Module Five: Patients with Diabetes Flashcards
Diabetes is associated with what other major conditions and complications?
heart attack, stroke, blindness (retinopathy), amputation, kidney disease, sexual dysfunction, serious psychiatric illness, cognitive decline accelerated, arthritis and nerve damage, foot problems (peripheral vascular issues)
Which Ethnic Groups are at highest risk
Aboriginal populations 3-4 times higher risk
Latino, Hispanic, South East Asian, Asian, African also at higher risk
Define Type 1
What % of diabetics?
Autoimmune destruction of Beta cells in the pancreas that produce insulin. Patient insulin dependent. Absolute deficiency of insulin
5-10% of diabetics
Define Type 2
What % of diabetics?
Pancreas does not produce enough insulin and/or the bodies’ tissues do not respond properly to the actions of insulin. Not generally insulin dependant, but could be.
90-95%
NOTE: TYPE 2 who begins requiring insulin is generally not becoming a TYPE 1 (That suggest autoimmunity) , just a Insulin dependent TYPE 2
Relating to age, when does High Blood glucose (BG) generally occur?
5th decade
Factors that put geriatric patients at risk
- Changes in carbohydrate metabolism • Poor diet
- Decreased activity
- Decreased lean body mass
- Altered insulin secretion
- Increased adipose tissue
Non Modifiable Risk factors
Age
ethnicity
family history
sex
Modifiable Risk factors
High sugar, high fat diet Low activity smoking HTN Inflamation and hyper coagulation
80% of those with diabetes will die from what?
Cardiovascular Disease
…MI’s generally occur 15-20 years earlier
What Kind of foot care might you suggest for Diabetic pt?
WHY?
Careful daily assessment of the feet
- Bathe, dry, & lubricate feet (avoid moisturizer b/ n toes)
- Wear closed toe, well- fitting shoes
- Do not go barefoot, shave calluses, or soak the feet
- Trim toe nails straight across, file sharp corners
WHY?
Decreased sensation and decreased vascular fx in feet. Glucose attached to RBC causing inhibition of vascular Fx and vascular Damage
Are thyroid issues associated with diabetes?
Yes, Hypothyroidism is an issue in both type 1 and 2
Signs and symptoms of Hyperglycemia
- BG > 7.0 mmol/L
- Polyuria – excessive urination
- Polyphagia – increased hunger
- Polydipsia – increased thirst
- Glucosuria – high levels of glucose in the urine
- Weight loss • Fatigue
Signs and symptoms oF Hypoglycemia
BG
Common Diagnostic of Diabetic Pt
B.G., FBG, GTT, A1C, BP, Cholesterol, Urine, Ketones
What is Fasting Blood Glucose (FBG)
Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes.
Diabetic will have abnormally high BG
What is a Glucose Tolerance Test?
Glucose Tolerance Test – done after FBG – the patient drinks a standard solution of glucose to challenge his/her system – followed by a second BG test at specific intervals to track ‘glucose challenge’ (how quickly it is cleared from the blood)
What are the three main glucose measuring levels
Fasting, Random, 2hr (GTT) [glucose tolerance test]
Diagnosis of Diabetes? 2 Key Parts
Presentation + diagnostic test
Major Lab tests for diagnosing disease?
Blood Glucose and HgA1c
What is Hg A1C
What level suggest diabetes mellitus?
When can it be taken?
Glycosylated hemoglobin. Glucose attached
> 6.5%
Anytime
Advantage of using HgA1c
Can be taken anytime, long term measure
Diagnosing Diabetes:
No symptoms?
With Symptoms?
WITHOUT: x2 diagnostic a week apart
WITH: x1 HgA1c postitive diagnostic
What are Sulfonylureas?
Group of Oral anti diabetic med that stimulate beta cells of pancreas to produce insulin.
Among other positive effects encourage insulin sensitivity and BG reduction
Common errors with self monitoring BG?
- Blood amount too small
- Improper maintenance of machine
- Damaged monitor strips
Ability to self Monitor dependent on?
skill level, cognitive ability, visual acuity, technology, comfort, cost
Targets levels for Diabetic Patient?
