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75 Cards in this Set

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Diabetes mellitus kills how many in the US?
15 million cases in US
5 million of those undiagnosed
650,000 new cases every year in US
Risk for diabetes increases with what groups the most?
Hispanic
African Americans
Native Americans
Those over 65 years of age
Obesity
Genetics
the economic costs of diabetes is diabetes and other losses are staggering like ...
Blindness
Amputation
Dialysis
Hospitalization 3rd leading cause of death by disease
Increase # of aging population
Education (not just a 1hr session)
goals for a DM patients are like...
Control of BG levels (if you do this it will prevent the 2nd problem)
Prevention of acute/long term complications
what is diabetes mellitus anyway?
the abnormal metabolism of carbs, proteins, & fats
the pancreas works to regulate BG...how?
Beta cells-secrete insulin which decrease BG how? Allows glucose to enter the cells to be used by the cells
Alpha cells-secrete glucagon which increases BG how? Stimulate the liver to release glucose from the glycogen that is stored there
the liver!
stores glucose in the form of glycogen. OK so far???
There are 3 Big Gs here that describe metabolism of this liver storing processes name..
Glyco-genolysis-catabolism of glycogen into glucose, carbon dioxide, & water (when fasting & then after 8-12 hrs then the next happens)
Glyco-neogenesis-catabolism of amino acids & glycerol (non glucose substances) into glucose for energy
Glyco-genesis anabolism of glucose into glycogen for storage
what is the role of insulin?
secreted by beta cells
moves glucose from blood into cells
muscle cells
liver cells
fat cells
inside these cells, insulin assists in...
use of glucose for energy

stimulating glucose storage in the form of glycogen in liver

helping store fat in adipose tissue

moving amino acids into cells

inhibits breakdown of stored glucose, fat & protein
Pancreas is the only gland that is endocrine. what does is secrete into the blood?
(secretes hormones into the blood stream) Islets of Langerhans secretes glucagons & insulin
what is Exocrine
A term applied to the external secretion of a gland.

2. A term applied to glands whose secretion reaches an epithelial surface either directly or through a duct.
So Exocrine in this context ..
(secretes hormones to the surface or to the organs) digestive enzymes to the duodenum & small intestine
non reversible Type 1 DM facts include:
5-10% of DM patients

Insulin Dependent (IDDM)

beta cells destroyed

inadequate amount of insulin produced
Factors that might have something to do with getting IDDM
Genetic-Inherit tendency
Immunologic (autoimmune)
Environmental (viral)
What are the results of IDDM?
Unchecked glucose production by liver (cells are still sending message to make more glucose, not being nourished)

High, high glucose levels

Glucose from food remains in blood
So the result of IDDM, meaning glucose from everywhere, the liver, the food you ate, the glucose from all this remains where?
in the blood and cannot be stored in the liver
Insulin normally decreases glycogenolysis & glyconeogenesis
Without insulin, these are unrestrained and contribute to h...
hyperglycemia
So, cells are not getting feed, remain under nourished, and say "I'm hungrey" so ...
the body breaks down fat & trys to feed the starving cells!
this isn't the case in type II
So type I IDDM onset is sudden
hits the young, < 30 years
thin w/ recent wt loss
have little of no insulin
and require ...
insulin to live!
what is the Tx for IDDM?
INSULIN
DIET
EDUCATION
EXERCISE
BG MONITERING
TYPE II DIABETES:

CAN BE REVERSED?
YES! W/ SOME EXERCISE & HEALTHY DIET!!!
TYPE II DIABETES:

90-95% DIABETIC PTS HAVE THIS
NIDDM MEANS WHAT?
NIDDM =
NON INSULIN DEPENDANT DIABETES MELLITUS
HOW DO YOU GET NIDDM?
ONSET AT EARLY AGE BUT USUALLY AFTER 30 YEARS

AGE (INCREASE AFTER AGE 60)

OBESITY

FAMILY HISTORY

ENTHNIC THING TOO
HOW DO YOU TREAT NIDDM?
DIET EXERCISE

MAY NEED ORAL AGENTS

MAY NEED INSULIN
HOW DO YOU TELL YOU GOT NIDDM?

