Type 2 diabetes Flashcards
DM and life expectancy
Approximately 65 to 80% of people with diabetes mellitus (DM) will die as a result of heart disease or stroke.
DM is a contributing factor in the deaths of approximately
41,500 Canadians each year.
Canadian adults with DM are twice as likely to die prematurely as people without DM.
Types of Diabetes
The two most common types
Type 1
Type 2
Other types
Gestational
Prediabetes
Secondary diabetes
how is insulin produced
Produced by beta cells in Islets of Langerhans
Released continuously into bloodstream in small increments with larger amounts released after food
Normal glucose level
Stabilizes glucose range to 4–6 mmol/L
function of Insulin
Facilitates glucose transport from bloodstream across cell membrane to cytoplasm of cell
Decreases glucose in the bloodstream
↑ Insulin after a meal
Stimulates storage of glucose as glycogen in liver and muscle
Inhibits gluconeogenesis
Enhances fat deposition
↑ Protein synthesis
Type 2 Diabetes Mellitus risk factors
over 35 years of age
High BMI
Genetic factors
Increased rate in people of Indigenous, Latin American, South Asian, Asian, or African descent
Individuals with hx of gestational diabetes
Individuals with metabolic syndrome
Sedentary lifestyle
Hypertension/dyslipidemia
4 factors thatdirecity cause high blood glucose DM2
1.) Insulin resistance
2.) Pacreas losing the ability to produce insulin
3.) Inapporatite glucose production from liver
4.) Alteration in the production of hormones and adipokines
Onset of DM2
Gradual onset
Person may go many years with undetected hyperglycemia
Clinical Manifestations of Type 2 Diabetes Mellitus
Nonspecific symptoms
May have classic symptoms of type 1
Fatigue
Recurrent infection
Recurrent vaginal yeast or monilia infection
Prolonged wound healing
Visual changes
4 main diagnostic findings for DM
A1C ≥6.5%
Fasting plasma glucose level ≥7 mmol/L
Random or casual plasma glucose measurement ≥11.1 mmol/L plus classic symptoms
2-hour oral glucose tolerance test (OGTT) level ≥11.1 mmol/L when a glucose load of 75 g is used
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The fasting plasma glucose (FPG) test, confirmed by repeat testing on another day, is the preferred method of diagnosis.
When the OGTT is used, the accuracy of test results depends on adequate patient preparation and attention to the many factors that may influence the outcome of such tests. For example, factors that can cause falsely elevated values include recent severe restrictions of dietary carbohydrate, acute illness, medications (e.g., contraceptives, corticosteroids), and restricted activity such as bed rest.
Hemoglobin A1C test
Recommended to be used as a diagnostic test
Useful in determining glycemic levels over time
Shows the amount of glucose attached to hemoglobin molecules over RBC lifespan
Approximately 120 days
Regular assessments required
Ideal goal
CDA ≤7.0%
Normal range is <6.0%
Normal A1C reduces risks of retinopathy, nephropathy, and neuropathy
Goals of diabetes management
Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of long-term complications
Classes of Diabetes Oral Agents
Sulphonylureas
Meglitinides
Biguanides
Thiazolidinediones
DPP4-Inhibitors
Sulphonylureas
↑ Insulin production from pancreas
↓ Chance of prolonged hypoglycemia
Examples
Gliclazide (Diamicron, Diamicron MR)
Glimepiride (Amaryl)
Meglitinides
Increase insulin production from pancreas
Taken 30 minutes before each meal up to time of meal
Should not be taken if meal skipped
Example
Repaglinide (GlucoNorm)
Biguanides
Reduce glucose production by liver
Enhance insulin sensitivity at tissues
Improve glucose transport into cells
Do not promote weight gain
Common side effects include GI upset
Hypoglycemia is not common
Example
Metformin (Glucophage)
Special Considerations for Patients taking Metformin
Lactic acidosis is a rare, serious metabolic complication that occurs due to metformin accumulation – kidney and liver impairment, advanced age, surgery, hypoxia and alcoholism increase the risk
Alcohol is not advised – increases the risk for lactic acidosis
Should be held during contrast studies – contrast dye is hard on the kidneys
Ongoing monitoring required – kidney and liver function, glycemic control etc.
Thiazolidinediones
Most effective in persons with insulin resistance
Improve insulin sensitivity, transport, and utilization at target tissues
Examples
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Dipeptidyl peptidase-4 (DDP-4) inhibitor
Slows inactivation of incretin hormones
Potential for hypoglycemia
Examples
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Glucagon-like peptide (GLP)-1 receptor agonists (incretin mimetics)
Stimulates release of insulin from cells
Subcutaneous injection
Suppresses glucagon secretion
Example: Ozempic
Uses of B-adrenergic blockers
Mask symptoms of hypoglycemia
Prolong hypoglycemic effects of insulin
Uses of Thiazide/loop diuretics
Can potentiate hyperglycemia
By inducing potassium loss
Diabetes: Nutritional Therapy
The cornerstone of care for a person with diabetes
Most challenging for many people
Recommended that diabetes mellitus nurse educator and registered dietitian with diabetes expertise be members of health care team
Diabetes: Exercise
Exercise
An essential part of diabetes management
↑ Insulin sensitivity
Lowers blood glucose levels
Contributes to weight loss
Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent hypoglycemia.
Best done after meals
Exercise plans should be individualized and started
After medical clearance
Slowly, with gradual progression
Hyperosmolar hyperglycemic syndrome (HHS)
Life-threatening syndrome
Less common than DKA
Often occurs in older persons with type 2 DM
The patient has enough circulating insulin that ketoacidosis does not occur.
Produces fewer symptoms in earlier stages
Neurological manifestations occur because of ↑ serum osmolality.
Angiopathy: Macrovascular
Diseases of large and medium-sized blood vessels
Occur with greater frequency and with an earlier onset in diabetics
Development promoted by altered lipid metabolism common to diabetes: all patients with diabetes should be screened for dyslipidemia at diagnosis
Tight glucose control may delay the atherosclerotic process.
Risk factors of Angiopathy: Macrovascular
Obesity
Smoking
Hypertension
High fat intake
Sedentary lifestyle
Angiopathy: Microvascular
Result from thickening of vessel membranes in capillaries and arterioles
In response to chronic hyperglycemia
Is specific to diabetes, unlike macrovascular
Angiopathy: Microvascular Areas most noticeably affected
Eyes (retinopathy)
Kidneys (nephropathy)
Nerves (neuropathy)
Skin (dermopathy)
