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Foot - DIABETIC > Unit 1 - Diabetes > Flashcards

Unit 1 - Diabetes Flashcards

1
Q

Evidence from 2016 indicated that:

Diabetic complications are r/t (1)

Diabetes contributes to (4)

Diabetes is the leading cause of (1)

A

premature death (lifespan reduced by 5-15 years)

30% of strokes
40% of heart attacks
50% of kidney failure requiring dialysis
70% on non-traumatic lower limb amputations

vision loss

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2
Q

Seniors and Diabetes

What %age of people with diabetes are age 65 and older?

What are important for decreasing risk for developing diabetes in elderly people?

Describe diabetes in the elderly in comparison to that of younger people.

Therefore?

A

Approximately 25.9 %
.
Lifestyle interventions

Diabetes in the elderly is metabolically distinct from that of younger people
It therefore should be treated differently.
(Canadian Diabetes Association, 2013).

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3
Q

Aboriginal People and Diabetes

Aboriginal populations living in Canada are among…

Diabetes prevention efforts should focus on?

Diabetes screening for adults should occur how often?

Are males or females more impacted by DMII?
When?

Aboriginal women in Canada experience gestational diabetes at a rate that is…

A

the highest risk populations for diabetes and related complications

diabetes risk factors (obesity, proper management of gestational diabetes, smoking, inactivity, poor eating habits, and stress)

every 1-2 years for individuals with one or more risk factors

Aboriginal females are impacted by type 2 diabetes more than males, with the most noticeable difference being seen during reproductive years.

2-3 times higher than other women.

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4
Q

Diabetes and Psychiatric Illness

Psychiatric disorders are more prevalent in…

People diagnosed with psychiatric illness are more likely to

Those individuals with both diabetes and psychiatric illness have decreased (2)

Those individuals with both diabetes and psychiatric illness have increased (4)

Risk factors leading to insulin resistance and metabolic disorder? (4)

A

people with diabetes than in the general population.

develop diabetes than the general population.

medical adherence
self-care

functional impairment
risk of diabetic complications
healthcare costs
mortality

Psychotropic drugs cause weight gain
COMBINED WITH 
poor diet
inadequate exercise 
smoking common in this population
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5
Q

The Economic Costs of Diabetes

The economic burden of diabetes in Manitoba is estimated to be ? in 2010

How much was the cost expected in increase by 2020?

Estimated cots in 2020 (by Canadian Diabetes Association)?

A

$498 million in 2010 (measured in 2009 dollars)

28%

$639 million

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6
Q

Definitions

Diabetes

A

a metabolic disorder characterized by the inability to manufacture or properly use insulin
and
impaired ability to convert sugars, starches, and other foods into energy.

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7
Q

Definitions

Diabetes in terms of blood glucose (2)

A

FBG - fasting blood glucose > 7.0 mmol/L

or

2 hour blood sugar of > 11.1 mmol/L

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8
Q

Definitions

Type 1 Diabetes

More commonly Dx’ed in?

Etiology

A

children and adolescents

Pancreatic beta cell destruction causes the pancreas to stop producing insulin.
Without enough insulin, glucose isn’t metabolized properly, so it builds up in the bloodstream.

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9
Q

Type 1 Diabetes

What is thought to be the cause of beta cell destruction?

Onset?

Prevention?

A

an autoimmune process

can be sudden

Cannot be prevented.

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10
Q

Type 1 Diabetes

How is it treated?

A

diet
exercise
insulin (clients are dependent)

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11
Q

What % of people Dx’ed with diabetes have type 1?

A

10% of people diagnosed with diabetes have Type 1 diabetes.

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12
Q

Type 2 Diabetes

Commonly diagnosed in?

Etiology?

Onset?

A

adults

The pancreas does not produce enough insulin
or
the body does not use the insulin effectively (insulin resistance).

Can be slow in onset.

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13
Q

Type 2 Diabetes

How is it treated?

A

diet
exercise
oral medication and/or insulin

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14
Q

What % of people Dx’ed with diabetes have type 2?

A

90% of people diagnosed with diabetes have Type 2 diabetes.

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15
Q

Prediabetes is defined as?

Prediabetes is associated with?

A

blood sugars that are above normal levels
but
below those of diabetes

an increased risk of developing either diabetes or cardiovascular disease.

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16
Q

IFG

A

impaired fasting glucose

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17
Q

IFG - impaired fasting glucose is

A

6.1 to 6.9 mmol/L

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18
Q

IGT

A

impaired glucose tolerance

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19
Q

IGT - impaired glucose tolerance is

A

2 hour blood sugar of 7.8 to 11.1 mmol/L

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20
Q

What is a key feature of type 2 diabetes?

A

Insulin resistance

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21
Q

Define Insulin Resistance

A

a condition in which the body’s cells and tissues do not respond properly to the effects of insulin.

