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45 Cards in this Set
- Front
- Back
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Diabetes Risk Factors
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• Family history
• Obesity • Race • Advancing age • Hypertension • Hypercholesterolemia • Gestational diabetes |
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Classification of Diabetes
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• Type 1 Diabetes
• Type 2 Diabetes • Gestational diabetes mellitus • Diabetes mellitus associated with other conditions; trauma, surgery, Cushing syndrome, drug induced, cystic fibrosis, hyperthyroidism |
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Type 1 Diabetes
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• 5%-10% ( 1 of 10) of diabetics
• Usually before age 30 • Beta cells destroyed/ produce no insulin • Autoimmune response • Environmental factors-toxins, viruses • Need insulin to preserve life • Genetic predisposition- HLA |
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Type 2 Diabetes
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• 90%-95% of people with diabetes
• >30 years & obese • Increasing number of children • Onset of type 2 undetected for years |
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Impaired Glucose Intolerance
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• Usually pre-diabetic/borderline diabetic
• Fasting blood sugar between 100-125 (previously 110-125) • 29% eventually develop diabetes • Greater susceptibility for cardiovascular disease |
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Normal Physiology of Diabetes
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• Food breaks down into glucose
• Levels of glucose rise in blood • Beta cells in pancreas secretes insulin into blood • Insulin transports glucose from the blood into the muscle, liver & fat cells • In the body cells, insulin metabolizes glucose for energy = Fuel |
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Pathophysiology: Type 1
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• Destruction of beta cells
• Results in: – Decreased or no insulin production – Fasting hyperglycemia – Glucose from food can’t be stored in liver = hyperglycemia – Kidney excretes glucose at levels of 180-200mg/dl = glucosuria – Osmotic diuresis – Fat broken down = ketones produced |
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Pathophysiology: Type 2
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• Insulin resistance
• OR • Impaired beta cell functioning leading to decrease insulin production • Insulin less effective on cell receptors, more insulin is required • Beta cells can “burn out” as more insulin is required • Enough insulin present to prevent fat breakdown = no ketone production |
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Insulin Resistance
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• Major factor in Metabolic syndrome
• Insulin less effective at cellular receptive sites • More insulin released to “over ride” IR • High insulin levels increase obesity, cardiovascular, hypertension & high cholesterol & triglycerides • Acanthosis nigricans |
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Diagnostic Tests
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• Fasting Plasma Glucose (FPG) >126mg/dl (No intake for 8 hrs)
• Random Plasma Glucose > 200mg/dl • Oral Glucose Tolerance Test = no longer recommended for clinical use |
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ADA Criteria
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• Signs & symptoms of diabetes + RBS > 200
• OR • FBS > 126 • OR • 2 hr postprandial glucose level > 200 |
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• Three P’s
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– Polyuria
– Polydipsia – Polyphagia |
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• Type 1-Acute- Behaviors
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• Sudden weight loss
• Nausea,vomiting • Abd cramping • Fatigue • Irritable, trouble functioning in school |
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• Type 2-Behaviors
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• May have NONE
• Fatigue • Dry, itchy skin • Blurred vision • Genital itching • Numbness in hands |
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Hyperglycemia
Diabetic Management |
• Nutrition
• Exercise • Monitoring • Pharmacological therapy • Education |
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Nutrition
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• Control total caloric intake
• Control blood glucose levels • Type 2 –weight loss primary treatment • Type 1 –consistency in time interval between meals with added snacks, balance calories & CHO • Carb counting |
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Meal Planning
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• Consider:
• With insulin: have a greater flexibility in timing and content of meals • Previously: individuals needed to maintain constant dose of insulin and adjust schedule |
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ADA Recommendations
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• CHO = 50 to 60% of calories
• Fat = 20 to 30% of calories • Protein = 10 to 20% of calories |
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Diabetic Food Pyramid
Exercise |
• Can prevent or delay Type 2 diabetes
• Increases uptake of glucose by muscles & improves insulin utilization • Reduces cardiovascular risk factors • Increases HDL’s, decreases triglycerides & total cholesterol level |
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Considerations
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• Blood glucose > 250 and with ketones in the urine should not begin exercising until the levels return to normal
• Medical ID should be worn |
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Exercise Recommendation
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• Same time and same amount each day
• Slow, gradual increase • Walking is safest and most beneficial |
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Monitoring Glucose Levels
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• Self Monitoring of Blood Glucose SMBG
– Advantages – Disadvantages • HgbA1C – Blood test reflects BG levels over 2-3 mos. – Glucose molecules attach to HgB – Normal range 4%-6% – Goal is <7% |
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Insulin
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• Goal: mimic normal pancreas
• Varies from 1-4 injections/day • Usually see combination of short & long acting |
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Rapid-Acting Insulin
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• Names:
– Humalog (Lispro) – Novolog • Onset: 5-15 min • Peak: 1 hour • Duration: 2-4 hours • Precaution: |
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Short-Acting Insulin
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• Names:
– Regular • Onset: 30 to 60 minutes • Peak: 2-3 hours • Duration: 4-6 hours • Clear solution |
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Intermediate-Acting Insulin
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• Names:
– NPH, Lente • Onset: 3-4 hours • Peak: 4-12 hours • Duration: 16-20 hours • White, cloudy • Precaution: |
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Long-Acting Insulin
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• Names:
– Ultralente • Onset: 6-8 hours • Peak: 12-16 hours • Duration: 20-30 hours |
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Very Long Acting Insulin
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• Name:
– Lantus • Absorbed slowly over 24 hours • Precautions: |
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Insulin Regimen
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• Goal: mimic normal pancreas
• Varies from 1-4 injections/day • Usually see combination of short & long acting • Accuchecks, CHO counting may be used to vary insulin doses – Allows flexibility in timing and content of meals and exercise periods |
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Complications of Insulin
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• Allergic reactions
• Lipodystrophy: – Lipohypertrophy – Lipoatrophy: rare • Dawn phenomenon • Somogyi effect |
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Oral Anti-diabetic Agents
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• Stimulate pancreas to produce insulin
• Enhance insulin action at receptor sites • Not used in pregnancy • Diet and Exercise still needed |
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Types of Oral Hypoglycemics
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• Sulfonylureas (Glyburide, Glypizide)
– Stimulate pancreas to secrete insulin • Metformin (Glucophage) – Enhance insulin action on receptor sites • Acarbose: – Delay absorption of glucose in GI tract • Actos, Avandia – Enhance insulin action at receptor site without increasing secretion from beta cells |
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Education
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• Diet
• Exercise • Total educational plan |
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Hypoglycemia: Behaviors
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• Shakiness
• Dizziness • Sweating • Nervousness • Irritability • Headache • Weakness • Pale skin • Hunger • Numbness or tingling around the mouth |
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Hypoglycemia Untreated
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• Confusion
• Seizures • Loss of consciousness |
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Management
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• Immediate treatment
• Conscious: – 15 g of fast acting CHO orally • Unconscious- Glucagon 1 mg IM/SC • In hospital- 1 amp (50ml) 50% dextrose IV push over 3- 5 minutes |
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Glucagon
Diabetic Ketoacidosis |
• Hyperglycemia- increased glucose level
• Dehydration & electrolyte loss- due to kidneys excreting Glucose, Na & K • Acidosis- breakdown of fats & converted to ketone bodies by liver • Caused by decreased insulin, illness, or undiagnosed/untreated diabetes |
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Symptoms of DKA
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• Fruity breath
• Vomiting • Stomach cramps or pain • Extreme weakness • Sleepiness • Difficulty breathing • Coma |
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• Long Term Complications:DKA
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– Macrovascular
– Microvascular – Neuropathy |
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Macrovascular Complications
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• Result from changes in medium to large blood vessels
• Types: – Coronary artery disease – Cerebrovascular disease – Peripheral vascular disease |
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Microvascular Complications
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• Characterized by capillary basement membrane thickening
• Areas affected: – Retina – Kidney |
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Nephropathy
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• With increased glucose levels, kidney’s filtration mechanism is stressed
• Blood proteins leak into urine increasing pressure in the kidney blood flow • Microalbuminia seen in 24 hour urine collection |
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Diabetic Neuropathies
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• Affects all types of nerves
• Behaviors: – Paresthesias – Burning sensation – Numbness – Decrease in proprioception – Decrease sensation of light touch, pain, temperature |
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Foot and Leg Problems
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• 50 to 70% of amputations associated with diabetes
• Contribute to increase risk: – Neuropathy – Peripheral vascular disease – Immunocompromise |
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Foot Care
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• Properly bathe, dry and lubricate feet
• Wear closed-toe shoes that fit well • Trim nails straight across |
