DM Flashcards
diabetes mellitus
disorder of glucose metabolism r/t
- absent/insufficient insulin supply
- poor utilization of insulin that is available
primary organ involved in DM
pancreas
pancreatic beta cells
regulate the manufacture, storage, and release of insulin
alpha cell
produce excess glucagon
autoimmune reaction
beta cells that produce insulin are destroyed
glucose in normal metabolism
simple sugar provides energy to body cells
glycogen in normal metabolism
long chains of glucose that are produced when there is an overproduction of glucose
-stored in the liver and muscles
insulin in normal metabolism
a storage hormone that is responsible for growth, repair, and storage.
-stores glucose as glycogen
counterregulatory hormones
- increases BG level
- prevents hypoglycemia
- glucagon
- epinephrine
- GH
- cortisol
glucagon
- polypeptide hormone
- mobilizes glucose from stores inside the body
- increases glucose concentration in the bloodstream
type 1 diabetes
- 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
type 2 diabetes
- 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
DM1 risk factors
- children & young adults
- affects 10%
- genetics
- Native Americans, Hispanics, African American
- autoimmune
- seasonal in winter, spring
DM2 risk factors
- usually 35+
- affects approx 90%
- associate with age and weight
- Native Americans, Hispanic Americans, AA, Asian Americans
- frequently 55+
4 major metabolic abnormalties in DM2
- insulin resistance
- pancreas’ decreased ability to produce insulin
- inappropriate glucose production from liver
- alteration in production of hormones and adipokines
two main adipokines
- adiponectin
- leptin
prediabetes
- 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
conditions that characterize prediabetes
- obesity (apple)
- visceral fat around abd
- unhealthy cholesterol
- HBP
- insulin resistance
cardinal symptoms of DM
- polyuria
- polyphagia
- polydipsia
- wt loss
- glycosuria
glucosuria
glucose in the urine
renal threshold
- 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
diagnosing DM
- 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
hemoglobin A1C test
- ideal goal <7%
- shows the amt of glucose attached to hgb molecules over RBC lifespan
- normal: 4-6
- reduces the risk of diabetic complications
fructosamine
- reflects blood glucose values over previous 1-2 wks
- used when A1C is not reliable (pregnancy, sickle cell anemia)
metabolic syndrome
- insulin resistance
- obesity, esp around waist & abd
- low levels of physical activity
- prothrombotic tendencies
- aging and hormonal imbalance
- genetic predisposition
labs for metabolic syndrome
- increased Na, BUN/Cr, triglycerides, LDL, cholesterol
- decreased K, HDL
secondary diabetes
caused by another medical condition or due to the tx of a medical condition
*medical condition, meds, hormone tx
macrovascular complications of DM
- caused by dmg to the large and medium sized blood vessles
- CAD
- CVD
- TIA
- PVD
microvascular complications of DM
caused by dmg of the small blood vessels
- retinopathy
- nephropathy
- dermopathy (late s/s)
acanthosis nigricans
DM2
necrobiosis lipoidica
DM1
sensory neuropathy
numbness, tingling, pain, and loss of sensation that affects extremities, distally and symmetrically
autonomic neuropathy
affects sexual function, digestion, bladder function
diabetic ketoacidosis
- diabetic coma
- caused by absolute insulin deficiency and an excess of insulin counterregulatory hormones causing and increased glucose, increased ketone bodies, and metabolic acidosis
factors causing DKA
- inadequate insulin dosage
- illness
- infection
- undiagnosed DM1
- poor self mgmt
- neglect
late signs of DKA
- Kussmaul’s respiration
- fruity acetone breath
- hypotension
- weak pulse
- confusion
- renal failure
- stupor
HHS
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
factors causing HHS
- hx of inadequate fluid intake
- acute illness
- meds
- concentrated glucose solutions
- other endocrine disorders
late signs of HHS
- hypothermia
- muscle weakness
- seizures, stupor, coma
- shock
mgmt of DKA & HHS
- initially NS (if hypovolemic), 1/2 NS if not
- regular insulin
- F/E imbalance
- determine/tx precipitating cause
- education to prevent future episodes
gestational DM
- develops during pregnancy
- detected 24-28 wks
- normal BG 6 wks postpartum
- increased irks for developing DM2 in 5-10 yrs
risk factors for gestational DM
- 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
maternal concerns in diabetes
- hydramnios
- PIH
- ketoacidosis
- dystocia
- anemia
- UTI
fetal concerns in diabetes
- increased still births/neonatal births
- congenital defects
- macrosomia LGA
- IURG or SGA
insulin in pregnancy
- 1st: decrease insulin
- 2nd: increase insulin
- 3rd: increase insulin energy needs during labor
- decrease insulin need after labor, increase energy needs during labor
Meds causing secondary diabetes
- corticosteroid
- Dilantin
- thiazides
- epinephrine
- atypical antipsychotic
Medical conditions causing secondary diabetes
- pancreatitis
- pancreatic CA
- Cushing’s syndrome
- hyperthyroidism
- cystic fibrosis
- use of TPN