WHAT KIND OF THINGS HAPPEN?
HYPERGLYCEMIA
GLYCOSURIA (SUGAR URINE)
OSMOTIC DIURESIS (PEE ALOT)
POLYURIA (LOTS OF PEE)
POLYDIPSIA (EXESSIVE THIRST)
DEHYDRATION
POLYPHAGIA (LITTLE HUNGRY ALOT
FATIQUE
HEADACHE
WT LOSS
KETONURIA (TYPE 1) KETONES IN URINE
ACIDOSIS (TYPE 1)
LETS TALK ABOUT HYPERGLYCEMIA
THE LACK OF ... DOES WHAT?
INSULIN TO MOVE GLUCOSE INTO CELLS
HYPERGLYCEMIA IS AN ILLNESS THAT ...
puts stress on the body

elevates the blood glucose by producing stress hormones such as cortisol, growth hormone, adrenal gland hormones) preparing ourselves for flight or fight
hperglycemia puts so much stress on the body that it ...
causes emotional & physical stress
What is glycosuria? (glucos uria)
kidneys unable to reabsorb all of glucose filtered out

spills over into the urine, shouldn't be there
what is osmotic diuresis?

di u re sis
kidneys want to dilute the glucose in the blood & so kidneys pull extra fluid ! this is terrible
during osmotic diuresis,

hypertonic solution in our vessels, so what now?
so fluid is pulled from other areas to dilute our urine.
polyuria is peeing alot

what causes this?
dehydration from this osmotic diuresis
there is polydipsia or being thirsty all the time why?
from dehydration

dehydration from osmotic diuresis
polyphagia is hungrey all the time whY?
cell hunger

and tired all the time from lack of nourishment, AND dehydration
what about weight loss?
lack of metabolism of food or nourishment to the cells so, breakdown of fat for energy
what is Ketonuria? (type 1)
a by product of fat breakdown

should not be here
Ketones in the blood (type 1) is from what
a by product of fat breakdown
what is and why is Acidosis in this discussion?
its a type 1 problem

Acidosis is keytones are acid and the keytones are there from fat breakdown, right?
what kind of factors affect DM? (type II)
obesity so ...

weight loss is a major preventive factor to treatment of NIDDM
Whats another factor affecting DM?
well, its associated with increased insulin resistance so tissues are not able to utilize the insulin that is there

this is a biggy for type II
lossing weight can help eliminate need for what too?
need for meds!

so lossing weight means might not need medicines
BMI is important here,

the formula is:
weight in lbs
_____________ X 703 =

(inches X inches)

my BMI is 27

b/t 25 - 29 = overweight
30 > is obese
below 18 is under nourished and over 25 fat
there is another way to calculate this what?
hip to waist method

this is the pear shape and apple shape thing

hips should be larger than waist in women & at least the same in men
Diet for DM must be consistant
Ex
amt of calories & carbs at meals

time of meals

what else?
intervals B/T meals

snacks at HS (not eating all night so they need the extra nutrition to keep BG up thru out the night, right?
so keeping daily eating regiment the same helps what?
helps prevent decreased BG episodes! to keep BG within limits or WNL
what food nutrient has the biggest effect on BG? why?
carbs have the biggest effect on BG

why? breakdowns quickly int glucose & enters the blood stream quickly
ADA american diabetic ass
AHA american heart ass
ACA american cancer ass

all recommend what dietary things?
carbs 45-65%
fats 20-30%
proteins 10-20% 3 oz qd

Wt in lbs & multiply by 15 & that is how many calories you burn in a moderately active lifestyle Ex 185X15=2775 cals
Exercise and DM?

what effect does exercise have on Diabetes?
decreases BG

decreases cardiovascular risks

you can then eat more!
Exericse also

increases uptake of glucose by muscles

improves: insulin utilazation (not as insulin resistant) what else does it improve?
muscle tone
circulation
where should your BG be anyway?
250

you should have no keytones in your urine. Why?

more glucose produced causes keytones in urine not being utiized can cause more problems, breakdown more fat b/c of cell hunger
Exercise for type I DM

to try and prevent hypoglycemia you will need to do what?
have a carb snack b/f exercise

snack after exercise

decreased dose insulin

to have an observer present
Type II DM and exercise
improves glucose metabolism
enhances weight loss
improves sensitivity to insulin ******** biggy here
can decrease need for oral meds
so for both types DM any tips about exercise?
be consistant
same time & amt daily
regular is better than sporatic
what tips would help w/ complications?
no trauma to feet
no increased BP problems (Exercise can elevate BP too high)
what about stress & illnes for DM?
stress & illness can cause similar stree to physical & emotional stress therefore can cause
illness
infection
emotional stress
mental episodes
all this is related to insulin resistance
SO...
strss & illnes causes stress hormones to fly! like which ones?
epinepheron
norepinepheron
growth hormone
coritsol comes from adrenal gland
these stress released hormones cause the liver to produce what?
glucose!

