Module 5 - Diabetes Flashcards
True or false: people with diabetes mellitus are more likely to be admitted to the hospital with cardiac and renal issues than someone without diabetes?
True
What is a normal, pre-prandial CBG range?
4-6 mmol/L
What is a typical post-meal CBG range?
5-10 mmol/L
What is a pre-diabetic pre-prandial CBG?
6.1-6.9 mmol/L
At what CBG is someone considered to be hyperglycemic after meals?
above 11 mmol/L
At what pre-prandial CBG is someone considered to be hyperglycemic?
above 7 mmol/L
What CBG range would someone be considered to be in diabetic ketoacidosis?
14-33 mmol/L
What CBG range would someone be considered to be experiencing hyperosmolar, hyperglycemic syndrome?
Anything above 34 mmol/L
Is DKA associated with type 1 or type 2 diabetes? Is HHS associated with type 1 or type 2 diabetes?
DKA with type 1
HHS with type 2
What cells create insulin?
Beta islet cells of the pancreas
What is the main role of insulin?
Facilitate the transport of glucose across cell membranes and into cells for use and storage
What are 3 sources of glucose for the body?
1) ingestion and breakdown of food
2) glucagon stimulating glycogenolysis in the liver (breakdown of glycogen)
3) glucagon stimulating gluconeogenesis in the liver (making new glucose from non-carbohydrate sources)
The liver and skeletal muscle stores glucose as _______
Glycogen
Adipose tissue stores glucose as ________
Triglycerides
How does the inflammatory process reduce blood glucose levels?
If blood glucose is still high after storage, white blood cells and cytokines may be released to break down glucose
What mechanism of eliminating glucose from the body is indicative of diabetes? Why?
Glucose in the urine. If blood glucose levels are chronically high then holes may appear in the glomerular filtration system, leading to proteins and glucose being voided.
How does prolonged high blood glucose affect macrovasculature?
Can lead to high circulating lipids that attach to the walls of large blood vessels, causing a loss of elasticity and hypertension
How does prolonged high blood glucose affect the microvasculature?
Can cause chronic inflammation due to WBCs trying to break down the glucose, which leads to thickened capillary membranes. This affects internal and external respiration as cells are unable to get adequate glucose or oxygen
How does prolonged high blood glucose affect the retina?
Can cause vision loss due to decreased blood vessels from atherosclerosis and hypertension
How does prolonged high blood glucose affect the kidneys?
Decreased blood flow from atherosclerosis and hypertension causes leaky glomerular filter (nephropathy).
How does prolonged high blood glucose affect the nervous system?
Decreased blood flow causes damage to nerves, and high blood glucose impairs nervous signal transmission. This increases cognitive decline and peripheral neuropathy.
How can prolonged high blood glucose lead to limb amputations?
Peripheral neuropathy and cardiovascular issues mean blood flow and neural signals to extremities are impaired. The patient may not be able to tell if they’ve been hurt due to loss of sensation, which can lead to infections that require amputations.
What are the 4 types of diabetes?
1) Type 1
2) Type 2
3) Gestational
4) Secondary
Why are pregnant women at risk for gestational diabetes?
Pregnancy increases the body’s demand for glucose, which can become chronically high if not monitored.
How can secondary diabetes arise?
An illness or pharmacological intervention causing destruction of the beta cells in the pancreas
How can DKA lead to hypokalemia?
High blood sugar can disturb the osmolarity balance of the blood, leading to the kidneys NOT reabsorbing sodium, potassium, or water.
How is metabolic syndrome a precursor for type 2 diabetes?
The body has an increased glucose demand and impaired insulin response, which can lead to hyposensitivity of the cells to insulin, which can develop into DMT2
What type of disease are the metabolic syndrome symptoms risk factors for?
Cardiovascular disease
What are the metabolic syndrome symptoms/risk factors?
- Increased abdominal obesity
- insulin resistance
- hypertension
- high triglyceride
- impaired fasting blood glucose
- low HDL levels
How can weight loss improve metabolic syndrome?
Can improve insulin sensitivity, which will help decrease glucose demands.
What are the diagnostic criteria for metabolic syndrome?
- elevated weight circumference (depends on country)
- elevated triglyceride levels ( >/= 1.7 mmol/L)
- decreased HDL levels ( <1 for men, <1.3 for women)
- hypertension ( >/= 130 systolic or >/= 85 diastolic)
- increased fasting plasma glucose levels >/= 5.6 mmol/L
True or false: once you are diagnosed with prediabetes, you will develop DMT2 within 5 years.
False. Prediabetes IS reversible with lifestyle changes, but if none are made then it can take up to 5 years to develop DMT2
What is the main difference in cause of type 1 vs type 2 diabetes?
Type 1 is genetic while type 2 is primarily environmental but can be genetic in some cases.
What are the 3 main symptoms of diabetes?
3 Ps
- polyuria
- polydipsia
- polyphagia
Also weight loss, vision changes, delayed wound healing, and fatigue
What are 4 diagnostic tests for diabetes?
1) fasting blood glucose >/= 7 mmol/L
2) glycated hemoglobin A1C >/= 6.5% over 3 months
3) random plasma glucose level >/= 11 mmol/L
4) oral glucose tolerance test (OTT) >/= 11 mmol/L
How many diagnostic assessments are needed to confirm diabetes?
At least 2 if they are asymptomatic
What are some of the goals of diabetes management?
