DM1 & DM2 Flashcards
What is metabolism
Refers to all physical and chemical reaction occurring in the body’s cells that are necessary to sustain life
What is type 1 Diabetes
A metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas (formerly: insulin-dependent diabetes, or juvenile diabetes)
What causes type one DM
Combined genetic, immunologic, and possibly environmental (e.g., viral) factors are thought to contribute to beta-cell destruction
What is DKA
a metabolic derangement that occurs most commonly in persons with type 1 diabetes and results from a deficiency of insulin; highly acidic ketone bodies are formed, and metabolic acidosis occurs-fruity odor
What are some Complication of DM1
Infection, Hypoglycemia/DKA, Insulin Depend, Micro/Macro vascular problem
What is type 2 DM
a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance (formerly: non–insulin-dependent diabetes, or adult-onset diabetes)
What is hyperglycemic hyperosmolar syndrome (HHS)
HHS is a metabolic disorder, most often of type 2 diabetes, resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. In HHS, the insulin level is too low to prevent hyperglycemia (and subsequent osmotic diuresis), but it is high enough to prevent fat breakdown
What are the sign of HHS
Hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis
What is hyperglycemia?
blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL (9.9 to 11.1 mmol/L)
What are the signs and symptoms of hyper?
3 PPP, fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
What is hypoglycemia?
Low (hypo) sugar in the blood (glycemia) and occurs when the blood glucose falls to less than 70 mg/dL
What are the S/S for hypoglycemia for mild, moderate, & severe
Mild-sweating, tremor, tachycardia, palpitation, nervousness, and hunger.
Moderate-inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness.
Severe- disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.
What are the physical finding for DM assessment
*Blood pressure (sitting and standing to detect orthostatic changes)
*Body mass index (height and weight)
*Funduscopic examination and visual acuity
*Foot examination (lesions, signs of infection, pulses)
*Skin examination (lesions and insulin injection sites)
*Neurologic examination
*Vibratory and sensory examination using monofilament
*Deep tendon reflexes
*Oral examination
How do you assess a patient with diabetes
*History
*Symptoms related to the diagnosis of diabetes:
o Symptoms of hyperglycemia
o Symptoms of hypoglycemia
o Frequency, timing, severity, and resolution
* Results of blood glucose monitoring
* Status, symptoms, and management of chronic complications of diabetes:
o Eye; kidney; nerve; genitourinary and sexual, bladder, and gastrointestinal
o Cardiac; peripheral vascular; foot complications associated with diabetes
*Adherence to/ability to follow prescribed dietary management plan
*Adherence to prescribed exercise regimen
*Adherence to/ability to follow prescribed pharmacologic treatment (insulin or oral antidiabetic agents)
*Use of tobacco, alcohol, and prescribed and over-the-counter medications/drugs
*Lifestyle, cultural, psychosocial, and economic factors that may affect diabetes treatment
*Effects of diabetes or its complications on functional status (e.g., mobility, vision)
What is the treatment for hypoglycemia
15-minute rule, in hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of dextrose 50% in water (D50W) may be administered IV.
What labs do you look at for DM1 and 2
*DM1 HgbA1C (A1C) > or = 6.5%, Fasting Blood Glucose > or = 126, Random Blood Glucose > or = 200, Urinalysis, lipid panel, antibody test
*DM2 Hemoglobin A1C or 6.5
What are the goals of medical nutrition therapy
i. Blood glucose levels in the normal range or as close to normal as is safely possible
ii. A lipid and lipoprotein profile that reduces the risk for vascular disease
iii. Blood pressure levels in the normal range or as close to normal as is safely possible
What are the five component of DM management
Nutritional therapy, exercise, monitoring, pharmacologic therapy, and education.
What should be included in nutrition for DM
Meal planning, weight control, and increased activity are the foundation of diabetes management
What are the benefits of medical nutrition therapy
B To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
c. To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
d. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence
What are the benefits of medical nutrition therapy
b. To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle
c. To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
d. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence
What are the insulin time course, agent, onset, peak duration
What is the Sulfonylureas other names, MA, SE, and dosing
Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Glynase)
Mechanism of action: Increases insulin secretion
Side effects: hypoglycemia, weight gain, nausea
Dosing: immediate release glipizide is taken 30 minutes prior to the first meal of the day, all the rest can be take with the first meal of the day. Consider holding if NPO
How does excerise benefit people with DM
Lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization. It also improves circulation and muscle tone. Resistance (strength) training, such as weight lifting, can increase lean muscle mass, thereby increasing the resting metabolic rate. (don’t excersie at peak insulin )
