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.
