Exam 3 - Diabetes Flashcards
Risk Factors of Diabetes
- Age
- Ethnicity and family history
- body weight
- Hypertension
- Dyslipidemia (elevation of plasma cholesterol, triglycerides, or both, or a low high-density lipoprotein level that contributes to the development of atherosclerosis)
- metabolic Syndrome
- Gestational diabetes or delivery >9lb
- Polycystic ovary syndrome
- Prediabetes (impaired glucose tolerance/impaired fasting glucose)
Type 1: Acute onset manifestations
3 P’s
1. Polyuria: increase freq urination
2. Polydipsia: increased thirst
3. Polyphagia: increase hunger and food intake, but wgt loss.
Others:
Ketones (Acidic) leads to Metabolic Acidosis
Wgt Loss, weakness, fatigue, dizziness
Type 2: Manifestations
- slow onset; body adjusts because so gradual
- blurry vision, skin infections, vaginitis
- Hyperglycemia
- Target organ damage
- Lose B cell function
Type 1: Patho
Autoimmune destruction of pancreatic beta cells. Body does not make insulin.
Absolute insulin deficiency
5-10% of diabetics
Type 2: Patho
- Insulin resistance: from obesity; due to increase in adipose tissue makes difficult for glucose to uptake into cells.
- Decreased insulin receptors: inability to bind to muscle and adipose cells leading to inability to transport glucose into cell.
- Defect in pancreatic beta cell secreation
- Overactive liver
- 90-95% of diabetics
Fasting Plasma Glucose (FPG)
Preferred test for diagnosing diabetes Diabetes: >= 126 mg/dl Prediabetes: 100-125 mg/dl Non diabetic: <100 mg/dl **1 elevated BS does not mean diabetes; need another test to confirm.
Casual Plasma Glucose
Test for diagnosing diabetes
Random: any time of day casual plasma glucose
>= 200 mg/dl
A1C / HbgA1C/ Glyco
3 month avg of blood sugar. Glucose sticks to RBC. Looks at % of RBC covered in glucose.
Diabetes: >= 6.5%
Prediabetes: 5.7-6.4%
Non diabetic: <6.5%
Glycosylated albumin
Diagnostic test. Avg for the last week;. not used much.
% of glucose that sticks to albumin.
Kidney Function tests
Proteinuria: albuminuria, microalbuminuria
BUN, creatinine, GFR
1 unit of insulin lowers blood sugar ____ pts.
30-50 points
Blood Glucose Monitoring
- Plasma glucose (venous)
- Capillary blood glucose - some meters have a 15% difference between capillary and venous blood. Capillary blood glucose is lower.
- Continuous blood glucose monitoring (catheter) - subcutaneous sensor.
Non pharmacological Medical Therapy for Type 2 Diabetes
Ways to optimize BG control, improve blood lipids and control bp
- consistent carb intake
- modify fat and calorie content
- space meals
- increase physical activity
- moderate wgt loss
- monitor blood glucose to adjust therapy
Optimal BMI, waist circumference
BMI 18.5-24.9
WC male: <35 in
Nutrient Recommendations
Carbs: 40-60%
protein 15-20%
Fat 30% or less (<7% saturated fat, NO trans fat)
The types of insulin with onset, peak and duration.
Rapid acting (Humalog & Novolog): 15 min – 60-90 min – 2-4 hr Fast acting (Regular): 30-60min – 2-3 hr – 3-6 hr Intermediate acting (NPH) :2-4hr – 4-10hr – 10-16hr Long acting (Lantus): 1-2hr – peakless – 24hr
The symptoms and treatment of hypoglycemia.
Mild: shaking, sweating, fast heartbeat, dizziness, hunger
Moderate: Impaired vision, headache, irritable Severe: seizure, unresponsive, coma
Treatment: 15 g CHO, D50, Glucagon
Basal/Bolus Concept
2 different types of insulin that mimic what a pancreas would do; “Poor man’s pump”.
