exam 2: diabetic mellitus Flashcards
what hormone is secreted by alpha cells of the pancreas?
glucagon
what effect does glucagon have on insulin?
antagonist to the effect of insulin
what stimulates glucagon production? what inhibits it?
-stimulated by low glucose levels and sympathetic simulation
-increases blood glucose concentration by stimulating glycogenolysis, gluconeogenesis and lipolysis
-inhibited by high glucose levels
what hormone is secreted by beta cells of the pancreas?
insulin and amylin
what is insulin?
an anabolic hormone from precursor proinsulin which is formed from preproinsulin
what is a c peptide preproinsulin
used as an indirect measurement of serum insulin synthesis
what is a key component in maintaining normal cellular function
sensitivity of insulin receptor
what is a primary stimulus of insulin?
increase in blood levels of glucose and by PNS usually before eating a meal
what is the main function of insulin?
stimulate protein and fat synthesis and decrease the blood glucose levels
what is an amylin
an amyloid polypeptide co-secreted with insulin by beta cells in response to nutrient stimuli
how does amylin work with blood glucose
regulates blood glucose concentration by delaying gastric emptying and suppressing glucagon secretion after meals
what effect does amylin have with reducing blood glucose
has a satiety effect to reduce food intake and to prevent hyperglycemia
what hormone is secreted by delta cells of the pancreas?
gastrin and somatostatin
how does gastrin affect the blood glucose
it stimulates the secretion of gastric acid
how does somatostatin affect the blood glucose
essential in carbohydrate, fat, and protein metabolism
- involved in regulating alpha and beta cell function within the islets by inhibiting secretion of insulin, glucagon, and pancreatic polypeptide
what hormone do F (pp) cells of the pancreas secrete
pancreatic polypeptide
how does the pancreatic polypeptide affect the blood glucose
by inhibiting gallbladder contraction and exocrine pancreatic secretion
what is type 1 DM
it is a primary beta-cell defect or failure leading to severe insulin deficiency or no insulin secretion at all
what is the etiology of type 1 DM
autoimmune; genetic and environmental factors, resulting in gradual process of autoimmune destruction in genetically susceptible individuals
describe the pathophysiology of type 1 DM
genetic predisposition and environmental factors lead to autoantigens forming insulin-producing cells to circulate in the blood stream, which activates cellular immunity and humoral immunity toward beta cells leading to the destruction of beta cells with decreased insulin secretion
what is type 2 DM
insulin resistance with inadequate insulin secretion
what is the etiology of type 2 DM
genetic susceptibility (polygenic) combined with environmental determinants and defects in beta cell function combined with insulin resistance
describe the pathophysiology of type 2 DM
genetic factors and environment factors (obesity) alters insulin receptors leading to
- insulin resistance: leads to increased insulin > prediabetic
-decreased beta cell mass/function: leads to decreased insulin > hyperglycemic
describe metaBBOLic syndrome
B: BP meds leading to increase BP (>130 systolic)
B: increase fasting blood glucose (>1000
O: obesity based on waist size
L: high cholesterol levels
the body works to get rid of high blood glucose in hyperglycemia by:
polyuria: frequent urination
polydypsia: increased thirst
polyphagia: increased hunger
what causes hyperglycemia:
sepsis
stress
skip insulin
steroids
what are presenting symptoms of hyperglycemia
extreme thirst, polyuria, fruity breath odor, kussmaul breathing (deep, rapid, labored, distressed, dyspneic), rapid and thready pulse, dry mucous membrane, poor skin turgor, bl glucose >250 mg/dL
what is the treatment of hyperglycemia
fluid, insulin, and electrolyte replacment
what are symptoms of hypoglycemia (insulin shock)
headache, lightheadedness
nervousness, apprehension
tremor
excess perspiration; cold, clammy skin
tachycardia
slurred speech
memory lapse, confusion, seizures
bl glucose <60 mg/dL
simple nursing:
H- headache
I- irritable
W- weakness
A- anxiety and trembling (pallor)
S- sweating (diaphoresis)
H- hunger
what causes hypoglycemia
exercise
alcohol (decreases sugar synthesis)
insulin peak times
what are treatments for hypoglycemia
A-Awake
A-Ask to eat
S-Sleep
S-Stab (with IV D50- dextrose)
- reassess sugar Q15 after
immediate replacement of glucose either PO or IV
prevention is achieved with individualized management of medications and diet, monitoring blood glucose levels, and education
what is diabetic ketoacidosis
aka diabetic coma syndrome
-absolute or relative deficiency of insulin and an increase in the insulin counter regulatory hormones of catecholamines—cortisol, glucagon, and growth hormone.
what are presenting symptoms of DKA
malaise, dry mouth, headache, polyuria, polydipsia, weight loss, n/v, pruritus, abdominal pain, lethargy, SOB, Kussmaul respirations, fruity or acetone odor to breath
how it DKA managed
with a combination of fluids, insulin and electrolyte replacement
what is the relationship of retinopathy to DM and its associated symptoms:
it is a microvascular complication
-progresses from no visual changes to loss of visual acuity and blindess
- worsened by hyperosmolar lens edema and cataract formation
what is the relationship of nephropathy to DM and its associated symptoms:
it is a microvascular complication
-microalbuminuria and HTN slowly progressing to end-stage kidney failure
what is the relationship of neuropathy to DM and its associated symptoms:
it is a microvascular complication
-sensorimotor polyneuropathy progressing to distal paresthesias and muscle wasting
-postural hypotension, gastroparesis, urinary retention and erectile dysfunction
what is the relationship of skin and foot lesions to DM and its associated symptoms:
it is a microvascular complication
-pressure ulcers and delayed wound healing; abscess formation; necrosis and gangrene of toes and feet; infection and osteomyelitis
what is the relationship of cardiovascular system to DM and its associated symptoms:
it is a macrovascular complication
-HTN, CAD, cardiomyopathy, HF
what is the relationship of cerebrovascular system to DM and its associated symptoms:
it is a macrovascular complication
-increased risk for ischemic and thrombotic stroke
what is the relationship of peripheral vascular system to DM and its associated symptoms:
it is a macrovascular complication
-increased claudication, nonhealing ulcers, gangrene
SIMPLE NURSING INFO:
what diet should be avoided if a client has DM
simple sugars (soda, candy, white bread/white rice, juice)
SIMPLE NURSING INFO:
what diet should be encouraged if a client has DM
good carbohydrates:
high in fibers; brown- bean, rice, bread peanut butter; and whole- wheat, grain and milk
WHY?? since it is high in fat (lipid), it will slow down sugar absorption
AKA low-glycemic index food
SIMPLE NURSING INFO:
what precautions should be made for a client who has DM on their feet
keep clean, dry and injury free
F: no Flip Flops, high heels, nylon
O: no Otc corn removal
O: no Overly hot baths, pads, etc
T: no Toe injuries (daily inspection)
SIMPLE NURSING INFO:
how do you draw up insulin
clear to cloudy
SIMPLE NURSING INFO:
how do you properly administer insulin injections
-rotate every 2-3 weeks (best on abdomen near belly button)
-never aspirate as it can cause swelling and scar tissue
-never massage or add heat after subq
SIMPLE NURSING INFO:
if a client is experiencing DKA in Type 1 DM and is nauseous, what is an acceptable approach
can give insulin without food but must monitor glucose closely