and if insulin isn't avaliable, hyperglycemia!
So, this is where hyperglycemia might originate in the DM issue
*****************************
does a patient that isn't eating need insulin?
yes
what about sick day rules for Dm patients?
take meds as usual
test DM q 3-4 hours
type 1 test urine keytones q 3-4 hours
report increase in BG over 300 & keytones to Dr
try to keep taking food, even if just liquids
if N/V/D and fever persists, take fluids as able
report N/V/D to MD
nausea vomiting diarrhea
how do you check a blood glucose?
get gear
glucometer and strips
lancet
exam gloves
alcohol swab
cotton ball
may need band aid
so checking blood gluces:

wash hands and don gloves
and choose site...where on adult and infant?
infant? may use heel
adult? use lateral finger, avoid central tip b/c more nerves
hold finger in dependent position (pointing down)
massage toward punture site
cleanse site w/ alcohol
******must be dry (it hurts more)**********************
wipe away first drop w/ cotton
lightly squeeze for drop
apply to test strip
cover pad completely
proceed w/ glucometer
stop bleeding w/ pressure
Dx:

signs/symptoms
random BG>200 mg/dL (any time)
fasting BG>126mg/dL
2 hr post load (prandial) glucose g>200mg/dL
what tips about these Dx?
oral glucose tol. test
not recommended for routine
performed in gestational DM
Glycosylated Hemoglobin A1C

what is this, like a test? the A1C test???
a form of hemoglobin used primarily to identify the plasma glucose concentration over time. Its name is sometimes abbreviated to A1C. It is formed in a non-enzymatic pathway by hemoglobin's normal exposure to high plasma levels of glucose. Glycation of hemoglobin has been implicated in nephropathy and retinopathy in diabetes mellitus.
A1C is recommended by ADA q3 months
reflects ave. BG levels over past 2-3 months
longer BG is increased, the more glucose is attached
what else?
last for the life of a RBC
about 120 days or 3 months
norm is 4-8% and should be < 7 but want to see < than 6 in diabetic
could be hi A1C but testing at the wrong time like hi BG in the middle of the night
ADA exchange list in food

6 groups include
bread/grains
veggies
milk
what else?
meat/protein
fruit
fats
so the dietitican knows:
1500 cal ADA diet:
6 breads
3 fruits
3 proteins
2 milk
3-4 veg
2 fats
so what?
low carb diet are not recommended in mang. of DM
ADA recommends 4-60% of total cals from carbs
*********************88
both amt & type of carbs can predict glycemic response
what is retinopathy and why is it a discussion here in DM
retinopathy is a long term complication of diabetes in which the microvascular system of the eye is damaged
what is neuropathy and why is it an issue w/ DM
neuropathy is a long term complication of diabetes resulting from damage to the nerve cell
what is nephropathy
long term complication of diabetes in which kidney cells are damaged. characterized by microalbuniuria in early stages and later to renal disease
what is a BG level that would be considered hypocglycemic
hypoglycemic is low blood sugar
less than 60mg/dL
what is insulin
a hormone secreted by beta cells of the islets of Langerhan of the pancreas. necessary for metabolism of carbs, proteins, and fats. A deficiency results in DM
what is a keytone and why is it a part of this picture
keytones are highly acidic substances formed when the liver breaks down free fatty acids in the absence of insulin. the result is diabetic ketoacidosis
what is diabetic ketoacidosis?
DKA is diabetic ketoacidosis. a type 1 DM metabolic issue resulting from deficiency of insulin. Keytone acid bodies are formed making acidosis. puts you in the hospital for Tx from not watching your diabets regiment.
insulin is secreted by the pancreas. how many types of cell s in the isles of Langerhans are in the pancreas?
4 types of cells are in the pancreas. Insulin is an anabolic or STORAGE hormone. when you eat, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells.
insulin makes is so cells can:
transport / metablize glucose for energy
stimulate storage of glucose in liver and muscle (as glycogen)
signals liver to stop release of glucose
enhances storage of fat in adipose tissue
accelerates transport of amino acids from diet into cells
what else?
insulin also inhibits breakdown of stored glucose protein and fat