Type 2 Diabetes Mellitus Flashcards
What % of Type 2 DM cases are r/t obesity?
~ 80%
If both parents are type 2 DM, theres a 40% chance, person will be… Hint: 4
1) insulin resistance
2) deranged secretion of insulin
3) increased glucose production
4) beta cells become exhausted… apoptosis
List 10 risk factors of developing type 2 DM
1) family Hx
2) obesity
3) ethnicity
4) age
5) gestational diabetes / delivery of babies > 9 lbs
6) HTN
7) metabolic syndrome
8) polycystic ovary syndrome (PCOS)
9) smoking & alcohol
10) corticosteroids
What initially happens in type 2 DM?
Initially there is increased insulin secretion by beta cells to bring down glucose
After initial increase of insulin in type 2 DM what happens?
1) insulin is NOT effective & cannot bring down glucose
2) since insulin levels are high the body increases glucose levels
3) beta cells become exhausted (lose 50% of function) by trying to compensate for insulin resistance
Classic features of metabolic syndrome Hint: 5
1) increased waist circumference or belly fat
2) high triglycerides
3) elevated BP (HTN)
4) high blood sugar (hyperglycemia)
5) a low HDL (good cholesterol)
List 7 clinical manifestations of type 2 DM
1) polydipsia
2) polyuria
3) polyphagia
4) fatigue
5) weakness
6) weight loss
7) visual disturbances
What causes polydipsia in type 2 DM?
hyperglycemia causes ICF shifts
What causes polyuria in type 2 DM?
excessive diuresis
What causes polyphagia in type 2 DM?
Cell starvation from lack of glucose
List 4 reasons obesity causes insulin resistance
1) causes ↑ in adipose & free fatty acids
2) induces inflammation & release of associated inflammatory mediators
3) ↑ stress on pancreatic B cells as insulin is ↑
4) results in liver ↑ glucose in the blood (impaired suppression)
What is Acanthosis Nigricans?
*Sign of insulin resistance
Skin becomes darker & thicker, often seen around neck or armpits
How do elevated blood glucose levels affect blood vessels?
they can damage BV leading to development of atherosclerosis, a major risk factor of CV disease
What do insulin levels look like in patients with insulin resistance?
Chronically elevated insulin levels
How does no exercise increase insulin resistance?
Those who do not exercise have decreased intracellular enzymes (i.e. pyruvic acid)
How does exercise help prevent insulin resistance? Hint: 6
1) ↑ mitochondrial enzymes
2) ↑ insulin sensitivity
3) TG get broken into FFA to use for fuel
4) ↓ BS, ↓ insulin
5) ↑ glucagon
6) causes uptake of glucose from circulation
What can high glycemic diet lead to…
Insulin resistance; several other disease processes
What does smoking induce & lead to?
1) induces inflammation
2) leads to endothelial dysfunction & ↑ risk of CAD, CVA, & PAD
Diagnosis of diabetes Hint: 4
1) fasting BG > 126 (2 readings)
2) a 2 hr plasma glucose during an oral glucose tolerance test (OGTT) > 200
3) Random blood glucose > 200 w/ hyperglycemic Sx
4) Hgb A1C > 6.5% (2 readings)
What does Hgb A1C measure?
Reflects amount of glycated Hgb (Hgb bound to glucose) in RBCs, providing insight into long-term blood sugar levels
What is glycated Hgb A1C used for?
Used to Dx or monitor diabetes
How does glycated Hgb A1C work?
1) glucose does not normally go into RBC but membrane is very permeable
2) when glucose level is chronically high, it will move into RBC
3) once glucose is in RBC, it cannot leave
Hgb A1C measures amount of glucose over _____ days
120
List common cause of hypoglycemia Hint: 7
1) excessive exercise
2) alcohol
3) poor food intake
4) too much insulin
5) stress
6) surgery
7) medications
How do the hypothalamus & portal vein play a role in hypoglycemia?
