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interactive lecture diabetes Flashcards

1
Q

what are diabetes the leading cause of

A

end-stage renal disease
adult blindness
lower limb amputations

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2
Q

theories for causation of diabetes mellitus

A

genetic
autoimmune
environmental: viral, obesity

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3
Q

normal insulin level

A

70-130 mg/dL

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4
Q

purpose of insulin

A

allows transport of glucose from blood stream into the cells cytoplasm

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5
Q

where are insulin released from in the pancreas

A

beta cells

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6
Q

which 4 regulatory hormones increase blood glucose levels to maintain normal bg lvls

A

glucagon
epinephrine
growth hormone
cortisol

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7
Q

what is gestational diabetes

A

develops during pregnancy detected around 24 - 28wks of gestation;
will return to normal 6 weeks postpartum

the high bg of mother will bring extra glucose to the baby -> causing the baby to gain weight

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8
Q

what is secondary diabetes and what can cause it

A

treatment of a medical condition that in turn cause increased bg

corticosteroids - prednisone
thiazides
Total parental nutrition (TPN)
pancreatic dx

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9
Q

3 requirements for diagnosis of prediabetes

A
  • IGT: 2 hr plasma glucose 140 -199
  • IFG: fasting glucose lvls >100 but <126
  • A1c lvls: 5.7-6.4%
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10
Q

what are the A1c levels for normal, prediabetes, and diabetes

A

normal: <= 5.6
prediabetes: 5.7-6.4
diabetes: 6.5+

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11
Q

what are the fasting blood sugar test (FPG) levels for normal, prediabetes, and diabetes

A

normal: <=100
prediabetes: 100-125
diabetes: >=126

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12
Q

what are the oral glucose tolerance test (OGTT) levels for normal, prediabetes, and diabetes

A

normal: <=140
prediabetes: 140-199
diabetes: >=200

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13
Q

Type 1 diabetes peak onset, and most often occurs in people how old

A

happens to people <30yrs old
peak onset 11-13 yrs old
autoimmune disease

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14
Q

classic symptoms of diabetes type 1

A

polyuria - frequent urination
polydipsia - extreme thirst
polyphagia - excessive hunger

ketoacidosis
weight loss
weakness/fatigue/blurred vision

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15
Q

etiology and pathophysiology of diabetes

A

pancreas produces insulin but either not enough or poorly used
can be prevented or delayed with weight loss & physical activity

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16
Q

4 major metabolic abnormalities of diabetes type 2

A
  1. insulin resistance
  2. pancreas decreased ability to produce insulin
  3. not enough insulin produced
  4. alteration in hormones and adipokines
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17
Q

clinical manifestations of diabetes type 2

A

gradual onset with nonspecific symptoms
fatigue
recurrent infections/prolonged wound healing
visual changes

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18
Q

4 diagnostic studies for diabetes

A
  1. fasting plasma glucose lvl >126
  2. random plasma glucose >=200 mg/dL w/ symptoms
  3. 2hr OGTT >=200 mg/dl using glucose load 75G
  4. A1c>6.5% on 2 separate occasions
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19
Q

what does A1c measure

A

the amount of glucose that gets attached to Hgb over the RBC lifespan 90-120 days

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20
Q

what is the ambulatory glucose profile (AGP)

