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Med surg > DM > Flashcards

DM Flashcards

1
Q

diabetes mellitus

A

disorder of glucose metabolism r/t

  • absent/insufficient insulin supply
  • poor utilization of insulin that is available
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2
Q

primary organ involved in DM

A

pancreas

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3
Q

pancreatic beta cells

A

regulate the manufacture, storage, and release of insulin

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4
Q

alpha cell

A

produce excess glucagon

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5
Q

autoimmune reaction

A

beta cells that produce insulin are destroyed

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6
Q

glucose in normal metabolism

A

simple sugar provides energy to body cells

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7
Q

glycogen in normal metabolism

A

long chains of glucose that are produced when there is an overproduction of glucose
-stored in the liver and muscles

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8
Q

insulin in normal metabolism

A

a storage hormone that is responsible for growth, repair, and storage.
-stores glucose as glycogen

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9
Q

counterregulatory hormones

A
  • increases BG level
  • prevents hypoglycemia
  • glucagon
  • epinephrine
  • GH
  • cortisol
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10
Q

glucagon

A
  • polypeptide hormone
  • mobilizes glucose from stores inside the body
  • increases glucose concentration in the bloodstream
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11
Q

type 1 diabetes

A
  • JODM
  • IDDM
  • minimal or total absence of beta cell function
  • idiopathic diabetes
  • little or no insulin enters the bloodstream and glucose builds up in the bloodstream
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12
Q

type 2 diabetes

A
  • NIDDM
  • AODM
  • non functioning receptors or not enough receptors for insulin
  • at least 50% of beta cell mass is functional with adequate insulin secretion preventing diabetic ketoacidosis
  • insulin enters the bloodstream. glucose can’t get into the cells of the body and it builds up in the blood vessels
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13
Q

DM1 risk factors

A
  • children & young adults
  • affects 10%
  • genetics
  • Native Americans, Hispanics, African American
  • autoimmune
  • seasonal in winter, spring
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14
Q

DM2 risk factors

A
  • usually 35+
  • affects approx 90%
  • associate with age and weight
  • Native Americans, Hispanic Americans, AA, Asian Americans
  • frequently 55+
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15
Q

4 major metabolic abnormalties in DM2

A
  1. insulin resistance
  2. pancreas’ decreased ability to produce insulin
  3. inappropriate glucose production from liver
  4. alteration in production of hormones and adipokines
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16
Q

two main adipokines

A
  • adiponectin

- leptin

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17
Q

prediabetes

A
  • individuals at risk for diabetes
  • impaired fasting glucose: 100-125
  • impaired glucose tolerance: 140-199
  • Hgb A1C 5.7% - 6.4%
  • usually develop DM2 within 10 years
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18
Q

conditions that characterize prediabetes

A
  • obesity (apple)
  • visceral fat around abd
  • unhealthy cholesterol
  • HBP
  • insulin resistance
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19
Q

cardinal symptoms of DM

A
  • polyuria
  • polyphagia
  • polydipsia
  • wt loss
  • glycosuria
20
Q

glucosuria

A

glucose in the urine

21
Q

renal threshold

A
  • concentration level above which all glucose is not reabsorbed in the blood
  • the excess above the threshold level concentration remains in the urine
    normal: 150-180mg/100mL
22
Q

diagnosing DM

A
  • AiC > 6.5%
  • fasting plasma glucose level > 126 after an 8hr fast
  • 2hr oral glucose tolerance test > 200
  • random plasma glucose > 200 in a pt with classic symptoms of hyperglycemia
23
Q

hemoglobin A1C test

A
  • ideal goal <7%
  • shows the amt of glucose attached to hgb molecules over RBC lifespan
  • normal: 4-6
  • reduces the risk of diabetic complications
24
Q

fructosamine

A
  • reflects blood glucose values over previous 1-2 wks

- used when A1C is not reliable (pregnancy, sickle cell anemia)