Hypothalamus & portal vein sense a decreased glucose & in response sends signal to adrenal gland, pancreas, & liver
What is responsible for most of the S&S of hypoglycemia?
Release of epinephrine & glucagon that causes activation of the SNS
What happens as hypoglycemia continues…
epinephrine & glucagon promote glycogenolysis & gluconeogenesis in the liver
Blood glucose level considered MILD hypoglycemia
100-55 mg/dL
List 8 Sx of MILD hypoglycemia
1) fatigue
2) sweating
3) hunger
4) dizziness
5) rapid HR
6) anxiety
7) irritability
8) shakiness
Blood glucose level considered SEVERE hypoglycemia
< 55 mg/dL
List 7 Sx of SEVERE hypoglycemia
1) blurred vision
2) impaired thinking
3) confusion
4) palpitations
5) loss of consciousness
6) seizures
7) coma
What is a nrusing intervention for an awake patient experiencing hypoglycemia?
Give them juice & something to eat
What is a nursing intervention for a patient experiencing hypoglycemia that is not awake?
Give IV D50, sublingual glucose tablet
How should you Tx potential hypoglycemic episode in emergency situations? Why?
Better to treat with sugar
Blood sugar level may be unknown so giving sugar can help hypoglycemia w/o significantly harming those w/ elevated glucose
Give 2 examples of high-fat foods that should NOT be used to Tx hypoglycemia
1) peanut butter
2) milk
List 2 types of diabetic neuropathy
1) somatic neuropathy
2) autonomic neuropathy
Somatic neuropathy
-Diminished perception: vibration, pain, temperature
-Hypersensitivity: light touch; occasionally severe “burning” pain
Autonomic neuropathy
1) defects in vasomotor & cardiac responses
2) urinary retention
3) impaired motility of the GI tract
4) sexual dysfunction
What causes neuropathy?
high glucose levels can damage peripheral nerve endings
List 3 things neuropathy can lead to
1) decreased sensation in extremities (i.e. hands/ feet)
2) increased risk of injury & infection (pt may not feel cuts/ injuries)
3) balance issues due to loss of sensation & proprioception
Hyperosmolar hyperglycemic syndrome (HHS) is only seen in ____ DM
Type 2 DM
HHS is characterized by…
severe hyperglycemia (>600), hyperosmolality, & dehydration caused by insulin resistance
Cells are not absorbing glucose
How does HHS compare/ differ from DKA?
1) ECF increases & there is intracellular dehydration
2) B/c there is some insulin there is NO ketone formation in HHS unlike DKA
How does HHS develop?
Over several days to weeks
List 5 causes of HHS
1) infection
2) non-compliance with diet or meds
3) undiagnosed
4) substance abuse
5) alcohol
List 10 Sx of HHS
1) extreme glucose levels
2) rapid/ thread pulse
3) hypotension
4) profound dehydration
5) polydipsia
6) polyuria
7) confusion
8) disorientation
9) possible seizure
10) coma
List 3 Tx options for HHS
1) hydration (given first)
2) IV insulin
3) electrolyte replacement
Guidelines for hydrating as Tx in HHS
1) Give normal saline to correct dehydration & restore electrolyte balance
2) rehydration helps move glucose back into cells & corrects K+ imbalances
How does insulin help in treating HHS?
helps regulate glucose & prevent further complications, but hydration must come first to stabilize patient
What electrolytes are replaced in Tx of HHS?
1) potassium
2) magnesium
Why is it important to monitor potassium levels in HHS?
Rehydration & insulin therapy can lead to K+ shifts back into the cells, potentially causing hypokalemia
What is the importance of monitoring magnesium levels during Tx of HHS?
Magnesium levels can drop during rehydration
Question:
Why is it necessary for a person to maintain blood glucose no lower than 70? Hint: 4
1) To improve insulin secretion
2) allow beta cells to have periods of rest
3) maintain a continuous supply of glucose for energy
4) to avoid too much glucagon from being broken down in the liver
