T. Diabetes

Question 1

Diabetes Mellitus (DM)

Answer 1

• A chronic multisystem disease related to
• Abnormal insulin production
• Impaired insulin utilization
• Or both

Question 2

hyperglycemia

Answer 2

• high blood glucose (blood sugar).
• a blood sugar level of <70 mg/dL (<3.9 mmol/L), is considered a medical emergency
• occurs when there is not enough insulin to facilitate entry of glucose into the cells.

Blood glucose levels greater than 7.0 mmol/L (126 mg/dl) when fasting. Blood glucose levels greater than 11.0 mmol/L (200 mg/dl) 2 hours after meals.

Question 3

insulin

Answer 3

• insulin decreases glucose in the blood
• insulin causes the body cells to take in glucose when glucose levels are high. (ie after eating)
• insulin binds to receptor sites to open glucose channels
• glucose enters the cells and is used to make ATP
• too much glucose and it gets stored as glycogen (by liver/muscle) or turned into fat

Question 4

Type 1 Diabetes

Answer 4

• autoimmune disorder in which the body develops antibodies against insulin and/or the pancreatic beta cells that produce insulin.
• progressive destruction of pancreatic tissue. Early on no symptoms, once B cells are destroyed there’s rapid onset of symptoms. Produce no insulin of their own

Question 5

Type 2 Diabetes

Answer 5

• Affects overweight or obese persons, older adults, and those with family history of type 2 diabetes
• starts with insulin resistance.
• Pancreas makes some insulin but it’s poorly used. Sugar builds up in blood stream since the insulin can’t keep up.
• Therefore high levels of insulin and glucose in blood at same time
• Insulin produced is insufficient or is poorly utilized by tissues.
• impared glucose metabolism

More than 90% of clients with diabetes

Usually occurs in people over 35 years of age

80% to 90% of clients are overweight – biggest risk factor

Question 6

Gestational Diabetes

Answer 6

• Occurs during pregnancy
• Detected at 24–28 weeks of gestation
• Usually normal glucose levels at 6 weeks postpartum
• puts you at risk to later develop type 2

Question 7

glucose range

Answer 7

normal: 4–6 mmol/L

Question 8

Insulin resistance

Answer 8

when body makes insulin but the body doesn’t use it properly.

Question 9

Prediabetes

Answer 9

• Individuals already at risk for diabetes
• Blood glucose high but not high enough to be diagnosed as having diabetes
• Long-term damage already occurring (Heart, blood vessels)
• Usually present with no symptoms
• impaired fasting glucose: 6.1–6.9mmol/L
• impaired glucose tolerance: 7.1–11mmol/L

Question 10

Polyuria

Answer 10

frequent urination

Question 11

Polyphagia

Answer 11

excessive hunger

eats excessive amounts of food.

Question 12

Polydipsia

Answer 12

extreme thirstiness

Question 13

Latent autoimmune DM in

Answer 13

type 2 but with some immune loss of B cells

Question 14

Idiopathic diabetes

Answer 14

strongly inherited and not related to autoimmunity

Type 1B
an unusual form of phenotypic type 1 diabetes with almost complete insulin deficiency, a strong hereditary component, and no evidence of autoimmunity.

Question 15

Secondary Diabetes

Answer 15

• diabetes that results as a consequence of another medical condition
• Usually resolves when underlying condition treated
• May results from other conditions such as:
> Schizophrenia
> Cushing’s syndrome
> Hyperthyroidism
> Immuno-suppressive therapy
> Parenteral nutrition
> Cystic fibrosis

Question 16

Diabetic Ketoacidosis (DKA)

Answer 16

• Known as diabetic coma
• develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy
¨• a serious complication of diabetes that can be life-threatening
• Without insulin to transport glucose into cells, the body breaks down fat as a secondary source of fuel, resulting in the production of the by-product, ketones
• can be due t undiagnosed DM or mismanagement

Question 17

Hyperosmolar Hyperglycemic Syndrome (HHS)

Answer 17

• have enough insulin to prevent ketosis but not enough to prevent a deleterious increase in blood glucose
• results in severe dehydration and increased serum osmolality (from osmotic diuresis).

