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Module 3 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

What is diabetes the leading cause of?

A

Adult blindness
End stage kidney disease
Non-traumatic amputations

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2
Q

When is insulin released?

A

Released into the blood stream in small increments with larger amounts released after food to stabilize glucose levels

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3
Q

What is normal glucose range?

A

70-110 mg/dl

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4
Q

What are major contributing factors of DM?

A

Heart disease
Stroke
HTN

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5
Q

What are the counter-regulatory hormones?

A

Epinephrine
Growth hormone
Cortisol
Glucagon

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6
Q

What do counter-regulatory hormones do?

A

Stimulate glucose production and release by the liver, decrease movement of glucose into cells, and help maintain normal BG levels

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7
Q

What tests can be used to diagnose DM?

A

HA1C
FBG
RBG
OGTT

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8
Q

What medications can increase BG?

A

Corticosteroids
Phenytoin’s (anti-seizure)
Thiazide diuretics

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9
Q

What is the gold standard test for DM?

A

HA1C

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10
Q

What does HA1C measure?

A

The average blood glucose levels over the prior 3 months but does not give info on acute changes

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11
Q

What is the normal level HA1C?

A

<6.5%

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12
Q

What must a person do before a fasting plasma glucose test?

A

No caloric intake for at least 8 hours

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13
Q

What is the normal range for FBG test?

A

70-110 mg/dl

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14
Q

What level on FBG test is considered a positive DM diagnosis?

A

Greater than or equal to 126 mg/dl

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15
Q

What happens during an OGTT?

A

The pt consumes a beverage containing glucose after fasting for 8-12 hours; blood is taken before, and 1 & 2 hours after consumption

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16
Q

What is a normal level for an OGTT?

A

<140 mg/dl

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17
Q

What level from an OGTT would suggest prediabetes?

A

140–199 mg/dl

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18
Q

What level from an OGTT would be positive for DM?

A

200 mg/dl or greater

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19
Q

What are symptoms of hypoglycemia?

A

Stupor
Confusion
Difficulty speaking
Coma
Altered mental functioning
Visual disturbances

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20
Q

What can untreated hypoglycemia lead to?

A

Coma
Seizures
Death
Loss of consciousness

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21
Q

How do you treat low glucose levels outside of the hospital?

A

Administer glucose (juice, bread, soda, or crackers), check finger stick 15 mins after administration of glucose; if levels still low repeat glucose and after the BS reaches normal level, eat a meal or snack with fat and protein

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22
Q

How do you treat low glucose levels in the hospital (if patient is unable to swallow?

A

IV Dextrose 25-50 ml of D50
If no IV access, 1 mg IM glucagon injection to release glucose stored in liver

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23
Q

What is hypoglycemia unawareness?

A

No s/s until glucose levels are critically low, which is related to autonomic neuropathy and lack of counter-regulatory hormones

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24
Q

If a patient is at risk for hypoglycemia unawareness, what should they do?

A

Keep their blood sugar levels slightly higher (120-125)

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25
Q

Who is T2DM more common in

A

Adults
Non whites

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26
Q

What is the pathology of T2DM?

A

Slower onset
Produces endogenous insulin but cells resist and pancreas cannot keep up

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27
Q

By the time T2DM has been diagnosed, what is true about most organs in the body?

A

They are already damaged and cannot use insulin
6-8 years of damage

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28
Q

How long are autoantibodies present in the body before a DM diagnosis?

A

Months to years before symptoms occur

29
Q

When do symptoms manifest?

A

When pancreas can no longer produce insulin, then rapid onset with ketoacidosis

30
Q

What are leading factors for developing T2DM?

A

Insulin resistance, pre-diabetes, metabolic syndrome, and gestational diabetes

31
Q

What can be the cause of insulin resistance?

A

Decreased insulin production by the pancreas
Inappropriate hepatic glucose production
Altered production of hormones and cytokines by adipose tissue (adipokines)

32
Q

Does pre-diabetes have any symptoms?

A

It is asymptomatic but long-term damage is occurring

33
Q

What level on a HA1C would suggest pre-diabetes?

A

5.7–6.4%

34
Q

Metabolic syndrome increases the risk for T2DM; what causes this?

A

It elevates glucose levels
Abdominal obesity
Elevated BP
High levels of triglycerides
Decreased levels of HDLs
(Need 3 or more of these symptoms to be diagnosed with metabolic syndrome)

35
Q

What are modifiable risk factors for T2DM?

A

BMI greater than or equal to 26, risk increases at 30
Physical inactivity
HDL less than or equal to 35 mg/dl
Metabolic syndrome

36
Q

What are non-modifiable risk factors of T2DM?

