Test 1 Flashcards
What is diabetes the leading cause of?
Adult blindness
End stage kidney disease
Non-traumatic amputations
When is insulin released?
Released into the blood stream in small increments with larger amounts released after food to stabilize glucose levels
What is normal glucose range?
70-110 mg/dl
What are major contributing factors of DM?
Heart disease
Stroke
HTN
What are the counter-regulatory hormones?
Epinephrine
Growth hormone
Cortisol
Glucagon
What do counter-regulatory hormones do?
Stimulate glucose production and release by the liver, decrease movement of glucose into cells, and help maintain normal BG levels
What tests can be used to diagnose DM?
HA1C
FBG
RBG
OGTT
What medications can increase BG?
Corticosteroids
Phenytoin’s (anti-seizure)
Thiazide diuretics
What is the gold standard test for DM?
HA1C
What does HA1C measure?
The average blood glucose levels over the prior 3 months but does not give info on acute changes
What is the normal level HA1C?
<6.5%
What must a person do before a fasting plasma glucose test?
No caloric intake for at least 8 hours
What is the normal range for FBG test?
70-110 mg/dl
What level on FBG test is considered a positive DM diagnosis?
Greater than or equal to 126 mg/dl
What happens during an OGTT?
The pt consumes a beverage containing glucose after fasting for 8-12 hours; blood is taken before, and 1 & 2 hours after consumption
What is a normal level for an OGTT?
<140 mg/dl
What level from an OGTT would suggest prediabetes?
140–199 mg/dl
What level from an OGTT would be positive for DM?
200 mg/dl or greater
What are symptoms of hypoglycemia?
Stupor
Confusion
Difficulty speaking
Coma
Altered mental functioning
Visual disturbances
What can untreated hypoglycemia lead to?
Coma
Seizures
Death
Loss of consciousness
How do you treat low glucose levels outside of the hospital?
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
How do you treat low glucose levels in the hospital (if patient is unable to swallow?
IV Dextrose 25-50 ml of D50
If no IV access, 1 mg IM glucagon injection to release glucose stored in liver
What is hypoglycemia unawareness?
No s/s until glucose levels are critically low, which is related to autonomic neuropathy and lack of counter-regulatory hormones
If a patient is at risk for hypoglycemia unawareness, what should they do?
Keep their blood sugar levels slightly higher (120-125)
Who is T2DM more common in
Adults
Non whites
What is the pathology of T2DM?
Slower onset
Produces endogenous insulin but cells resist and pancreas cannot keep up
By the time T2DM has been diagnosed, what is true about most organs in the body?
They are already damaged and cannot use insulin
6-8 years of damage
How long are autoantibodies present in the body before a DM diagnosis?
Months to years before symptoms occur
When do symptoms manifest?
When pancreas can no longer produce insulin, then rapid onset with ketoacidosis
What are leading factors for developing T2DM?
Insulin resistance, pre-diabetes, metabolic syndrome, and gestational diabetes
What can be the cause of insulin resistance?
Decreased insulin production by the pancreas
Inappropriate hepatic glucose production
Altered production of hormones and cytokines by adipose tissue (adipokines)
Does pre-diabetes have any symptoms?
It is asymptomatic but long-term damage is occurring
What level on a HA1C would suggest pre-diabetes?
5.7–6.4%
Metabolic syndrome increases the risk for T2DM; what causes this?
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)
What are modifiable risk factors for T2DM?
BMI greater than or equal to 26, risk increases at 30
Physical inactivity
HDL less than or equal to 35 mg/dl
Metabolic syndrome
What are non-modifiable risk factors of T2DM?
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
Signs and symptoms of T2DM
Polyuria
Polydipsia
Polyphagia
Nocturia
Prolonged wound healing
Visual changes
Fatigue
Poor wound healing
Recurrent infection
Renal insufficiency
How is T2Dm managed?
Education (nutritional therapy)
Monitoring glycemic control
Diet and exercise
Insulin if needed
How do oral agents/medications work?
Stimulate insulin release from beta cells, modulate the rise in glucose after a meal, and delay CHO digestion/absorption
What are the steps for treatment of T2DM?
Diet & exercise
Lifestyle changes plus metformin
Lifestyle changes plus metformin and a second drug
Lifestyle changes plus metformin and insulin
What other meds are not directly related to DM and what do they do?
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
If patient gets a dry hacking cough from ace inhibitors, what are the alternatives?
Calcium channel blockers and ARBs
What medicine should you not give to a diabetic and why?
Beta blockers because it can mask signs of hypoglycemia
Diet, exercise, and weight loss may be sufficient for T2DM; this is also true for T1DM
True or false
False
What are the long term effects of hyperglycemia?
Major CVD, ischemic heart disease, stroke, lower extremity amputation, DKA, HHS, skin and soft tissue infections, pneumonia, flu, bacteriemia, sepsis, TB
What are macrovascular effects caused by DM?
CVD/PVD
MI
Stroke
What are Microvascular effects caused by DM?
Retinopathy, periodontal DZ, renal insufficiency/failure (Nephropathy)
What are effects on the CV system from DM?
HTN
Angina
Dyspnea
Mi
PVD
Hyperlipidemia
CVA (stroke)
What does periodontal disease cause?
Increased dental caries
Tooth loss
Gingivitis
Candidiasis (yeast)
What is proliferative retinopathy?
Involves the retina and vitreous humor, new blood vessels formed, and causes retinal detachment
What is non-proliferative retinopathy?
Partial occlusion of small blood vessels in the retina that causes micro aneurysms
If a patient has DM what other eye disease are they at risk for?
Glaucoma and cataracts
What is the leading cause of blindness in diabetic patients?
Diabetic macular edema
What should a patient do after being diagnosed with T2DM?
Go to specialty doctors to get eyes, kidneys, heart and teeth checked
What is Nephropathy?
Damage to small blood vessels that supply the glomeruli and the leading cause of ESRD
What are risk factors for Nephropathy?
HTN
Genetics
Smoking
Chronic hyperglycemia
What drugs are used to delay the progression of Nephropathy?
Ace inhibitors (don’t protect kidneys until there is some damage)
Angiotensin 2 receptor antagonists
What, other than drugs, is a good way to control Nephropathy?
Control of HTN
Tight BG control
What labs should be ran if a patient has Nephropathy?
BUN, creatinine, UA, GFR
What does it mean when albumin is present in the urine?
They are starting to have renal breakdown and rapid fat breakdown
Normal range of BUN
8–20 mg/dl
Normal range for creatinine?
0.6–1.2 mg/dl
Normal range for GFR?
> 60
What are the symptoms of nephropathy?
Edema of face, hands, and feet
Symptoms of UTI
Symptoms of renal failure: Edema, nausea, fatigue, difficulty concentrating
What are neurological effects of DM?
Diabetic peripheral neuropathy and autonomic neuropathy
What are the two kinds of diabetic neuropathy?
Sensory: loss of protective sensation
Autonomic
What is a neurotrophic ulceration?
Foot ulcer caused by not being able to feel the feet/lower extremities
What do neurotrophic ulcers look like?
White ring around would, normally round but not always