25
Q

metabolic syndrome

A
  • insulin resistance
  • obesity, esp around waist & abd
  • low levels of physical activity
  • prothrombotic tendencies
  • aging and hormonal imbalance
  • genetic predisposition
26
Q

labs for metabolic syndrome

A
  • increased Na, BUN/Cr, triglycerides, LDL, cholesterol

- decreased K, HDL

27
Q

secondary diabetes

A

caused by another medical condition or due to the tx of a medical condition
*medical condition, meds, hormone tx

28
Q

macrovascular complications of DM

A
  • caused by dmg to the large and medium sized blood vessles
  • CAD
  • CVD
  • TIA
  • PVD
29
Q

microvascular complications of DM

A

caused by dmg of the small blood vessels

  • retinopathy
  • nephropathy
  • dermopathy (late s/s)
30
Q

acanthosis nigricans

A

DM2

31
Q

necrobiosis lipoidica

A

DM1

32
Q

sensory neuropathy

A

numbness, tingling, pain, and loss of sensation that affects extremities, distally and symmetrically

33
Q

autonomic neuropathy

A

affects sexual function, digestion, bladder function

34
Q

diabetic ketoacidosis

A
  • diabetic coma
  • caused by absolute insulin deficiency and an excess of insulin counterregulatory hormones causing and increased glucose, increased ketone bodies, and metabolic acidosis
35
Q

factors causing DKA

A
  • inadequate insulin dosage
  • illness
  • infection
  • undiagnosed DM1
  • poor self mgmt
  • neglect
36
Q

late signs of DKA

A
  • Kussmaul’s respiration
  • fruity acetone breath
  • hypotension
  • weak pulse
  • confusion
  • renal failure
  • stupor
37
Q

HHS

A

hyperosmolar hyperglycemia syndrome

  • where enough insulin is secreted to prevent DKA, but inadequate to control hyperglycemia, dehydration, hyperosmolarity, with little or no ketosis
  • causes extreme dehyrdation
38
Q

factors causing HHS

A
  • hx of inadequate fluid intake
  • acute illness
  • meds
  • concentrated glucose solutions
  • other endocrine disorders
39
Q

late signs of HHS

A
  • hypothermia
  • muscle weakness
  • seizures, stupor, coma
  • shock
40
Q

mgmt of DKA & HHS

A
  • initially NS (if hypovolemic), 1/2 NS if not
  • regular insulin
  • F/E imbalance
  • determine/tx precipitating cause
  • education to prevent future episodes
41
Q

gestational DM

A
  • develops during pregnancy
  • detected 24-28 wks
  • normal BG 6 wks postpartum
  • increased irks for developing DM2 in 5-10 yrs
42
Q

risk factors for gestational DM

A
  • obesity
  • 25+ yrs
  • family hx of DM
  • personal hx of GDM
  • OB history of LGA baby, unexplained fetal or perinatal loss, or unexplained birth defects
  • member of high risk ethnic group
  • history of abnormal GTT
43
Q

maternal concerns in diabetes

A
  • hydramnios
  • PIH
  • ketoacidosis
  • dystocia
  • anemia
  • UTI
44
Q

fetal concerns in diabetes

A
  • increased still births/neonatal births
  • congenital defects
  • macrosomia LGA
  • IURG or SGA
45
Q

insulin in pregnancy

A
  • 1st: decrease insulin
  • 2nd: increase insulin
  • 3rd: increase insulin energy needs during labor
  • decrease insulin need after labor, increase energy needs during labor
46
Q

Meds causing secondary diabetes

A
  • corticosteroid
  • Dilantin
  • thiazides
  • epinephrine
  • atypical antipsychotic
47
Q

Medical conditions causing secondary diabetes

A
  • pancreatitis
  • pancreatic CA
  • Cushing’s syndrome
  • hyperthyroidism
  • cystic fibrosis
  • use of TPN

Med surg (11 decks)

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