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22
Q

Insulin resistance is a key feature of type 2 diabetes.

It is also implicated in? (2)

A

prediabetes and metabolic syndrome

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23
Q

Metabolic Syndrome is…

It is defined as people with 3 or more of the following 5 risk factors:

A

a grouping of conditions that is associated with a higher risk of developing diabetes and/or cardiovascular disease

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24
Q

Metabolic Syndrome is…

5 risk factors:

A

Fasting Blood Sugar > 6.1 mmol/L

Blood Pressure > 130/85

Triglycerides > 1.7 mmol/L

HDL- cholesterol
Men < 1.0 mmol/L
Women < 1.3 mmol/L

Waist Circumference
Men > 102 cm
Women > 88 cm

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25
Q

How many of the five risk factors must the person have to be Dx’ed with metabolic syndrome?

A

3 or more

26
Q

Targets for control of blood sugar
NORMAL RANGE

Hgb A1C %
Fasting glucose
2 hour glucose

A

Hgb A1C %: < 6.0

Fasting glucose: 4.0 – 6.0 mmol/L

2 hour glucose: 5.0 – 8.0 mmol/L

27
Q

Targets for control of blood sugar
TARGETS FOR MOST DIABETICS

Hgb A1C %
Fasting glucose
2 hour glucose

A

Hgb A1C %: < 7.0

Fasting glucose: 4.0 – 7.0 mmol/L

2 hour glucose: 5.0 – 10.0 mmol/L

28
Q

Risk Factors for Type 2 Diabetes

Genetics (2)

A

Parent of sibling with diabetes

Belonging to high-risk group
Aboriginal, African, Asian, South Asian, Hispanic descent

29
Q

High risk groups

A 
Aboriginal
African
Asian
South Asian
Hispanic
30
Q

Risk Factors for Type 2 Diabetes

Women’s Woes (3)

A

Having baby that weighed more than
4kg (9 pounds) at birth

Gestational diabetes (diabetes during pregnancy)

polycystic ovary syndrome Dx

31
Q

Risk Factors for Type 2 Diabetes

Pre-exisiting diagnoses (4)

A

Prediabetes (impaired glucose tolerance or impaired fasting glucose)

obstructive sleep apnea

Acanthosis nigricans (darkened patches of skin)

psychiatric disorders: schizophrenia, depression, bipolar

32
Q

Risk Factors for Type 2 Diabetes

High? (3)

A

High BP

High cholesterol or other fats in the blood

High weight (overweight), especially if mostly carried around the tummy

33
Q

Risk Factors for Type 2 Diabetes

Other (2)

A

Having health complications that are associated with diabetes

Having been prescribed a glucocorticoid med

34
Q

Prevention of Type 2 Diabetes

EARLY SCREENING recommended

For those without risk factors?

For those with risk factors?

A

Q 3 years starting at age 40

For those with risk factors, testing should be done more frequently and from an earlier age.

 Promotion of life style changes that include weight management through diet and regular physical activity for those with prediabetes and/or metabolic syndrome.

35
Q

Prevention of Type 2 Diabetes

In Manitoba, screening of obese children recommendations.

A

> 7 years of age

Q 2 years
IF 
members of a high risk ethnic group
or 
have a family hx
36
Q

Treatment of Type 2 Diabetes

Treatment is aimed at?
Using?
To?

A

control of blood sugar

using diet, exercise, oral medications and/or injected insulin

to control symptoms
and
reduce or prevent complications

37
Q

Each 1% drop in Hgb A1C is associated with:

A
  • 43% less risk of amputation
  • 37% less risk of microvascular complications
  • 21% less risk of diabetes complications
  • 21% less risk of death related to diabetes
  • 19% less risk of cataract extraction
  • 16% less risk of heart failure
  • 14% less risk of heart attack
  • 12% less risk of stroke
  • Reduced number of hospital stay days.
38
Q

What is the ONLY treatment to prevent the onset and delay the progression of diabetic neuropathy?

A

Control of blood sugar to within the recommended target range

is the ONLY treatment

39
Q

Diet and Diabetes

CDA 2013 Clinical Practice Guidelines recommend …

A

nutrition counselling from a registered dietician for all diabetics.

Refer to and other publications from the CDA website.

40
Q

Diet and Diabetes

Recommended CDA publication?

A

“Just the Basics - Tips for healthy eating, diabetes prevention and management”

41
Q

Physical Activity and Diabetes

Exercise and physical activity has been shown to be a very important part of…

A

controlling blood sugar and reducing complications in diabetes.

42
Q

Physical Activity and Diabetes

Recommended CDA publication?

A

“Physical Activity and diabetes management”

43
Q

Diabetes, Depression and Anxiety

Symptoms of depression are often seen in clients with diabetes and research is demonstrating that…?

