w4 management of acute and chronic illness diabetes Flashcards

Question

What is the Screening For Chronic Kidney Disease (CKD) ?

Answer 1

Type 1 diabetes 5 years after diagnosis and repeated yearly thereafter Type 2 diabetes start at diagnosis of diabetes and repeated yearly thereafter

Answer 2

-Glomeruli injured by .protein denaturation .hyperglycemia with high renal blood flow (hyperfiltration) .activation of RAAS .production of angiotensin II (intraglomerular HTN exacerbated by systemic HTN) -Progressive changes include .glomerular enlargement .glomerular basement membrane thickening .proliferation of mesangial cells and matrix -Later in the disease, this results in .diffuse and nodular glomerulosclerosis .loss of podocytes .resistance to glomerular capillary blood flow .decreased glomerular filtration rate (GFR) -Alterations in glomerular membrane permeability .albuminuria -Tubular and interstitial fibrosis .proximal tubule is particularly vulnerable

Answer 3

-Before proteinuria .clinical S&S of progressive glomerulosclerosis not likely -Microalbuminuria is first manifestation .develops within 5 to 10 years of disease -Later .hypoproteinemia, reduction in plasma oncotic pressure, fluid overload, anasarca (generalized body edema), and HTN may occur -As GFR drops .uremic signs, such as nausea, lethargy, acidosis, anemia, and uncontrolled hypertension, occur -Macroalbuminuria .strongly correlated with morbidity and mortality from cardiovascular disease, particularly in type 2 diabetes

Answer 4

-Most common complication of diabetes -Sensory deficits generally precede motor involvement -Peripheral neuropathy .distal portions of neurons initially affected and eventually more severely affected .axonal and Schwann cell degeneration -Distal symmetrical polyneuropathy .includes large and small nerve fibers .small: neuropathic pain, loss of sensation .large: sensory loss of proprioception -Extremities involved first in a “stocking and glove” pattern

Answer 5

- Coronary artery disease - MI - Cerebral vascular disease - Peripheral vascular disease

Answer 6

``` -Cause of death in up to 68% of people with diabetes .accelerated atherosclerosis .HTN .increased risk for thrombus formation -Can result in .CAD .HF .MI -MIs often asymptomatic as a result of sensory and autonomic neuropathy ```

Answer 7

-Twice as common in those with diabetes especially, type 2 ``` -Risk factors .HTN .hyperglycemia .hyperlipidemia .thrombosis ``` -Survival rate for those with diabetes after massive stroke is often shorter than for someone without diabetes -Treatment .aggressive management of BP, hyperglycemia, lipidemia

Answer 8

-Incidence increases in those with diabetes (especially type 2) ``` -Risk factors .age .duration of diabetes .glycemic control .genetics ``` -Occlusions of small arteries/arterioles (especially below the knee) cause gangrenous changes of lower extremities .lesions begin as ulcers .progress to osteomyelitis or gangrene .amputation

Answer 9

EDUCATE about proper foot care EXAMINE for structural, vascular, neuropathy problems at diagnosis then annually DO a 10 gram monofilament assessment IDENTIFY those at high risk of foot ulcers and educate, assess more frequently, consider footwear REFER persons with foot ulcers and other complications to those specialized in foot care

Answer 10

How to Apply the monofilament: Repeat this application twice at the same site, but alternate this with at least one ‘mock’ application in which no filament is applied (total three questions per site). Protective sensation is present at each site if the patient correctly answers two out of three applications. Incorrect answers – the patient is then considered to be Protective sensation is absent with two out of three at risk of ulceration.

Answer 11

-Morbidity and mortality from infectious agents increase in those with diabetes ``` -Risk for infection increases because of .impaired senses .hypoxia .rapid replication of pathogens from increased glucose .decreased blood supply .suppressed immune response .delayed wound healing ```

Answer 12

A • A1C – optimal glycemic control (usually ≤7%) glucose monitoring remains a cornerstone of diabetes management allows people living with diabetes and their health-care providers to assess glycemic status and adverse effects, and to determine the effectiveness of glucose lowering therapies B • BP – optimal blood pressure control (<130/80) C • Cholesterol – LDL <2.0 mmol/L or >50% reduction D • Drugs to protect the heart A – ACEI or ARB │ S – Statin │ A – ASA if indicated │SGLT2i/GLP-1 E • Exercise / Healthy Eating S • Screening for complications S • Smoking cessation S • Self-management, stress and other barriers A • A1C – optimal glycemic control (usually ≤7%) glucose monitoring remains a cornerstone of diabetes management allows people living with diabetes and their health-care providers to assess glycemic status and adverse effects, and to determine the effectiveness of glucose lowering therapies B • BP – optimal blood pressure control (<130/80) C • Cholesterol – LDL <2.0 mmol/L or >50% reduction D • Drugs to protect the heart A – ACEI or ARB │ S – Statin │ A – ASA if indicated │SGLT2i/GLP-1 E • Exercise / Healthy Eating S • Screening for complications S • Smoking cessation S • Self-management, stress and other barriers

Answer 13

Optimal glycemic control is fundamental to the management of diabetes Both fasting and postprandial plasma glucose levels correlate with the risk of complications

Answer 14

-indicates % of RBC hemoglobin that glucose is bound to .process called glycosylation (glycosylated hemoglobin) .assessed periodically to estimate overall glucose control over life of RBCs i.e. ~ 90-120 days - Higher levels of A1C = persistently elevated BG - Target A1C level of less than 7% is desirable to prevent complications -Advantages over FPG include .useful in determining glycemic control over time .greater convenience as fasting not required .fewer day to day alterations during periods of stress and illness -Disadvantage .does not provide information that can inform immediate/short-term decisions

Answer 15

``` TRY to do a minimum of 150 minutes of moderate-to vigorous-intensity aerobic exercise per week INCLUDE resistance exercise ≥ 2 times a week SET physical activity goals and INVOLVE an interprofessional team MINIMIZE uninterrupted sedentary time ```

Answer 16

Used to describe rise in BG levels after a person has consumed carbohydrate-containing food Foods of low GI converted to sugar slower than white bread → steadily ↑BG i.e. oat bran cereal, baked beans Foods of high GI converted to sugar faster than white bread → cause sharp rise in BG i.e. French fries, corn flakes, baked potato Soluble fibre, fats, proteins slow gastric emptying foods digested more slowly →↓ in glycemic response

Answer 17

- Nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight - Weight loss results in improved insulin sensitivity and glucose tolerance, preserves beta-cell function, and has an inhibitory effect on progression to type 2 diabetes

Answer 18

- Alcohol inhibits gluconeogenesis → hypoglycemia! - can occur up to 24 hours after, in those with type 1 diabetes - when taken with some oral antihyperglycemic drugs that increase insulin secretion → severe hypoglycemia - alcohol can also cause other serious adverse effects when used in conjunction with certain OHAs used to treat diabetes - risk of lactic acidosis in clients who use metformin - when alcohol is taken with sulfonylureas, some clients experience a serious disulfiram (Antabuse)-like reaction - flushing, angina, palpitations, vertigo, nausea - serious reactions, such as seizures and possibly death, also may occur