- maintain blood glucose as close to normal as possible
- delay onset/progression of long-term complications
- promote well-being
- reduce blood sugar
- prevent acute complications
What are some interventions implemented for both types of diabetes?
- medication
- education
- BG monitoring
- diet and exercise
If a patient has a CBG of 15 mmol/L, can we lower their CBG to 5 mmol/L in one go?
No - can be dangerous and lead to hypoglycemia for the patient if they’ve been living with chronically high CBG for so long.
if a patient comes into hospital with T2 diabetes + COPD flare up who is not on insulin at home, why might they be put on insulin?
Their COPD flareup is likely causing higher than normal blood glucose, which can cause damage. Giving exogenous insulin reduces strain on the pancreas
When is insulin given to a Type 1 diabetic? When is it given to a Type 2 diabetic?
Type 1: always. They don’t produce insulin, so always need exogenous insulin
Type 2: only when they are unable to control their blood glucose by other mechanisms
What is the difference between basal and bolus insulin?
Basal insulin is a slow, steady amount of insulin entering the body continuously, typically through an insulin pump. A bolus of insulin refers to an injection of a larger amount of insulin, typically right before a meal if blood sugars are too high.
What are 3 main side effects of insulin?
1) Hypoglycemia
2) Somogyi Phenomenon - rebound from late night hypoglycemia caused by hormone production
3) Lipodystrophy - thickening of adipose tissue at site of administration
What is the onset, peak, and duration of rapid acting insulin?
O: 10-15 minutes
P: 60-90 mins
D: 3-5 hours
What is the onset, peak, and duration of short-acting insulin?
O: 30 minutes - 1 hour
P: 2-4 hours
D: 5-8 hours
What is the onset, peak, and duration of intermediate insulin?
O: 1-3 hours
P: 6-8 hours
D: 12-16 hours
What is the onset, peak, and duration of long-acting insulin?
O: 1-2 hours
P: no peak
D: 24 hours+
What type of insulin is Lispro/humalog?
Rapid acting
What type of insulin are regular or Humulin R?
Short acting
What type of insulin are NPH or Humulin N?
Intermediate acting
What type of insulin are Glargine/lantus and Detemir/levemir
Long acting
If giving 4 units of NPH and 2 units of Humulin R, what will be the order you draw up?
Start by adding 4 units of air to NPH, then 2 units of air to Humulin R. Then draw up 2 units of Humulin R, then 2 units of NPH
Can you mix different types of insulin in the same syringe?
Yes, but you have to draw up the shortest acting insulin first to avoid contaminating it with longer acting insulin.
Where are the best sites for absorption of insulin?
Abdomen > arm > thigh > buttock
When would you give insulin via IV?
In an emergency situation in a hospital (ie. if a patient is very hyperglycemic)
How do medications like metformin help with diabetes management?
Metformin helps to lower insulin resistance by making cells more sensitive to insulin and lowers glucose production in the liver (glycogenolysis and gluconeogenesis)
What tips for healthy eating are included in patient education?
- eat 3 meals a day at regular times
- limit sugars and sweets
- limit high fat foods
- eat high fibre foods
- drink water
- increase physical activity
What CBG is considered hypoglycemia?
Below 4 mmol/L
What are some of the first symptoms of hypoglycemia?
- irritability/changes to level of consciousness
- hunger
If a patient has a severe hypoglycemic episode, what should be our first intervention?
Administer glucose somehow! Can give via glucose tabs, dextrose tabs, honey packets, or give them glucagon to release glucose into blood.
If a patient is unconscious with hypoglycemia, what should be our intervention?
Administer an IV with 50% dextrose (IV D50W)
What are the signs and symptoms of DKA?
- Kussmaul’s respirations (very deep and fast to try to blow off CO2 acidity)
- Sweet, fruity breath
- CBG > 14 mmol/L, pH < 7.35
- Ketones in blood/urine
What are the signs and symptoms of HHS?
- Somnolence
- Coma
- Seizures
- Aphasia
- Diuresis
- Dehydration
What are the treatments for DKA?
- IV fluids
- K+ replacements
- IV insulin
- Cardiac monitor
What are the treatments for HHS?
- IV fluids
- K+ replacements
- IV insulin
- Cardiac monitor
What is the difference in treatment for DKA and HHS?
Have to give the treatments for HHS slower than for DKA so you don’t cause swelling or hypoglycemia
What is the onset of HHS?
Slow onset as insulin production and sensitivity decline
Why are type 2 diabetics more likely to develop HHS than DKA?
Because they still have enough insulin present to prevent the breakdown of fats for energy, but not enough to prevent hyperosmolarity
What is the typical onset of DKA?
Rapid, usually occurs after an infection or exercise
Why are type 1 diabetics more likely to develop DKA?
Because they have no insulin, so glucose cannot be used for energy in cells. This leads to cells breaking down fat molecules for energy, producing ketones, which are acidic
How do DKA and HHS cause hypovolemia and electrolyte imbalances?
Both cause water to be pulled out of cells to try to balance the hyperosmolarity or changing pH of the blood.
What non-diabetic medications can cause hypoglycemia?
Anti hypertensives, calcium channel blockers, NSAIDs, some antibiotics, lithium
Which 2 organs are involved in blood glucose homeostasis?
Pancreas and liver
What are some common side effects of metformin?
Diarrhea and gas
Which lab test reflects glucose levels over 3-4 months?
Hemoglobin A1C