A

approximately 15% of diabetics

have symptoms of major depression

44
Q

Diabetes, Depression and Anxiety

Many of the physical symptoms of depression and diabetes are?

A

the same

 The CDA 2013 Clinical Practice Guidelines are now recommending that regular screening for depression and anxiety be done with referral to mental health professionals for those with depression, anxiety or eating disorders.
 There is literature available for the public and professionals on the CDA website.

45
Q

Diabetes, Depression and Anxiety

Many of the physical symptoms of depression and diabetes are the same, therefore…?

This may be leading to…?

A

many health professionals assume that depression is inevitable with chronic illness

this may be leading to under-diagnosis

46
Q

Diabetes, Depression and Anxiety

There is evidence of ??? among diabetics than in the general population.

A

There is evidence of more generalized anxiety disorder among diabetics than in the general population.

47
Q

Diabetes, Depression and Anxiety

What % of diabetics have some anxiety Sx?

Often experienced is…?

A

14%

fear of hypoglycemia

48
Q

The Diabetes Management Team

The person with diabetes needs to?
In order to?
This can seem like?

A

balance diet, exercise and medication

control their disease and manage complications

a difficult and daunting undertaking for many

49
Q

The Diabetes Management Team

This is most successfully done with the help of a multidisciplinary team that may include…

DD E FF P

A 
dietician
diabetes educator nurse
endocrinologist
foot care specialists
family doctor
pharmacist
50
Q

The Diabetes Management Team

What is essential for the long-term management and support that diabetics need?

A

Good communication
and
common current standards of care among caregivers

51
Q

The Diabetes Management Team

CDA Clinical Practice Guidelines also make recommendations for?

A

the integration of mental health professionals

and the use of CBT based techniques

onto the diabetes team

52
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

(5)

A

Know the current basics of diabetic management

Know where clients can get diabetes education locally

Be prepared to make and receive referrals within your local team

Support ALL positive efforts that clients make to improve self care

Document and follow up all referrals.

53
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

Know the current basics of diabetic management:

A

targets for glucose testing and Hgb A1C

managing hypoglycemia

managing ‘sick days’

current care recommendations for foot care
(CDA Diabetes Service Directory 2018 Clinical Practice Guidelines)

54
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

Know where clients can get diabetes education locally

A

health resource centres, hospital or clinics
- Manitoba Health – Chronic Diseases Branch – Diabetes

home care resource

pharmacy

web based resources

  • Canadian Diabetes Association
  • WRHA Diabetes Service Directory

health links

55
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

Be prepared to make and receive referrals within your local team

A

keep referral information readily available

know what information is needed to make a referral

keep business cards with your information handy

be prepared to explain what you do to others

56
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

Support ALL positive efforts that clients make to improve self care

A

encourage them to seek answers to their questions

encourage them to persist in their efforts

be prepared give support repeatedly

57
Q

The Foot Care Nurse as a Member of the Diabetes Health Care Team

Document and follow up all referrals.

A

That’s it.

58
Q

S/S hyperglycaemia

A

Excess glucose in the blood creates an osmotic effect that results in increased thirst, hunger, and increased urination.

The patient may also report nonspecific symptoms of fatigue, mild confusion, lethargy

blurred vision

HA

warm, dry skin

59
Q

Hyperglycaemia Tx

A

Insulin

Exercise Regularly. ... 
Control Your Carb Intake. ... 
Increase Your Fiber Intake. ... 
Drink Water and Stay Hydrated. ... 
Implement Portion Control. ... 
Choose Foods With a Low Glycemic Index. ... 
Control Stress Levels. ... 
Monitor Your Blood Sugar Levels.
9. Get Enough Quality Sleep
Eat Foods Rich in Chromium and Magnesium
60
Q

S/S hypoglycaemia

A 
Capillary blood glucose level, 
weakness, fatigue, 
muscle cramps, decreased muscle tone, 
insomnia, 
tachycardia, tachypnea, 
dizziness, headaches, numbness/ tingling, decreased level of consciousness, or change in consciousness, seizure, visual impairment

anxiety, irritability, dizziness, diaphoresis, pallor, tachycardia, headache, shakiness, and hunger.

severe hypoglycemia may lead to alteration of mental function that proceeds to headache, malaise, impaired concentration, confusion, disorientation, irritability, lethargy, slurred speech, and irrational or uncontrolled behavior

61
Q

Hyperglycaemia Tx

A

Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods without protein or fat that are easily converted to sugar in the body. Try glucose tablets or gel, fruit juice, regular — not diet — soft drinks, honey, and sugary candy.

Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck the blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).

Have a snack or meal. Once your blood sugar is normal, eating a snack or meal can help stabilize it and replenish your body’s glycogen stores.

Foot - DIABETIC (2 decks)

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