DM ppt

Question 1

DM risk factors

Answer 1

genetics
obesity
race/ethnicity
age
HTN
high HDL
gestational diabetes, baby >9 lbs

Question 2

DM 1

Answer 2

FKA brittle diabetes, juvenile diabetes
beta cells in panrease are destroyed
decreased insulin production and unchecked glucose production
5% of DM

Question 3

DM 2

Answer 3

95% of DM
most common in obese >30 y/o
insulin resistance
impaired insulin secretion

Question 4

gestational diabetes

Answer 4

hyperglycemia develops with pregnancy 2/2 secretion of placental hormones
r/o HTN during pregnancy
highest risk: obesity, Hx of gestational diabetes, glycosuria, genetics

Question 5

latent autoimmune diabetes of adults (LADA)

Answer 5

progression of autoimmune beta cell destruction is slower than in DM1/DM2
not insulin dependent initially

Question 6

3 Ps

Answer 6

polyuria
polydipsia
polyphagia

Question 7

DM diagnostic findings

Answer 7

casual glucose reading > 200mg/dL
flasting glucose >126 mg/dL
greater than 200mg/dL in oral glucose tolerance
A1C > 6.5%

Question 8

DM medical mgmt

Answer 8

A1C < 7%
nutritional therapy
exercise
monitoring
medication
educatoin

Question 9

nutritional therapy

Answer 9

control of total caloric intake to maintain or attain reasonable body weight
control blood glucose levels
meal planning
maintain pleasure of eating

Question 10

meal planning

Answer 10

carbs: 50-60%
fat: 30%
cholesterol: <300mg
non animal sources of protein

Question 11

rapid acting insulin

Answer 11

shorter duration

eat within 5-15 min

Question 12

short acting insulin

Answer 12

clear solution
given 15 min prior to meal
can be given IV

Question 13

intermediate acting insulin

Answer 13

NPH or Lente
white and cloudy soltuion
should eat food around onset/peak

Question 14

long acting “peakless” insulin

Answer 14

absorbed over 24 hrs

given once daily at the same time

Question 15

conventional insulin therapy

Answer 15

pt should not vary meal patterns
1-4 injections qd
appropriate for:
terminally ill
frail older adult with self-care limitations
pts unwilling to do self mgmt

Question 16

complications of insulin therapy at injection site

Answer 16

redness, swelling, tenderness, induration, 2-4 cm wheal at site
may appear 1-2 hr after injection
another type of insulin may be needed

Question 17

complications of insulin therapy (systemic)

Answer 17

rare
immediate skin reaction that spreads in hives
associated with edema, anaphylaxis
give desensitization kit

Question 18

complications of insulin therapy: insulin lipodystrophy

Answer 18

localized reaction at injection site

lipoatrophy: dimpling, loss of subcutaneous fat (mostly resolved with use of human insulin)
lipohypertrophy: development of fibrofatty masses at injection sites caused by repeated use of site; absorption may be delayed

Question 19

complications of insulin therapy: resistance

Answer 19

immune antibodies develop and bind the insulin
all insulins cause antibody production
treated by administering a more concentrated insulin

Question 20

complications of insulin therapy: morning hyperglycemia

Answer 20

insulin waning
dawn phenomenon
Somogyi effect

Question 21

insulin waning

Answer 21

progressive rise in glucose from bedtime to moring

increase evening dose or administer before evening meal

Question 22

dawn phenomenon

Answer 22

normal until 3 am. then level begins to rise

change time of evening insulin from dinner time to bedtime

Question 23

Somogyi effect

Answer 23

normal at bedtime, decrease 2-3 am caused by production of counter regulatory hormones

decrease evening dose or increase evening snack

Question 24

insulin pens

Answer 24

prefilled cartridges loaded into pen-like holder
attach disposable needle
convenient for eating out, traveling

Question 25

jet injectors

Answer 25

deliver insulin under skin through a fine stream
expensive, require training
insulin absorbed faster

Question 26

insulin pumps

Answer 26

small and worn externally
needle/cath in subcutaneous tissue gets changed every 3 days
infused at basal rate; calculates carbs at meal
good for people with hectic lifestyles

Question 27

insulin pump issues

Answer 27

tubing may get dislodged
battery is depleted
supply of insulin runs out

Question 28

oral antidiabetic agents

Answer 28

used for DM2 patients

major side effect: hypoglycemia