Living With Diabetes Flashcards
Chronic care model
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Diabetes
blood glucose that is increased to a point where it could cause microvascular disease. Can impact:
- kidneys (proteinuria, progressing to end stage renal failure requiring dialysis)
- Eyes: proliferative retinopathy, bleeding, potentially progressing to blindness
- nerves: pain, numbness, propensity to injury, potentially leading to amputation.
Glucose levels that define diabetes
Fasting: >126 mg/dl
2 hr plasma glucose >200 mg/dl during 75g OGTT
Sx of diabetes with random plasma glucose >200 mg/dl
HbA1C >6.5% on 2 occasions in absence of illness is diagnostic for diabetes (illness may increase blood glucose through an increase in counter-reg hormones, especially cortisol and catecholamines)
HbA1C
represents average blood sugar over preceding three months.
Impaired fasting glucose, impaired glucose tolerance
- increased risk for MACROvascular disease (CAD, cerebrovascular disesae), but no for microvascular disease
- 8-10%/year risk of progressing to T2D
- Impaired fasting glucose: 100-125 mg/dl
- impaired glucose tolerance (IGT): 2hr glucose 140-199 mg/dl during OGTT
- HbA1C: 5.7-6.4% indicates “prediabetes”
Sx of DKA
abdominal pain
nausea
vomiting
Type 1 diabetes cause, result, common characteristics
- autoimmune destruction of beta cells in pancreas
- insulin deficiency
1. Usually occurs in childhood.
2. Evidence of insulin deficiency: low C-peptide.
3. Genetic contribution
Type 1 diabetes cause, result, common characteristics
- autoimmune destruction of beta cells in pancreas
- insulin deficiency
1. Usually occurs in childhood.
2. Evidence of insulin deficiency: low C-peptide.
3. Genetic contribution
Type 2 diabetes
- most common (90%)
- insulin resistance and “relative” reduction in insulin secretion
1. Usually adults, although more recently adolescents too.
2. More common in specific ethnic groups: Hispanics, African Americans, Native Americans and Pacific Islanders.
3. Affected individuals are usually overweight or obese, and risk increases with progressive weight gain over time.
4. STRONG genetic component. Patients usually have a positive family history for type 2 diabetes.
5. Usually do not have ketoacidosis.
6. Caused by both insulin resistance and insulin deficiency.
7. No evidence of beta cell autoimmunity.
Which type of diabetes responds to oral hypoglycemic drugs?
Type 2 diabetes
Pancreatic diabetes
-results from surgical removal of pancreas or injury from pancreatitis
-shares features of T1D
w/ unique features:
1. May have pancreatic malabsorption causing diarrhea and steatorrhea (fat in the stool), and fat soluble vitamin deficiency.
2. May be markedly underweight.
3. Lack glucagon in addition to insulin because of generalized pancreatic injury. Predisposes to hypoglycemia.
4. May occur in an alcoholic (associated with pancreatitis) who may have liver disease which may predispose to hypoglycemia (alcohol use also impairs gluconeogenesis).
5. Prone to hypoglycemia.
6. May have bad peripheral neuropathy because of the combined neurotoxicity of alcohol and diabetes.
Pancreatic diabetes
-results from surgical removal of pancreas or injury from pancreatitis
-shares features of T1D
w/ unique features:
Factors that predispose to high blood sugars
stress, increased carbohydrate intake and occasionally exercise
Factors that predispose to low blood sugars
excessive glucose lowering medication use, adrenal insufficiency, and in some situations exercise.
Chronic Care model
-diabetes is a chronic health condition, managed by pt and team
Important features:
- informed/active patient
- prepared/proactive team
- self management support
- Delivery system design: roles for team members, planned interactions/ev based, clinical case management services, regular follow up
- case management (possible)
- decision support for providers
- clinical information systems
- community resources
- focus on the health care organization