Important knowledge for self care
A1C: ≤7.0% (or Normal person ≤6.0%)
BP: ≤130/80 mm Hg
Cholesterol: LDL-C
Why might Ketones be found in Urine of a Diabetic Patient?
No effective insulin availableBody breaks down stored fat for energy Ketones are by products of fat metabolism Accumulate in blood and urine. Puts patient at risk for DKA (Diabetic Ketoacidosis)
To reach targets what cocktail of drug might a diabetic have to take?
Challenge to self management
- To lower blood glucose: 1-3 pills (Hypoglycemic) try avoid insulin
- To lower cholesterol: 1 or 2 pills (Statins- d/t diabetic risk of high HDL levels)
- To lower blood pressure: 2 or 3 pills
- For general vascular protection: aspirin
KEY knowledge/skills that patient must develop for self management
- Test their own blood sugar
- Give their own insulin
- Identify a low blood sugar
- Treat their low blood sugar
- Follow their prescribed protocol at home • Know who their support people are
- Diabetic nurse? Doctor? Family?
Clinical presentation ACUTE Type 1 Diabetes
Diabetic Ketoacidosis (30% Type 1 initial presentations andiagnosis)
Very Sick quickly
Nausea, vomiting, abd pain, dehydration, LOC change
Acidotic
DKA-
Glucose is not being metabolized (no insulin). Fats are metabolized, Ketones created as byproduct. Ketones are acidic. Acidosis occurs
Clinical Presentation of ACUTE Type 2
Hyperosmolar non ketonic state (HHNS)
Not Common
NO keto acids produced
Clinical presentation SUBACUTE?
Most common way to present For type 1
~70% of initial presentation
Slow digression over Weeks to Months
Symptoms of Fatigue, increased thirst and urination, weight loss.
In type 2 symptoms more vague, less weight loss
How is type 2 most commonly presented on initial diagnosis?
Asymptomatic
If you have risk factors you should be screened on occasion
What is Glycosylation?
Non enzymatic attached of glucose to proteins. Hemoglobin being the important one
What would you use urine testing for?
Drawbacks?
What specifically might you be looking for?
Non invasive strip, inexpensive detect hyperglycemia
Drawbacks • Not accurate result • Does not detect hypoglycemia • Some drugs interfere with results • ASA, Vit. C, some Abx
Looking for: Ketones and high protein levels
Why is diet, weight loss and exercise the first line treatment for Type 2 diabetes?
Shown to increase insulin production and decrease insulin resistance
Basic levels exercise required?
- 5 moderate aerobic
- 5 stregth pre week
or 1.5 hrs serious exercises
What is the first line pharmacological tx of Type 2 diabetes
Why? what are the affects
Metformin- (Biguanides)
Improve
INC insulin sensitivity
DEC production of glycogen (i.e. reduced hepatic glucose production)
DEC GI absorption of glucose
What do Sulfonylureas do?
Ex Glyburide (Diabeta)
Increase production of insulin by stimulation beta cells
What is the Onset, peak and duration of Fast acting insulin?
Lispro/humalog
Onset- 10-15mins
Peak-60-90mins
Duration 3-4 hrs
What is the onset, peak and duration of long lasting insulins?
Onset 1-2 hrs
Duration- 24hrs
(no peak)
Considerations before administering Humalog/Lispro
Is food immediately available by time of onset (10-15min) Food should be there with patient
What is the intermediate insulin?
Onset, Peak, Duration?
(intermediate not learning outcome)
NPH
2-4hrs onset
4-10hrs Peak
10-16hrs Duration
Common delivery methods of insulin?
Subcu, pen and pump
What are the oral Antihyperglycemics?
- Biguanides (Metformin)
- Sulfonylureas
Not in learning outcomes
- > Incretin enhancers, DPP (increase insulin secretion-pancreas targeted)
- > others
Patient is Hypoglycemic- what to do?
Follow hypoglycemic protocol (check BS)
-> (
What do you do with severe hypoglycemia in Unconscious pt?
Hypoglycemic Protocol (check BS) -> Often IM or IV glucagon
