Week five Flashcards
What is the age of onset for DM1?
Most common in younger people by can occur at any age
What is the age of onset for DM2?
More usually age 35 years or older but can occur at any age. Incidence is increasing in children
What is the type of onset for DM1?
Abrupt but disease process may present for several years
What is the type of onset for DM2?
Insidious, may go undiagnosed for years
What is the prevalence of DM1?
5-15%
What is the prevalence of DM2?
85-95%
What are environmental factors of DM1?
Virus, toxins
What are environmental factors of DM2?
Obesity, lack of exercise
What is the primary defect of DM1?
Absent or minimal insulin production
What is the primary defect of DM2?
Insulin resistance, decreased insulin production over time, alterations in production of adipokines
What are islet cell antibodies in DM1?
Often present at onset
What are islet cell antibodies in DM2?
Absent
What is endogenous insulins for DM1?
Absent
What is endogenous insulins for DM2?
Initially increased in response to insulin resistance. Secretion diminishes over time
What is the nutritional status of a DM1 patient?
Thin, normal or obese
What is the nutritional status of a DM2 patient?
Obese or normal
What are symptoms of DM1?
Thirst, polyuria, polyphagia, fatigue, weight loss
What are symptoms of DM2?
Frequently none, fatigue, recurrent infections
How does ketosis occur with DM1?
Prone at onset or during insulin deficiency
How does ketosis occur with DM1?
Resistant except during infection or stress
What therapy is needed for both forms of DM?
Nutritional therapy
Is insulin required for DM1?
Yes, for all individuals
Is insulin required for DM2?
Required for some. Disease is progressive and insulin treatment may need to be added to treatment regimen
What complications are common for both forms of DM?
Vascular and neurological complications
What is presentation of DM1?
Polyuria, polydipsia, weight loss, fatigue, ketosis, hyperglycaemia, nausea, vomiting, blurry vision
What are risk factors of DM1?
- Genetic susceptibility
- Autoimmunity
- Environmental (exposure to viruses and triggers in diet)
What are risk factors for DM2?
- Genetics
- Obese
- Decreased physical activity
- High fat diet
- Age
- Ethnicity
- Hypertension
- History of gestational diabetes
What are long term complications of diabetes?
- Stroke
- Hypertension
- Dermopathy
- Artherosclosis
- Nephropathy
- Peripheral neuropathy
- Neurogenic bladder
- Infections
- Erectile dysfunction
- Islet cell losee
- Gastroparesis
- Coronary artery disease
- Retinopathy
How does hypertension occur in diabetes?
Hypertension progresses along with nephropathy
What is dermopathy?
Small brown lesions on skin
What is nephropathy?
Damage to kidneys from hyperglycaemia
What is peripheral neuropathy?
Loss of peripheral sensation due to damage to the axons of the neurons
What is neurogenic bladder?
Retention of urine in the bladder caused by diabetic neuropathy
Why are diabetic patient at increased risk of infections?
Impairment of immune system due to hyperglycaemia
Why does erectile dysfunction occur with diabetic patients?
Due to microvascular disease, peripheral and autonomic neuropathy
What does peripheral vascular disease do?
Due to narrowed blood vessels there is decreased perfusion, decreasing wound healing
What is gastroparesis?
Delayed emptying of stomach due to impaired neural control. This occurs since hyperglycaemic damages the axons of nerve cells
What is coronary artery disease?
Damage to blood vessels causing buildup of plaque due to macro vascular complications
What is diabetic retinopathy?
Damage to blood vessels in the eye from microvascular changes from hyperglycaemic
What drugs address insulin resistance by increasing cellular uptake of glucose and/or improving cellular insulin sensitivity?
- Biguanides (Metformin)
- Sulfonylureas (Glipizide)
- Thiazolidinediones (Actos)
What drugs increased insulin production by stimulating beta cells or mediating factors that prevent beta cell response to glucose levels
- Sulfonylureas (Glipizide)
- Didpeptidyl Peptidase-4 Inhibitors (Sitagliptin)
- Glucagon-like peptide 1 receptor agonists (exentide)
What drugs decrease hepatic glucose production?
- Biguanides (Metformin)
- Sulfonylureas (Glipizide)
- Didpeptidyl Peptidase-4 Inhibitors (Sitagliptin)
- Glucagon-like peptide 1 receptor agonists (exentide)
What drugs reduce blood glucose levels by delaying carbohydrate digestion?
- Alpha-Glucosidase Inhibitor (Acarbose)
- Glucagon-like peptide 1 receptor agonists (exentide)
What is the route, onset, peak and duration of Rapid Acting Insulin?
- Route - subcutaneous
- Onset - 30 minutes
- Peak - 1-3 hours
- Duration - 8 hours
What is an example of Rapid Acting Insulin?
Aspart
What is the route, onset, peak and duration of Short Acting Insulin?
- Route - subcutaneous
- Onset - 10-20 minutes
- Peak - 1-3 hours
- Duration - 3-5 hours
What is an example of Short Acting Insulin?
Lipsro
What is the route, onset, peak and duration of Intermediate Acting Insulin?
- Route - subcutaneous
- Onset - 1-1.5 hours
- Peak - 4-12 hours
- Duration - 12-24 hours
What is an example of Intermediate Acting Insulin?
Isophane
What is the route, onset, peak and duration of Long Acting Insulin called Detemir?
- Route - subcutaneous
- Onset - 1-2 hours
- Peak - 3-4 hours
- Duration - up to 24 hours
What is the route, onset, peak and duration of Long Acting Insulin called Glargine?
- Route - subcutaneous
- Onset - 1-1.5 hours
- Peak - no peak
- Duration - 24 plus hours
What causes hypoglycaemia?
- Not enough food
- Not enough carbohydrates
- Missing or delaying meal
- Introducing exercise without adjusting insulin level
- Taking too much insulin
- Excessive alcohol without carbohydrates
How to manage hypoglycaemia?
1) Consume quick acting carbohydrate
2) Retest glucose level after 10 minutes and consume more if below 4.0mmol/L
3) Consume more substantial carbohydrate
How to monitor diabetes?
- Blood draws (HbA1c and lipid profile
- Self blood glucose monitoring
- Urine testing for microalbuminuria
- Diabetic foot exams
- Self-management skills
- Weight and BMI
- Healthy eating plan
- Diabetic retinopathy screening
What are the functional health patterns of diabetics?
- Activity and exercise
- Coping
- Sexuality-reproductive pattern
What are interventions for diabetes?
- Education on disease process
- Exercise
- Medications
- Diet
- Monitoring
