy
Need some candy
What fat should a dm pt limit?
Trans fat
And limit cholesterol <200 mg a day
Saturated fat <7% of total calories
Glycemic index
Something a pt can hold
Rates food based on 0-100 and how quickly it raises your blood sugar
(We want to stay with foods less than 55)
Based on portion sizes
What is the key to a pump pt success?
Motivation , compliance
How many glasses of alcohol can men and women have
Men 2 (body mass ^)
Women-1
12 oz of beer, 5 oz of wine and 1 1/2 of distilled liquor
Benefits of excercise in diabetics
Decrease insulin resistance and blood glucose by increasing muscle mass
Weight loss
Decrease bad chol and increase hdl
Improve bp and circulation
T/f do not excercise when medicine is at its peak
True - medication lowers blood sugar and so does exercising
T/f you should not test BG before exercise but you test it after
False test both before and after
When should you not excercise?
When BG is greater than 300 and ketones are in the urine (DKA)
Phenytoin
Is Dilantin, anti seizure med can cause diabetes if used long term
Autonomic neuropathy
Vaginal dryness- painful sex
Erectile dysfunction
When does a type 2 diabetic need to be seen by a doctor when diagnosed?
Asap
When does a type one diabetic need to be seen by a doctor when diagnosed
Within 5 years
What happens when you are sick or your body is under a lot of stress?
BG goes up
Sick day rules
Maintain normal diet if able
Increase non caloric fluids(water, pedialyte)
Continue taking anti diabetic medications and insulin even if not eating
If normal diet not possible supplement with Cho-contains fluids while continuing medications
Sick day rules for hydration
8 oz fluid per hour
Every 3rd hour, consume 8 oz of a sodium rich choice like bouillon
Sick day rules for SMBG
Every 2-4 hours while BG is elevated or until symptoms subside
Sick day rules for Keytones (t1dm)
Every 4 hours or until negative
Sick day -keytonesrules for type 2
Determined for the individual
Medication adjustments sick day rules t1dm
Continue as able
Adjust insulin doses to correct hyperglycemia
Instruct the pt to call their health care provider for specific instructions
Medication adjustments for t2dm
Hold metformin during serious illness
Sick day rules for food and beverage selections
Guide pt to consume 150-200g CHO daily in divided doses
Switch to soft or liquids as tolerated
Sick day rules for contact health care provider
Vomiting more than once, diarrhea more than 5x longer than 6 hrs
BG > 300 x2 moderate to lg, urine in Keytones
Dm1
There isn’t insulin producing
T2dm
not enough insulin
Insulin resistance
Cells resisting insulin
Normal glues 70-110
Counter regulatory hormones
Glucagon , epinephrine, growth hormone, cortisol
