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43 Cards in this Set
- Front
- Back
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Type I vs. Type II
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Type I: 10%, juvenile or young adult onset. Does not produce insulin
Type II: 90%, usually onset after 40, Dec insulin production or dec'd receptor sensitivity (less binding to insulin) |
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What nationalities are most at risk to develop DM
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Native Americans
Latino Americans Asians Pacific Islanders |
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What happens to glucose after a meal w/ DM?
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After a meal we have an increased BG--which is normally converted to glycogen in the liver and sent out to skeletal muscle and fat for storage
With dec insulin glucose stays in BS b/c not taken up by tissues Inc synthesis of glucose by liver |
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Protein and fat metabolism in DM
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AA's require insulin to be taken up by cells, so protein synthesis is impaired
Fat is partially broken down to liberate glucose and this oxidation results in production of ketone bodies |
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What happens to osmotic conditions with DM
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Excess glucose in blood pulls water out of cells and into BS = hyperosmotic
Fluid loss thru kidneys b/c excreted with glucose (glucosuria) Causes increased thirst and overall pulling of fluid from the interstitial tissues |
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What meds may exacerbate hyperglycemia?
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Corticosteroids (GCCs)
GH Epi Also STRESS can result in inc'd BG levels |
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s/s of uncontrolled DM
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Polyuria and polydipsia (thirst)
Polyphagic = sig inc in appetite (typically seen with type 1) Weight loss: improper fat metabolism (type 1) Inc in BG > 126 mm/dL (fasting) Glycouria Ketourea Fatigue/weakness Blurred vision Irritability Recurrent skin, gums, bladder infections N/t peripheral limbs Cuts/bruises that don't heal well |
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Brittle diabetic
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Uncontrolled (usually type 1) DM
Large swings in BG from hypo to hyperglycemia Can't seem to get BG under control Large swings = longer term and more serious effects |
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Diagnosis of DM
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Fasting BG >126 mg/dL on 2 deperate days
>100 mg/dL = pre diabetic |
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Complications of DM
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Infection
Atherosclerosis Macrovascular dx Microvascular dx |
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Macrovascular dx associated with DM
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CVD
CAD RAD PVD |
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Microvascular dx associated with DM
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Retinopathy
Dec's in microcirculation to skin and organs Neuropathies - peripheral and ANS |
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Peripheral vs. ANS neuropathis wih DM
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Peripheral = polyneuropath and diabetic foot
ANS may cause Gastropareses, problems with diarrhea, incontinence, postural hypotension |
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MSK issues that may emerge with DM
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CTS
Charcot joint: diabetic arthropathy Periarthritis Hand stiffness, flexor tenosynovitis, dupetrens contracture (4 and 5 digits curl in), reflex sympathetic dystrophy (CRPS) |
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Why is depression common with Type II DM?
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Assoc'd with inc'd mortality
Think it's hopeless to check lood sugar, don't regulate dieat, won't exercise, take medication holidays |
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What is diabetc neuropathy due to?
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Secondary to accumulation of sorbitol in nerve cells
Sorbitol is a byproduct of improper glucose metabolism Waht you get is an abnormal fluid and electrolyte shift which leads to nerve cell dysfunction |
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What combo with DM causes diabetic neuropathy
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Accumulation of sorbitol with dec'd vascular perfusion to clear the sorbitol
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What inc's your risk of neuropathies with DM?
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Duration and severity of DM (accumulative effect)
Elevation of TG's High BMI Hx or smoking Hx of HTN |
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Clinical presentations: PNS
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Chronic sensorimo. distal polyneuropathy
Burning/numbness in feet Classically bilateral mm weakness and drop foot 5-16% have CTS due to ischemic changes to median nerve b/c of microvascular changes |
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Clinical presentations: ANS
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Problems with BP and HR
Inc'd sweating Bladder dysfxt Gastroparesis ED |
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What is Charcot Joint?
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Neuropathic arthropathy brought on by dec in proprioception, severe degenerative arthritis, and CPPD/Chondrocalcinosis (crystals depositing into joint spaces called pseudo gout)
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What s/s does Charcot Joint present with?
