Endocrine II - Diabetes Flashcards
What is the Normal lab value for Glucose?
70-110mg/dL (3.9-6.1 mmol/L)
Describe Type 1 Diabetes
- Little to no Insulin
- Usually diagnosed at Childhood
- Autoimmune response (Type 1 A) or Idiopathic ( Type 1B).
- First sign maybe DKA
- Appears abruptly, despite years of beta cell destruction.
- 3 P’s - Polyuria, Polydipsia, Polyphagia
Describe the Pathophysiology of Type 1 Diabetes
You have to have insulin to carry glucose out of the blood and into the cell…since there is no insulin, the glucose just builds up in the blood, the blood becomes hypertonic and pulls off the fluid into the vascular space…the kidneys filter excess glucose and fluids ( polyuria and polydipsia) The cells are starving so they start breaking down protein and fat for energy (polyphagia). When you break down fat you get ketones (acids). Now this Pt. is acidotic - so is metabolic with Kussmaul Respirations - lungs compensate with C02.
List the Signs and symptoms of Type 1 Diabetic
HYPERGLYCEMIA = 3 P’S
- Polyuria - think SHOCK FIRST
- Polydipsia
- Polyphagia
Describe the Treatment used to Type 1 Diabetic
They need Insulin!
Describe the Pathophysiology of Type 2 Diabetes
- Not enough Insulin or the insulin they do have is no good or they have b/c insulin resistant..
- Pt. usually over weight
- Not making enough insulin to keep up with the glucose load compared to what they are taking in.
- Usually found by accident; wound not healing or repeat infection.
Why does the Pt. with Type 2 Diabetes have such a hard time with recurrent infections and wound healing?
Because they have a lot of glucose in their blood and bacteria thrive in this environment. Also, excess glucose causes immune system to b/c dysfunctional. Plus, poor circulation = poor blood supply. Decreased blood supply increases risk for wound healing.
Individuals with Type 2 Diabetes should be evaluated for What Syndrome?
Metabolic Syndrome ( Syndrome X)
In order to be Diagnosed with metabolic Syndrome what 3 or more symptoms must the Pt. have?
- Waist Circumference:
> 40 in (101.6 cm) for males
> 35 in ( 88.9 cm) for females - Triglycerides:
> 150 mg/dL (1.60 mmols/L) - HDL:
< 40 mg/dL (1.036 mmols/L) for males
< 50 mg/dL (1.295 mmols/L) for females - Blood Pressure:
> 130/85 - FBS
> 100 mg/dL ( 5.55 mmols/L)
How do we Treat Metabolic Syndrome?
Start with diet and exercise and then add oral agents.
Some Pt. may have to take insulin to control control BS especially in the presence of non compliance.
Pt. with metabolic syndrome are at risk for developing CAD, so teach Pt. about lifestyle changes to decrease risk of metabolic syndrome M.I. or stroke.
Describe Gestational Diabetes
- Resembles T2 Diabetes
- Mom needs 2-3x more insulin than normal
- If mom has risk factors for gestational diabetie, screen at FIRST prenatal visit.
- Screen ALL moms at 24-28 wks gestation, weather they are high risk or not.
- Complications to baby: Increased birth weight and Hypoglycemia
Why does an infant get Hypoglycemia?
After delivery the infant is no longer exposed to the mothers glucose rich blood. The infants pancreas has been in over drive due to the moms elevated blood surgery and it takes time for the infants pancreas to revert back to reduced normal secretions of insulin usually resolves in a few days and is self limiting. Baby will require glucose supplements until blood sugar normalizes.
What is the General Treatment of Diabetes: ( Type 1 and Type 2)
DIET:
Majority of calories should come from:
- Complex Carbs 45%, Then Fats 30-40%, Protein 15-20%
- Sugar destroys vessels like fat does
- High fiber slows down glucose absorption in the intestines, therefore, eliminating the sharp rise and fall blood sugar. Want to keep the glucose normal or destroys vessels.
EXCERCISE:
Wait till blood sugar normalizes to begin exercise.
Eat prior to exercise to prevent HYPOGLYCEMIA
Exercise when blood sugar is at its highest.
Exercise the same time and amt. daily- routine is key.
MEDS: Oral Anti-diabetics / Non-Insulin Injectables.
- Prescribed for T2 - used when diet/exercise fails.
- Administered PO or Sub Q
- Helps body produce insulin
- Helps body how to use insulin and glucose.
- All oral Anti-Diabetics work to decrease the amount of circulating glucose*
What is the most widely used Anti-Diabetic Med?
Metformin (Glucophage)
- 1st choice for most pt.
- Used for weight control in T2 diabetics
- Used for some Pt. with Pre-diabetes
- Decreases glucose production & enhances how glucose enters the cell
- May see them prescribed in combination, If Metformin is not controlling the blood glucose levels, another anti-diabetic will be ordered, may even be Glargine (Lantus)
When should a Pt. temporaily discontinue Metformin
Any Pt. undergoing surgery or any radiologic procedure that involves contrast dye should emporaily discontinue Metformin. They can resume 48hrs after the procedure if kidney function has returned and creatinine is normal.
How is the insulin dose determined?
Initially it is based on weight. The average adult dose is adjusted until the blood sugar is normal and until there is no more glucose or Ketones in the urine.
What happens if there is glucose smiling over into the urine?
Then the blood sugar will be high, therefore will need more insulin, if you have ketones in the urine that means Pt. is breaking down fat, which leads to metabolic acidosis which is very dangerous.
What are the Peak and Onset times of the various insulin types?
Rapid Acting: Onset - 15 min Peak - 1-3hrs Duration - 3-5 hrs Give with Food.
Regular: Short Acting (R) Onset - 30 min Peak - 2-4 hours Duration- 6-8hrs Can give I.V. CLEAR
NPH: (N) Onset - 1.5 hrs Peak - 4-12 hrs Durations - 16-24 hrs CLOUDY
Long Acting: Lantus, Glargine
No peak- b/c long term vessel damage is caused from flucuation in glucose.
Onset - 2-4 hrs
Duration - 24 hrs