A

summary of a pt’s daily glucose and insulin patterns over time

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21
Q

why use AGP or A1c

A

AGP is great for those prone to glycemic swings vs. A1c only show one snapshot

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22
Q

target range of bg for diabetics

A

70-180 at least 70% of the time with minimal hypo or hyperglycemia

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23
Q

who is exogenous insulin prescribed for

A

type 1 diabetes
type 2 who can’t control bg by other means

24
Q

fastest absorption rate of insulin injection locations

A

abdomen, back of arm, thigh, butt

25
name 3 meds in class sulfonylureas
glipizide (Glucotrol), glimepiride (Amaryl), glyburide
26
purpose of sulfonylureas
help pancreas make and secrete insulin for DM2 decreases A1C by 1-2%
27
patient considerations for sulfonylureas
hypoglycemia - severe GI: N&V, constipation
28
drug in class biguanides
metformin
29
purpose of metformin
Increases glucose tolerance by: decrease glucose absorption in intestines decrease hepatic glucose production increase glucose uptake and usage -> decrease A1c by 1.5-1.8% in DM2
30
contraindications for metformin
renal failure, liver dx, severe infection
31
considerations for metformin
hold 48hrs before invasive procedure such at cath lab GI issues
32
what 2 drugs go in the thiazolidinediones (TZDs) class
pioglitazone (Actos) rosiglitazone (Avandia)
33
purpose of thiazolidinediones
insulin ensitizers that decrease insulin resistance by inhibiting hepatic gluconeogenesis reduce A1c 1.5%
34
considerations for taking TZDs
- fluid retention -> don't use in CHF [may cause weight gain, edema] - weeks to months to work - start low dose, titrate q2-4wks - reduce effectiveness of oral contraceptives - liver function tests (LFTs)
35
list the drug under DPP-4 inhibitors
sitagliptin (Januvia)
36
how does sitagliptin work
increase incretins and increase GLP-1 levels (released in response to food and regulates insulin), thus increasing insulin secretion lowers A1c 0.5-1% few side effects
37
what are the 2 incretin mimetics inj meds
exenatide (Byetta) liraglutide (Victoza)
38
how do incretin mimetics work
binds to GLP-1 receptors and slow down digestion of food -> glucose absorbed slower can reduce appetite -> weight loss
39
causes of DKA
hyperglycemia dehydration infection mostly in DMtype1
40
DKA signs and symptoms
- 3Ps - polyurea, polydipsia, polyphagia - dehydration - -poor skin turgor, dry mucosa, tachycardia - orthostatic hypotension - Kussmaul's respirations - acetone breath, fruity breath
41
DKA labs - 4
bg >240-300 arterial blood pH <7.3 serum bicarbonate <15mEq/L ketones in blood and urine
42
DKA treatment
- ensure airway/O2 - IV NS 1/L until stable BP & urine output >30/hr - insulin bolus Regular IV 5-10units - then cont. insulin drip until bg around 250 1-2U/hr 0.5U/kg/hr, add D5W to prevent hypoglycemia - monitor bg q1-2hr - potassium (K) replacement
43
what is hyperosmolar hyperglycemic syndrome (HHS) and treatment
occurs mostly in elderly >60yrs with DMtype2 - prolonged hyperglycemia >400 but no ketoacidosis because there is enough insulin treat is similar to DKA
44
what is considered hyperglycemia and symptoms
bg>200 3P's weight loss, visual changes or asymptomatic
45
causes of hyperglycemia
- not enough basal insulin (overnight insulin) - dawn phenomenon & Somogyi effect - poor food choices - incorrect timing of insulin given - insulin resistance - illness/stress
46
dawn phenomenon vs. Somogyi effect how to tell difference
dawn phenomenon (our body produces cortisol and growth hormone to wake up but also effects bg) Somogyi effect (hypoglycemia at night but hormones overcompensate to hyperglycemia) check if bg is low around 2-3AM, if it's low it's Somogyi if normal or high it's dawn phenomenon
47
how to avoid dawn phenomenon and Somogyi effect
- avoid carbs at bedtime - have a low fat, high fiber dinner - use insulin pump at night, take insulin before bedtime instead of late afternoon
48
what range of bg should diabetics be kept in
140-180 bg maintained premeal bg <140 no higher than 180 after therapy
49
common causes of hypoglycemia
- meal delayed - insulin timing - excessive exercise - alcohol
50
signs and symptoms of hypoglycemia
- confusion/irritability - diaphoresis, tremors - hunger - weakness - visual disturbances
51
hypoglycemia treatment
if ALERT and can swallow: - 15-20g simple carbs, 4-6oz fruit juice, regular soft drink avoid foods with fat: decrease absorption of sugar recheck bg 15mins after until bg>70 if NOT awake: - 1mg of glucagon IM/subQ (may cause rebound hypoglycemia) - ingest complex carbs after recovery - 20-50mls of D50W IVP
52
factors that worsen and exacerbate chronic diabetes issues
obesity smoking hypertension high fat intake sedentary lifestyle
53
areas mostly effected by chronic diabetes
eyes: retinopathy kidneys: nephropathy skin erectile dysfunction typically 10-20 yrs of diabetes
54
most common cause of diabetic retinopathy
hyperglycemia leading to microvascular damage to the retina
55
what to screen to prevent nephropathy
yearly screening of albumin in urine, serum creatinine
56
what happens in nephropathy
damage to small blood vessels that supply the glomeruli, Main cause of end-stage renal disease
57
how does diabetes effect the immune system
- defect in mobilization of inflammatory cells - impairment of phagocytosis by neutrophils & monocytes ---> more likely to get infections

NURS122 (28 decks)

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