A

First degree relative with DM
Members of high risk ethnic population
Women who delivered a baby 9lbs or greater who had gestational diabetes
HTN
PCOS
HA1C of 5.7% or greater
History of CVD

37
Q

Signs and symptoms of T2DM

A

Polyuria
Polydipsia
Polyphagia
Nocturia
Prolonged wound healing
Visual changes
Fatigue
Poor wound healing
Recurrent infection
Renal insufficiency

38
Q

How is T2Dm managed?

A

Education (nutritional therapy)
Monitoring glycemic control
Diet and exercise
Insulin if needed

39
Q

How do oral agents/medications work?

A

Stimulate insulin release from beta cells, modulate the rise in glucose after a meal, and delay CHO digestion/absorption

40
Q

What are the steps for treatment of T2DM?

A

Diet & exercise
Lifestyle changes plus metformin
Lifestyle changes plus metformin and a second drug
Lifestyle changes plus metformin and insulin

41
Q

What other meds are not directly related to DM and what do they do?

A

Statin drugs — used to treat hyperlipidemia
Ace inhibitors/calcium blockers/ and angiotensin 2 receptor blockers — for HTN and renal insufficiency
Diuretics — for fluid overload and HTN
Beta Blockers — NOT recommended but are used for HTN and decrease CVD

42
Q

If patient gets a dry hacking cough from ace inhibitors, what are the alternatives?

A

Calcium channel blockers and ARBs

43
Q

What medicine should you not give to a diabetic and why?

A

Beta blockers because it can mask signs of hypoglycemia

44
Q

Diet, exercise, and weight loss may be sufficient for T2DM; this is also true for T1DM
True or false

A

False

45
Q

What are the long term effects of hyperglycemia?

A

Major CVD, ischemic heart disease, stroke, lower extremity amputation, DKA, HHS, skin and soft tissue infections, pneumonia, flu, bacteriemia, sepsis, TB

46
Q

What are macrovascular effects caused by DM?

A

CVD/PVD
MI
Stroke

47
Q

What are Microvascular effects caused by DM?

A

Retinopathy, periodontal DZ, renal insufficiency/failure (Nephropathy)

48
Q

What are effects on the CV system from DM?

A

HTN
Angina
Dyspnea
Mi
PVD
Hyperlipidemia
CVA (stroke)

49
Q

What does periodontal disease cause?

A

Increased dental caries
Tooth loss
Gingivitis
Candidiasis (yeast)

50
Q

What is proliferative retinopathy?

A

Involves the retina and vitreous humor, new blood vessels formed, and causes retinal detachment

51
Q

What is non-proliferative retinopathy?

A

Partial occlusion of small blood vessels in the retina that causes micro aneurysms

52
Q

If a patient has DM what other eye disease are they at risk for?

A

Glaucoma and cataracts

53
Q

What is the leading cause of blindness in diabetic patients?

A

Diabetic macular edema

54
Q

What should a patient do after being diagnosed with T2DM?

A

Go to specialty doctors to get eyes, kidneys, heart and teeth checked

55
Q

What is Nephropathy?

A

Damage to small blood vessels that supply the glomeruli and the leading cause of ESRD

56
Q

What are risk factors for Nephropathy?

A

HTN
Genetics
Smoking
Chronic hyperglycemia

57
Q

What drugs are used to delay the progression of Nephropathy?

A

Ace inhibitors (don’t protect kidneys until there is some damage)
Angiotensin 2 receptor antagonists

58
Q

What, other than drugs, is a good way to control Nephropathy?

A

Control of HTN
Tight BG control

59
Q

What labs should be ran if a patient has Nephropathy?

A

BUN, creatinine, UA, GFR

60
Q

What does it mean when albumin is present in the urine?

A

They are starting to have renal breakdown and rapid fat breakdown

61
Q

Normal range of BUN

A

8–20 mg/dl

62
Q

Normal range for creatinine?

A

0.6–1.2 mg/dl

63
Q

Normal range for GFR?

A

> 60

64
Q

What are the symptoms of nephropathy?

A

Edema of face, hands, and feet
Symptoms of UTI
Symptoms of renal failure: Edema, nausea, fatigue, difficulty concentrating

65
Q

What are neurological effects of DM?

A

Diabetic peripheral neuropathy and autonomic neuropathy

66
Q

What are the two kinds of diabetic neuropathy?

A

Sensory: loss of protective sensation
Autonomic

67
Q

What is a neurotrophic ulceration?

A

Foot ulcer caused by not being able to feel the feet/lower extremities

68
Q

What do neurotrophic ulcers look like?

A

White ring around would, normally round but not always

Module 3 (7 decks)

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