Question 18

Microvascular Disease

Answer 18

Results from a thickening/narrowing of capillary and arteriole cell membranes
Specific to patients with diabetes
Found throughout the body but primarily affects the eyes, kidneys, and lower limbs

is heart disease that affects the walls and inner lining of tiny coronary artery blood vessels that branch off from the larger coronary arteries

Question 19

Macrovascular Disease

Answer 19

Occurs in patients with or without diabetes but progresses more rapidly in the setting of diabetes
Damage to large and medium-sized vessels, which leads to cardiovascular, cerebrovascular, and peripheral vascular disease

Question 20

Hypoglycemia

Answer 20

occurs when there is too much insulin and not enough glucose.

(3.9 mmol/L) is low and can harm you. A blood sugar level below 54 mg/dL (3.0 mmol/L) is a cause for immediate action

Question 21

Exogenous insulin

Answer 21

• Insulin from an outside source

* Required for type 1 diabetes

Question 22

Human insulin

Answer 22

• synthetically developed to mimic normal insulin.

* Prepared through genetic engineering

Question 23

Rapid-acting (bolus)

Answer 23

• Lispro, aspart, glulisine
• Injected 0–15 minutes before meal
• Onset of action 15 minutes

Question 24

Short-acting (bolus)

Answer 24

• Regular
• Injected 30–45 minutes before meal
• Onset of action 30–60 minutes

Question 25

Long-acting (basal)

Answer 25

* Injected once a day at bedtime or in the morning * Released steadily and continuously * No peak action * Cannot be mixed with any other insulin or solution

Question 26

Insulin Pump

Answer 26

* Continuous subcutaneous infusion * Battery-operated device * Connected via plastic tubing to a catheter inserted into subcutaneous tissue in abdominal wall * Potential for tight glucose control

Question 27

Lipodystrophy

Answer 27

scarring/fat/lumps under skin | a problem with the way your body uses and stores fat.

Question 28

Somogyi effect

Answer 28

most people get insulin to combat the large amount of insulin we get when we wake up. These people don’t have insulin so their blood gluc levels will be too high. an overcompensation by the body in response to extremely low blood sugar levels occurring during the night, resulting in early morning hyperglycemia. The body releases stored glucagon in reaction to the untreated nighttime hypoglycemia. This is typically managed by instituting a bedtime snack and/or by decreasing the evening insulin dose.

Question 29

Dawn phenomenon

Answer 29

A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night. The person's body responds to the low blood sugar by releasing hormones that raise the blood sugar level. is also early morning hyperglycemia caused by the release of cortisol and growth hormone during the early morning hours. It tends to happen to younger patients during periods of growth. This is typically managed by increasing the evening insulin dose.

Question 30

Oral Agents

Answer 30

``` Not insulin Work to improve mechanisms by which insulin and glucose are produced and used by the body Work on three defects of type 2 diabetes Insulin resistance Decreased insulin production Increased hepatic glucose production ```

Question 31

Glycemic Index

Answer 31

a scale that ranks a carbohydrate-containing food or drink by how much it raises blood glucose after it is eaten or drank. Foods with a high GI increase blood glucose higher and faster than foods with a low GI. Term used to describe rise in blood glucose levels after carbohydrate-containing food is consumed Should be considered when a meal plan is formulated

Question 32

Intermediate-Acting

Answer 32

• Onset: 1.5-4 hr

Question 33

Kussmaul’s Respirations

Answer 33

a deep, rapid breathing pattern. It is typically an indication that the body or organs have become too acidic. In an attempt to expel carbon dioxide, which is an acidic compound in blood, the body starts to breathe faster and deeper.

Question 34

malaise

Answer 34

a general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify.