Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
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
|