Low Vision Final Study Guide Part 3 Flashcards
Diabetes Self-Management & Functional Mobility
Be able to distinguish comparison of control differences between the endocrine and nervous systems.
* Nervous and endocrine systems act together to coordinate functions of all body systems.
– Nerve impulses trigger release of neurotransmitters.
– Endocrine system releases mediators called hormones.
1. endocrine system – Slow responses: growth, metabolism
* Hormones transmitted throughout body
* Act far from site of release (bloodstream)
* Target cells throughout body
* Onset is slow (seconds to hours to days)
* Duration is long (seconds to days)
2. nervous system – Rapid responses: skeletal muscle contraction
* Neurotransmitters released locally
* Act close to site of release (at synapse)
Understand how hormones released from an endocrine gland reach and influence target cells.
- Hormones are molecules released in one part of the body but regulate activity elsewhere.
– Delivered to cells through the bloodstream - Hormones (like neurotransmitters) influence target cells by binding to specific receptors.
- Only target cells for a given hormone have receptors that will recognize and bind it.
Understand what a cell target cell may do in the presence of excess hormone quantity and in deficient hormone quantity. What effect does this have in terms of sensitivity to a hormone?
- If a hormone is present in excess, the number of target receptors may decrease.
– Process is called down regulation
– Makes cells less sensitive to hormone - When a hormone is deficient, the number of target receptors may increase.
– Known as up regulation
– Makes cells more sensitive to hormone
Be able to distinguish between the hormones secreted by alpha pancreatic islet cells and beta pancreatic islet cells.
* Alpha cells secrete glucagon
– Glucagon raises blood glucose levels when low (signals liver to release glucose).
* Beta cells secrete insulin
– Insulin lowers blood glucose levels when high (signals cells to take up glucose).
Know the steps involved in regulation of glucagon and insulin!
- Low blood glucose levels (hypoglycemia) stimulate secretion of glucagon form alpha cells.
- Glucagon acts on liver cells to release glucose.
- Blood glucose levels rise.
- If blood glucose continues to rise, high blood glucose level (hyperglycemia) inhibits release of
glucagon. - Hyperglycemia stimulates secretion of insulin by beta cells.
- Insulin acts on cells to accelerate diffusion of glucose into cells (among other things).
- Blood glucose level falls.
- If blood glucose level drops below normal, hypoglycemia inhibits release of insulin and stimulates
release of glucagon.
Be able to distinguish between Type 1 and Type 2 diabetes mellitus.
Type 1
* Result of an absolute deficiency of insulin secretion.
* Autoimmune process destroys pancreatic beta cells.
* Insulin is not produced or released into bloodstream.
* Accounts of 5% - 10% of cases
* Previously referred to as juvenile diabetes or insulin-dependent diabetes
Type 2
* Results when body is resistant to effect of insulin, or Beta cells produce insulin, but in insufficient amounts
* Glucose stays in the bloodstream and is unavailable for energy.
* Body must burn protein and fat
* Accounts for 90% - 95% of cases
What is the most important risk factor for Type 2 diabetes?
Obesity
Recognize possible complications (comorbidities) associated with diabetes?
- Cardiovascular disease, stroke, blindness, neuropathy
- Associated with ten year shorter life expectancy
– Heart disease
– Dental disease
– Stroke
– Hypertension
– Kidney failure
– Nervous system disease
– Vision related problems, i.e., diabetic retinopathy
Which type of diabetic retinopathy is the most serious form?
Proliferative
How are blood glucose levels associated with diabetic retinopathy?
- Major cause of vision loss is damage done by persistent high blood glucose to the small blood vessels of the retina.
– Retinal blood vessels leak or become blocked, impairing vision over time
– If abnormal new blood vessels grow on surface of retina, can cause serious damage
Is visual fluctuation associated with diabetes? In what way?
Yes – changes with rising and falling blood glucose levels
What is a CDCES (previously known as CDE)?