- Long acting insulin to have a little in body at all time AND Rapid acting insulin when they eat.
Basal Insulins
- Lantus (insulin glargine)
- NPH
Bolus Insulins
Correction scale/supplemental insulin/ sliding scale
With Food or if BS too High
- Humalog (lispro)
- Novolog (insulin aspart)
- Regular (best for tube feedings and hyperal)
Premixed insulins
- Humulin 70/30
- Novolog 70/30 mix
- Humalog 75/25 mix
U 500
Insulin Therapy for extremely resistant patients that need large amounts insulin.
Lipoatrophy
Insulin side effect: Loss of subcut fat (saw more when people used beef and port insulin)
Lipohypertrophy
Insulin side effect: Buildup of scar tissue; need to rotate sites of insulin.
Why do ppl get hypoglycemia
- Not eating after insulin
- Too much insulin
- Over exertion
- alcohol intake
Body Response to hypoglycemia
Normal response to hypoglycemia- it triggers the counter regulatory hormones to increase blood sugar. Body releases glucogon and epinephrine in response to a low blood sugar.
What is the class of drugs that mask S&S of hypoglycemia
Beta Blockers
Treatment to hypoglycemia
Mild-Mod: RULE OF 15 - Give 15 grams fast acting carb (glucose tabs, gel, 4 oz oJ, 8 oz milk). Then check again in 15 minutes.
Mod- Severe: Glucagon, D50; test in 15 min.
Somogyi Effect
If blood sugar level drops too low in the early morning hours, hormones (cortisol, grwth hor) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in morning.
9pm: Blood glucose 120 mg/dl
8am: Blood glucose 210 mg/dl
Insulin was doing too good of job - gave middle of the night hypoglycemia then rebound hyperglycemia. So person needs LESS insulin at night.
Dawn Phenomena
Normal rise in blood sugar as a persons body prepare to wake up. Needs MORE insulin at night.
Diabetic Ketoacidosis (DKA) S&S
Type 1 complication Sugars ~ 300-1000+ Fluid Volume Deficit Metabolic Acidosis Hyperkalemia N/V - abd pain dehydration Kaussmal Resperations Acute weight loss Acetone breath
Treatment of DKA
Restore blood volume: IV Fluids - Isotonic (possible hypo eventually)
Correct Electrolyte imbalance: Potassium - Insulin shifts K back into cells
Normalize blood glucose: Insulin - normalize with IV insulin (Regular)
Correct Acidosis
Check sugars qh
**Dont stop when sugar comes down, run at least 24 hr after back down. Add dextrose (glucose) to IV.
Hyperosmolar Hyperglycemic Syndrome (HHNS) S&S
Type 2 Severe hyperglycemia without ketosis Older Adults with significant health issues Sugars 600-2000+ Dehydrated NO Kaussmal Resperations because NO Ketones Acid/Base balance is normal Very dehydrated Increase HR Decreased BP
Treatment of HHNS
Hydrate slower due to other issues
Insulin drip- helps shift potassium
Dextrose after BS normalize, maintain for 24 h
Hyperglycemia - Microvascular Complications
Type 1 OR Type 2
Small blood vessels
- Retinopathy: 12% of all new cases of blindness
- Nephropathy: Kidney’s - check for protein in urine = begin of kidney failure
- Neuropathy: Nerve Endings - increase blood sugar cause damage to nerve endings.
Hyperglycemia - Macrovascular complications
Type 1 OR Type 2 Large Blood Vessels - Cerebrovascular Disease: strokes - Heart Disease: Diagnosed in 3702% patients with diabetes > 35 yrs old - Peripheral Vascular Disease: High BP Acute MI
Autonomic Neuropathy
Type 1 - Over several years
- Fixed heart rate
- orthostatic hypotension
- delayed gastric emptying
- Urinary retention
- Impotence