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Shoulder, hand, feet
Warmth, redness Severe unilateral swelling Sensitivity to deep pressure Less pain than expected Normal X-ras |
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Diabetic shoulder - Type 1 or 2?
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Odd presentation - adhesive capsulitis with no mechanism of injury. Does not follow typical adhesive capsulitis and have lots of spontatneous remission & exacerbation
Particularly hard end feel Type 1 > type 2 |
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Charcot's Joint - cause?
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Neuropathic arthropathy from dec'd sensory and mo. control leading to cont'd painless trauma
Bony destruction, resoprtion, and eventual deformity Normal x-rays early on before deformity Swelling, warmth, redness, deep pressure sensitive |
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Education for DM
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Shoe sweep, etra depth shoes, foot inspections
Wounds often become known to pt when they smell it |
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Periarthritis
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5x more common in DM
Often bilateral, mechanism unkown, presents in unpredictable manner Can have spontaneous recovery with sudden exacerbations No matter what you do during exacerbation, nothing will change it |
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Things causing hand stifness in DM?
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Limited joint mobility syndrome
Flexor tendon synovitis Complex regional pain syndrome |
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Presentation of CRPS and possible tx suggested by Dr. T
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Skin loses hair over region
Glossy appearance to skin Rubor Touch painful Extreme hyperesthesia seen in periphery (Hands/feet) TENS superior to affected area to block pain stimulus, and then progressively use different surface contacts |
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What should glucose be maintined between ideally?
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80-120 mg/dL
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Ex with DM?
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Type 2 - ex improves ability to use insulin (helps translocation of Glut4 receptors to cell surface)
Will dec insulin released by pancreas Causes mm to take up glucose EX MUST be planned event |
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What BG levels will you postpone ex? Any other conditions that will cause you to postpone ex?
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>250 mg/dL
<100 mg/dL have them ingest 10-15 g CHO snack Postpone if active nephropathy or retinopathy (at least avoid high intensity) |
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Ex considerations for Type 1 diabetic
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May need to dec insulin or food intake when initiating ex program
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2 types of hyperglycemic states
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BG > 400 mg/dL
DKA - type 1 Hperglycemic hyperosmolar nonketotic coma - type 2 |
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What is DKA and why does it predominatley occur in type 1?
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Diabetic ketoacidosis results from severe insulin deficiency, as often occurs in undiagnosed type 1
No insulin and body turns to lipolysis, and ketones are a byproduct of FA metabolism |
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What is HHNC and why does it occur predominatley in type 2? Possible causes?
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Hyperglycemic Hyperosmola non-ketotic coma
Occurs more with older adults Presence of insulin inhibits lipolysis--results in high glucose without ketoacidosis Infecitons, meds (corticosteroids), surgery (stressor = dump cortisol), certain procedures (dialysis) |
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S/s of severe hyperglycemia. Action?
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Lethargy and stupor, confustion, change in mental function
Get a finger stick and physician referral |
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Definition of hypoglycemia and cause?
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<70 mg/dL
Dec food intake or inc physical activity all RELATIVE to your normal glucose level Also occurs if their is a major complication with insulin |
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How can someone present with signs of hypoglycemia even if BG is still high?
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Relative change (400 to 200) will cause s/s of hypoglycemia
The more rapid the drop in BG the more severe the s/s |
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What med may increase the risk of hypoglycemia?
Tx? |
B blockers
10-15 g CHO snack (fruit juice) 8 oz glass of milk 2 oz of honey |
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Define DM
What does hyperglycemia lead to |
Chronic d/o caused by deficient insulin production or insulin action in the body
Disruption in carbohydrates, fats, & proteins |
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Why shouldnt you inject insulin into a muscle before intense exercise of that mm
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Exercise speeds up metabolism in the muscle and the insulin will be broken down quicker
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What is a good recommendation for type 1 diabetic pts beginning an exercise program
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Decrease insulin injection dosage and increase food intake
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What may be a good tool to use to control blood sugar levels during exercise
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Insulin pump
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