- Certified Diabetes Educator
– Most CDEs are nurses, registered dieticians, physicians, pharmacists, and some OTs
What effect does physical activity have on blood glucose levels? Should a person with diabetes monitor BG levels prior to exercising?
yes
* For the person with diabetes, activity level is even more important to maintain blood glucose control
* Helps improve body mass index, enhances weight loss, help control lipids and blood pressure and reduces stress
* Physical activity program may need to be adapted in the presence of complications
* Exercise Induced Hypoglycemia
– Hypoglycemia is the most commonly encountered problem for those taking oral medications or insulin
What are some physical activity precautions for a person with diabetes?
- Have a simple carbohydrate available during exercise program
- Encourage carrying diabetes identification
- Wear appropriate shoes
- Avoid exercises that can aggravate diabetic retinopathy and other conditions:
– Lowering head below waist level
– Vigorous bouncing
– Holding breath while sustaining effort
– Strenuous upper extremity exercise
What are some of the basics of healthy eating?
-
Healthy food choices
– Decrease saturated fat intake (<7% of total calories)
– Minimize intake of trans fats (to lower LDL and increase HDL cholesterol)
– Monitor carbohydrate intake
– Eat whole grains, fresh vegetables, and fruits - Understanding portion control
- Learning the best times to eat
Be able to determine if someone’s meal is within a given recommended carbohydrate range by reading nutrition labels.
Goal is 45 to 55 grams per meal
– 1 carb serving is approx. 15 grams, so 3 servings of carbs per meal would be 45 grams
– E.g., slice of cake = 45 grams or 3 servings of carbs
Must reference “serving size”
– # of carbs per serving
How does Metformin work as an oral diabetes medication?
Metformini s generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving body’s sensitivity to insulin so that it uses insulin more effectively.
Why might drawing insulin be a challenge for persons with low vision?
Seeing the colorless insulin level and the small numbers on the side of the syringe.
–** Requires good acuity**
– Requires good contrast sensitivity
Be able to distinguish between the 3 types of insulin delivery systems.
-
Syringes
– Cheapest
– Ability to mix
– Come in different unit measurements to match dose 2. -
Pens
– Prefilled insulin cartridges of single or mixed insulin types
– Reusable or disposable
– Measure dosage by turning dial (audible and tactual click per unit of measurement)
– Discrete
– May be more costly -
Pumps
– Connects to flexible tubing
– Needle inserts into abdomen
– Delivers steady basal dose
– Person adjusts bolus doses at mealtimes
How is diabetes associated with skin integrity?
Neuropathy – over time diabetes affects circulation and nerve endings
* Decreased circulation affects body’s ability to heal
– Minor injuries like blisters and scrapes don’t heal
– Increases risk for infection
* Decreased sensation means
– Person may not “feel pain” or recognize signs of infection
Be able to describe appropriate skin care/foot care precautions.
Skin Care Precautions
* Wearing hard soled shoes
– Unobstructed pathway
* Checking water temperature before bathing
* Avoiding use of hot and cold packs
Foot Care
1. Wash and dry feet thoroughly each day
2. Inspect feet daily by running fingers over entire surface of foot
– Have a sighted person visually inspect and confirm * Check any irregularity
– Small problems become big complications
3. Apply lotion daily, but not between toes
4. Do not cut own toenails
– Ask sighted person
– Podiatrist
5. Check shoes inside before putting them on to remove small stones etc.
6. Pay attention to unusual smells when taking off shoes
– Can be a sign of infection
What is an appropriate blood glucose reading for a person with diabetes 2-hours after a meal?
less than < 180 mg/dl
Distinguish between hypoglycemia and hyperglycemia. When is each a serious condition?
Hypoglycemia (BG < 70 mg/dl)
– Very dangerous condition
– Without intervention, can lead to coma or death
Hyperglycemia (BG above 150)
– Everyone experiences hyperglycemia after meals (normal)
– Not a medical emergency if transitory
– If levels stay high over extended period of time, can lead to complications
Distinguish between symptoms of hypoglycemia and hyperglycemia.
-
Hypoglycemic symptoms include:
– Shaking
– Sweating
– Irritability
– Confusion
– Tingling -
Hyperglycemic symptoms include:
– Increased thirst
– Dry mouth
– Frequent urination
– Headache
– Blurred vision
– Sleepiness/Lethargic