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NURS 220 > LEC 7: Diabetes Mellitus > Flashcards

LEC 7: Diabetes Mellitus Flashcards

1
Q

What is the function of the pancreas?

A

Has both exocrine and endocrine functions

- Releases enzymes

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2
Q

Endocrine Functions

A

Group of cells that secrete hormones into circulation that have an effect on tissues in a different are of the body

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3
Q

What are the two cells in the Islets of Langerhans?

A
  1. Alpha cells

2. Beta cells

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4
Q

What cells secrete glucose?

A

Alpha cells

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5
Q

What cells secrete insulin?

A

Beta cells

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6
Q

What is the role of insulin in the body?

A

Normally, inulin is continuously releases into the blood stream with extra released when food is ingest
- Insulin is secreted 24 hours a day

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7
Q

What does insulin help to do?

A
  • Helps transport glucose across the cell membrane
  • Helps to decrease glucose within the blood stream
  • If there is any extra sugar, it is stored in the liver
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8
Q

What tissues in our body are dependent on insulin?

A
  • Muscle

- Adipose tissue

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9
Q

What tissues do not rely on insulin?

A
  • Brain
  • Liver
  • Blood cells
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10
Q

What happens is there is no insulin to assists glucose?

A

Our cells start to think that our body is starving and start ti break down fat and protein as fule sources for our body

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11
Q

What is the role of glucagon in the body?

A
  • Stimulated by the pancreas

- Stimulates the liver into releasing glucose into the blood stream when body says its hungry

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12
Q

What is diabetes mellitus (DM)?

A

A chronic multisystem disease related to:

  • Abnormal insulin production
  • Impaired insulin utilization
  • Or both
  • The pancreas is not able to produce any or enough insulin that the body needs OR the insulin cannot be used
  • Insulin cannot be bound to cell
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13
Q

Etiology and Pathophysiology

A

Theories link cause to single/ combination of these factors

  • Genetic
  • Autoimmune
  • Viral
  • Environmental
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14
Q

What are the three types of diabetes?

A
  1. Type 1 diabetes
  2. Type 2 diabetes
  3. Gestational diabetes
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15
Q

What are the two common types of diabetes?

A
  • Type 1 diabetes

- Type 2 diabetes

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16
Q

Type 1 DM

A
  • 10% if diabetes
  • Usually diagnosed by age 30
  • Though to be autoimmune disease- own body destroys beta cells
  • Bata cells incapable of producing insulin (80 to 90% damaged)
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17
Q

What are the clinical manifestations of Type 1 DM?

A
  • Polydipsia
  • Polyuria
  • Polyphagia
  • Weight loss
  • Fatigue
  • Weakness
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18
Q

Polydipsia

A

Excessive thirst retaliated to:

  • High sugar concentration
  • Fluid is being pulled through from osmosis
  • Water is pulled by osmosis to a high concentration
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19
Q

Polyuria

A

Excess urination

- Kidneys trying to eliminate the excess water

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20
Q

Polyphagia

A

Excessively hungry

  • Telling the body they are hungry
  • Cells are starving
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21
Q

Pre-Diabetes

A
  • At risk for Type 2 DM

- Blood glucose high but not high enough to be diagnosed as having diabetes

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22
Q

What is pre-diabetes characterized by?

A
  1. Impaired fasting glucose (IFG)

2. Impaired glucose tolerance (IGT)

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23
Q

What needs to happen for pre-diabetic patients?

A

Need to change their lifestyle, if they do not change lifestyle will have Type 2 diabetes within 10 years

  • Weight loss
  • Medication
  • Diet
24
Q

What are risk factors for DM?

A
  • Genetics
  • Aboriginal, Hispanic, African, Asian, populations high risk
  • History of pre-diabetes
  • Obesity
  • Increased cholesterol
  • Hypertension
  • Increased waist circumference
25
Q

Type 2 DM

A
  • 90% of diabetes
  • Insulin resistance, insulin deficiency or both
  • Usually diagnosed after age 40
  • Often asymptomatic
  • Progressive nature, gets worse if left untreated
26
Q

What are the four major metabolic abnormalities?

A
  1. Insulin resistance
  2. Pancreas reduced ability to produce insulin
  3. Inappropriate glucose production from liver
  4. Alteration of regulating hormones and adipocytokines
27
Q

Metabolic Abnormalities: Insulin Resistance

A
  • Body tissue dose not respond to insulin
  • Insulin receptors are either unresponsive or insufficient in number
  • Results in hyperglycaemia
28
Q

Metabolic Abnormalities: Pancreas Reduced Ability to Produce Insulin

A
  • Beta cells fatigued from compensating
  • Beta cell mass lost
  • Beta cells become damaged due to overuse
29
Q

Metabolic Abnormalities: Inappropriate Glucose Production from Liver

A

Liver’s response of regulating release of glucose is haphazard

30
Q

Metabolic Abnormalities: Alteration in Production of Hormones and Adipocytokines

A

Play a role in glucose and fat metabolism

31
Q

What is the clinical manifestation of Type 2 DM?

