Obesity and Diabeetus

Question 1

Obesity

Answer 1

chronic, relapsing disease r/t abnormal or excessive accumulation of fat and weight gain

Question 2

Obesity patho

Answer 2

metabolic imbalance. increase in body fat cause adiposopathy (adipose tissue promotes development of metabolic, biochemical and psychosocial diseases and disorders)
- impairs normal body functions
- chronic inflammation
- causes morbidity

Question 3

obesity management

Answer 3

BMI is the definitive measure
- screenings for CV diseases, cholesterol, triglyceride, T2DM, non-fatty liver disease, and OSA
- lifestyle modification
- pharm: anti obesity meds- inhibit GI absorption of fats (ozempic), others alter brain receptors for satiety or reduce cravings

• check your bias and language

Question 4

BMI classification

Answer 4

Overweight/pre-obese: 25-29.9
Class 1 obesity:30-34.9
Class 2 obesity: 35-39.9
Class 3 obesity (extreme/severe obesity: >40

Question 5

bariatric surgery

Answer 5

treats obesity after nonsurgical attempts at weight control fail
- patient must meet certain criteria (ADL, support system, failure with nonsurgical, ability to adhere to post mgmt, BMI>30 with T2DM and poor glycemic contorol, >35 with comorbidities, >40 without excessive surgical risk)

Question 6

types of bariatric surgery

Answer 6

1. Sleeve gastrectomy: most common- large portion of stomach lumen removed (looks like an extension of esophagus, connecting to duodenum
2. Roux-en-Y gastric bypass (RYGB): 2nd common, has pouch for food - stomach is still in place to produce digestive juices- duodenum and stomach bypassed, jejunum connect to gastric food pouch from esophagus
3. Biliopancreatic diversion w/ duodenal switch: results in most post-op weight loss (ideal for high BMI pt)- “reroutes” everything- duodenum attached to gall bladder, jejunum connected to stomach pouch and routes to colon
4. gastric banding: least invasive but highest rate of inefficacy or failure- reduces circumference of stomach

Question 7

post-op bariatric mgmt

Answer 7

IV fluids, drains, early ambulation, pain mgmt, antiemetics

diet: clear diet x48H, progress to full, sugar free liquid puree, pureed, soft, solid food around 8 weeks

Question 8

post-op bariatric surgery complications

Answer 8

change in bowel habits, infection, hemorrhage, venous thromboembolism, bile reflux, dumping syndrome, dysphagia, bowel or gastric outlet obstruction

Question 9

Dumping syndrome

Answer 9

rapid transit of food from stomach into intestines causes release of metabolic peptides
- vasomotor and GI symptoms
- occurs within minutes to 2 hours after eating
- s/s: tachy, dizzy, sweating, n/v/d, bloating, cramping
- symptoms resolve after defecation
- reactive hypoglycemia

Question 10

Insulin

Answer 10

hormone secreted by the beta cells of islets of lagerhands of pancreas
- anabolic, “storage” hormone
- needed for metabolism of carbs, proteins, and fats

Question 11

Type 1 diabetes

Answer 11

insulin isn’t secreted from pancreas (No Key to open the cells for glucose)
RF: genetic predisposition

Question 12

Type 2 diabetes

Answer 12

deficiency in insulin action/production (broken key for the cell door)
RF: liefstyle factors
- largely preventable

Question 13

classic symptoms of diabetes

Answer 13

Polyuria, polydipsia, polyphagia (very hungry)

Question 14

common diabetic manifestations

Answer 14

fatigue, weakness, visions change, tingling/numbness in extremities, dry skin, skin lesions/wounds that are slow to heal, recurrent infections

type 1- may have sudden weight loss, n/v

Question 15

diabetic labs

Answer 15

• serum glucose (BG)- diabetic symptoms and casual BG >200 or fasting plasma > 126, 2 hr post load glucose > 200
• A1C >6.5%

Question 16

Oral antidiabetic agents

Answer 16

used for Type 2 diabetics who require more than diet and exercise

-may be used in combo with long-acting insulin

Question 17

hypoglycemia

Answer 17

caused by too much insulin/antidiabetic agents, excessive physical activity or not enough food
s/s: headache, tinnitus, trembling, irritability, sweatiness, blurry vision, tachy, hunger, anxiety, weakness/fatigue

Question 18

hypoglycemia mgmt

Answer 18

• give 15-20g of concentrated carb
• retest BG in 15 min, retreat if ,70
• give snack and notify provider
• if <54 and unable to swallow or unconscious: subQ or IM glucagon or 25-50 mL of dextrose (D50W)

Question 19

DKA

Answer 19

Diabetes along with 1of 3 causes: infection, insulin deficiency, or undiagnosed/untreated diabetes

• most common in type 1
• s/s: hyperglycemia, dehydration and acidosis

-PREVENTION IS KEY

Question 20

DKA risk factors

Question 21

manifestations of DKA (Patho)

Answer 21

hyperglycemia s/s (poluria, polydipsia, fatigue, blurred vision, weakness, HA, hypotension

ketosis and acidoses related s/s (GI symptoms, acetone breath, kussmaul breathing)

Question 22

DKA labs

Answer 22

BG: 250-800mg/dL
Ketoacidosis labs: low pH, low bicarb, low pCO2, ketone bodies in blood and urine
- electrolyte imbalance: hyperkalemia, increase in creatinine, hematomacrit, BUN (dilutional)

Question 23

DKA management

Answer 23

correct acidoses, dehydration and e- loss FIRST!!

• then correct hyperglycemia with insulin
  -monitor BG, renal function and UO
  -EKG, e- levels, VS, lung sounds

Question 24

Hyperglycemic hyperosmolar syndrome (HHS)

Answer 24

insulin deficiency initiated by an illness/increased insulin demand
- ketosis is minimal or absent
- most common in type 2

Question 25

HHS labs

Answer 25

BG >600, serum osmolality (>320), chem (Na) and other e-, BUN and creatinine are elevated

Question 26

HHS manifestations

Answer 26

hypotension, profound dehydration, tachycardia, variable neuro signs (caused by cerebral dehydration)
- high mortality rate

Question 27

HHS treatment

Answer 27

rehydration, correct e-, insulin

-prevention: BG monitoring, dx and mgmt of diabetes, self-care