living with diabetes

Question 1

1. List the signs and symptoms that a person might experience with new onset diabetes.

Answer 1

Symptoms of high blood glucose:
Polyuria and nocturia: Frequent urination and urination at night due glucose rising above the renal threshold and creating an osmotic diuresis.
Polydipsia: Polyuria produces excessive thirst and drinking.
Blurry vision: Osmotic shifts caused by increase plasma glucose cause the lens of the eye to swell.
Weight loss: Inability to produce insulin results in increased gluconeogenesis. Gluconeogenesis breaks down protein and fat and leads to loss of muscle and fat mass.

Question 2

3. List the tools available to a person with diabetes that allow them to assess their own blood sugar level.

Answer 2

All people with diabetes should have a glucose meter to keep track of their sugars daily. Meters can be in the form of a handheld meter that requires blood to be drawn and blotted on a test strip or they can be continuous glucose meters that constantly measure blood sugars throughout the day and alert the patient when levels are outside the normal range. Many diabetics will also wear an insulin pump that delivers insulin subcutaneously. The pump can be linked to the glucose meter, so that insulin is administered when the glucose meter detects rising blood sugars. This setup is called a closed loop insulin pump.

Question 3

4. List factors that will tend to make a person with diabetes have an increase in their blood sugar levels.

Answer 3

This was not discussed in the notes, but the patient from class mentioned several things that tend to increase her sugar levels including most foods (especially carbohydrates and fat), fluctuating hormone levels accompanied with menstruation, and stress.

Question 4

5. List factors that will tend to lower blood glucose levels in a person with diabetes.

Answer 4

The patient from class indicated that exercise (running for her) helps her to maintain normal sugar levels for several hours. Besides insulin administration, maintaining a bland, low fat, low carbohydrate diet is really the best way to keep blood sugars under control. For Type II diabetics, weight loss and exercise are pivotal in controlling blood sugars.

Question 5

6. Describe the Chronic Care Model.

Answer 5

1. An informed and activated patient: Make sure that the patient has the motivation, information, skills, and confidence necessary to effectively make decisions about their health and manage it appropriately should they choose to.
2. A prepared and proactive practice team: At the time of the interaction the team should have the patient information, decision support, and resources necessary to deliver high-quality care.
3. Self-management support:
   a. Emphasize the patient’s central role.
   b. Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving, and follow-up.
   c. Organize resources to provide support.
4. Delivery System Design:
   a. Define roles and distribute tasks among team members.
   b. Use planned interactions to support evidence-based care.
   c. Provide clinical case management services for high risk patients.
   d. Ensure regular follow-up.
   e. Give care that patients understand and that fits their culture.
5. Potential utility of Case Management
   a. Regularly assess disease control, adherence, and self-management status.
   b. Either adjust treatment or communicate need to primary care immediately.
   c. Provide self-management support.
   d. Provide more intense follow-up.
   e. Provide navigation through the health care process.
6. Decision support for providers
   a. Embed evidence-based guidelines into daily clinical practice.
   b. Integrate specialist expertise and primary care.
   c. Use proven provider education methods.
   d. Share guidelines and information with patients.
7. Clinical information systems
   a. Provide reminders for providers and patients.
   b. Identify relevant patient subpopulations for proactive care.
   c. Facilitate individual patient care planning.
   d. Share information with providers and patients.
   e. Monitor performance of team and system.
8. Community resources
   a. Encourage patients to participate in effective programs.
   b. Form partnerships with community organizations to support or develop programs.
   c. Advocate for policies to improve care.
9. A focus on the health care organization
   a. Visibly support improvement at all levels, starting with senior leaders.
   b. Promote effective improvement strategies aimed at comprehensive system change.
   c. Encourage open and systematic handling of problems.
   d. Provide incentives based on quality of care.
   e. Develop agreements for care coordination.

Question 6

Type I Diabetes clicncal features

Answer 6

Usually occurs in childhood
Low C-peptide
Positive Ab tests to islet antigens
Normal weight
Predisposition to ketoacidosis
Insulin sensitive

Question 7

Type II Diabetes clinical feautres

Answer 7

Usually occurs in overweight adults
Retinopathy, nephropathy and neuropathy
More common in specific ethnic groups (Hispanics, African Americans, Native Americans, Pacific Islanders)
Strong genetic component 50% from parent
Seldom have ketoacidosis
No evidence of beta cell autoimmunity

Question 8

Gestational Diabetes

Answer 8

May resolve after pregnancy
Different diagnosis criteria than other types of diabetes These criteria are based on glucose levels that may affect the pregnancy and lead to macrosomia (big baby), delivery complications and risk for later development of Type II DM in the mother or baby.

Question 9

Pancreatic diabetes

Answer 9

Shares many features with Type I diabetes.
Pts are often very underweight
Pts. lack glucagon as well and may have periods of hypoglycemia
Pts. have signs/sx of malabsorption (Steatorrhea, vitamin deficiencies)
More common in alcoholics and is assc. with periods of hypolglycemia in these pts. (secondary to impaired gluconeogenesis)
Severe peripheral neuropathy