A
  • Gradual onset
  • May have classic symptoms
  • Fatigue
  • Recurrent infections
  • Prolonged wound healing
  • Visual changes
32
Q

Diabetes Diagnosis

A
  1. Fasting blood sugar
    - NPO for at least 8 hours prior
    - Greater than or equal to 7.0 mmol/L
  2. Casual blood sugar
    - Taken at any time in the day
    - Greater than or equal to 11.1 mmol/L with symptoms of high blood sugars
  3. 75 gram oral glucose tolerance test (OGTT)
    - Greater than or equal to 11.1 mmol/L
    - 2 hours after ingesting glucose drink
  4. Hemoglobin A1C
    - Greater or equal to 6.5%
    - Glucose control or 3 months
33
Q

Oral Antihyperglycemic Meds

A
  • Alpha-glucosidase inhibitors
  • Biguanides
  • Dipeptidyl peptidase-4 inhibitors
  • Sulfonylurea insulin secretagogues
34
Q

Basal Insulin

A

Type of insulin for Type 1 diabetics

- Background insulin: mimics the function of pancreas

35
Q

Prandial Insulin

A
  • Can give 4 times a day
  • Meal time/ bolus insulin
  • Given in anticipation of a spike in blood glucose
36
Q

Correction Insulin

A
  • Extra dose when glucose level above range

- Used when blood glucose levels are higher then the targeted range

37
Q

Intermediate Acting

A

Used as basal insulin

- Can give 2 times a day

38
Q

Extended Long Acting

A

Used as basal insulin

- Can give 1 a day

39
Q

Rapid Acting

A

Used as prandial and/or correction insulin

- Can give 4 times a day

40
Q

Short Acting

A

Used as prandial and/or correction insulin

- Can give 4 times a day

41
Q

What is the stepwise approach to Type 2 DM management?

A
  1. Diet and exercise
  2. Oral mon therapy
    - 1 drug orally to start
  3. Oral combination
  4. Oral and insulin
  5. Insulin
42
Q

Exercise: Type 2 DM

A
  • Accumulate 150 minutes of aerobic activity spread over at least 3 nonconsecutive days of the week
  • Goal is to increase to 4 hours or more per week
  • Encourage resistance exercise in addition to aerobi
  • Start with small realistic goal
43
Q

Nutrition: Plate Method

A
  1. Vegetables
    - Half the plate with 2 kinds of vegetables at least
  2. Grains & Starches
    - A quarter of the plate
    - Potato, rice, corn, pasta
  3. Meat & Alternatives
    - A quarter of the palte
    - Fish, lean meat, chicken, beans, lentils
44
Q

Dose fiber count as a carbohydrate?

A

No, fiber does not count as a carbohydrate because it dose not raise glucose levels

45
Q

Carbohydrate Counting

A
  • Women: 45 to 60 grams of carb per meal
  • Men: 60 to 75 grams of carb per meal
  • Snacks: 15 to 30 grams
46
Q

ABCDE’s to Reduce Cardiovascular Risk

A
  1. A: A1C measure of blood sugar levels over the previous 2 to 3 months
    - Target is 7% lower
  2. B: Blood pressure
    - Target is 130/80 mmHg or lower
  3. C: Cholesterol LDL
    - Target is 2.0 mmol/L or lower
  4. D: Drugs to protect the heart
    - ACR inhibitors, ARBs, Statins, and/or ASA
  5. E: Exercise- regular
    - Physical activity and a balanced diet to achieve a healthy body weight

6.S: Smoking cessation and manage stress

47
Q

What are chronic complications of DM?

A
  • Macrovascular
  • Microvascualr
  • Foot and lower extremities
  • Integumentary
  • Infection
48
Q

Chronic Complications of DM: Macrovascular

A

Disease of large and medium-sized blood vessels

49
Q

Chronic Complications of DM: Mircorvascular

A
  • Result from thickening of vessel membranes in capillaries and arterioles
  • Retinopathy. neuropathy
50
Q

Chronic Complications of DM: Foot and Lower Extremities

A

Related to micro and macrovascular complications

51
Q

Chronic Complications of DM: Integumentary

A

Related to micro and macrovascualr complications

52
Q

Chronic Complications of DM: Infection

A

Related to micro and macrovascualr complications

53
Q

Hypoglycaemia in the Diabetic Patient

A
  1. Blood glucose levels less than 4 mmol/L
  2. Signs & Symptoms
    - Diaphoresis
    - Tremors
    - Hunger
    - Pallor
    - Palpitations
    - Irritability
    - Visual distrubances
    - Difficulty speaking
    - Confusion
    - Stupor
  3. Can lead to loss of consciousness, seizures, coma and death
54
Q

What is the treatment of mild to moderate hypoglycaemia?

A
  • BGM less than 4 mmol/L

Treat with 15 to 16 grams of fast acting carbs

  • 4 glucose tables
  • 3 tsp sugar (15mL) or 3 packets of sugar dissolved in warm water
  • 25 mL IV dextrose
55
Q

What is the treatment for severe hypoglycaemia?

A
  • BGM less then 2.8 mmol/L

Treat with 20 grams of fast acting carbs:

  • 5 glucose tables
  • 4 tsp of sugar (15mL) or 4 sugar packets dissolved in warm water
  • 50mL of IV dextrose

NURS 220 (41 decks)

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