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69 Cards in this Set
- Front
- Back
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In diabetic state, (2) |
1. cells dont respond to insulin OR 2. Pancreas stops producing insulin. |
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Major source of glucose (2) |
1. Food 2. Liver forms glucose from ingested food substances. |
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Hormone produced by pancreas, controls level of glucose in blood. ______% of population > 65 years old have some degree of glucose intolerance. Higher prevalence in (4) |
INSULIN 50% 1. Hispanics 2. African Americans 3. Native Americans 4. Caucasian "apples" |
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DM is the leading cause of new ________ in 25-74 year olds. Leading cause of non-traumatic ________. 50% of patients beginning _______ have DM. |
Blindness Amputations
Dialysis |
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(#) ______ leading cause of death by disease. ____ - _____ times higher hospitalization in DM pts. High economic _____ for care of DM. |
3 2-5 cost |
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Goals for DM pts (2) |
1. Control BG levels 2. Prevent acute/chronic complications |
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In the pancreas, the islets of Langerhans contain ____ cells which produce _______. (Eat meal--insulin secretion-- glucose transported by ______ from _____ to muscle, liver, and fat cells) |
Beta Insulin Insulin Blood |
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Inside cells, insulin: 1. Transports/Metabolizes ______ ie energy. 2. Stimulates glucose storage in _____/_______. ie stored energy 3. Storage in ______ tissue of fat. ie reserve energy 4. Transports _____ derived amino acids into cells ie energy |
Glucose liver/muscle adipose protein |
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Fasting periods btwn meals @ night: ______ releases a small amount of insulin-- BG level decreases-- _____ secreted by alpha cells in islet of Langerhans-- ____ and _____ stimulate liver to release stored ______-- BG level maintained. |
Pancreas Glucagon Insulin & Glucagon Glucose |
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Extended fasting periods > 12 hrs: Liver breaks down Glycogen (________) plus Amino Acids (_________). |
Glycogenolysis Gluconeogenesis |
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TYPE 1 DM: aka ________ ____ - _____ % of DM Onset: _______ Thin/recent weight loss Genetic/immunologic/environmental causes ______ to islet cells and insulin _____ endogenous insulin Treatment: _____!!! Predisposed to ________. |
Juvenile Diabetes, Insulin Dependent DM, T1DM 5-10 <30 yrs old Antibodies NO INSULIN DKA |
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TYPE 2 DM: aka ________ ____-_____% of DM Onset: _______ Wt: _______ (80%) Genetic/immunologic/environmental causes _____ to islet cells and insulin Decreased ______ to insulin (insulin resistance) or _______ insulin. |
Adult Onset 90-95% > 30 years old. OBESE NO Sensitivity Endogenous |
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Treatment of TYPE 2 DM: (3) Predisposed to ______ which stands for? |
1. Weight loss through diet & exercise 2. Oral Anti diabetics 3. Insulin HHNS Hyperglycemic Hyperosmolar Nonketotic Syndrome |
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DM associated with other syndromes secondary to Pancreatic disease, hormonal abnormalities, Drugs. (corticosteroids, estrogen) Treatment: (2) |
1. Oral Anti Diabetic Meds 2. Insulin |
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Gestational DM: (30-40% develop Type 2 DM within 10 years.) Occurs in 2-5% of all pregnancies in 2nd/3rd trimester.. Treatment: (3) |
1. Diet
2. Insulin 3. No PO meds. |
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What does IGT stand for? What is it? *BG levels fall btwn normal & diagnostic for DM Treatment (2) |
Impaired Glucose Tolerance Borderline DM, Latent DM, Chemical DM, Subclinical DM. 1. Diet Modifications 2. Wt loss if obese |
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Previous/Potential Abnormality of Glucose Tolerance: Treatment (2) |
1. Diet Modifications 2. Wt loss if obese |
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Previous history ^BG ie gestational DM Obese Family History Mother of >9 lb baby Ethnicity |
Risk factors of Previous/Potential Abnormality of Glucose Tolerance |
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Destruction of beta cells of pancreas |
Type 1 DM |
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Type 1 DM: 1. Genetically predisposed- _______ 2. Autoimmune response- ____ attack normal body tissues ie autoantibodies against islet cells. 3. Environmental factors- _____/_____ cause autoimmune response. |
HLA (Human Leukocyte Antigen) Antibodies Viruses/ Toxins |
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Type 1 DM PART ONE: Destruction of ____ cells -- excess glucose produced by liver causes _____ ______-- glucose from food cant be stored in liver remains in blood stream causing _______ _______-- ^BG concentration exceeds renal threshold (____-____) -- Kidneys cant reabsorb all filtered glucose causing _______ (glucose in urine) accompanied by F&E losses in urine causing _____ diuresis. |
Beta Fasting Hyperglycemia Postprandial Hyperglycemia 180-200 Glucosuria Osmotic |
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Type 1 DM PART TWO: Insulin deficiency-- ^glycogenolysis ( _____ of stored glucose) -- gluconeogenesis (production of _____ from amino acids and ______) causing further _______-- Fat is broken down causing production of _____( ketoacidosis) ie _____. |
breakdown glucose protein hyperglycemia Ketones DKA |
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TYPE 2 DM: Decreased _______ of tissues to insulin-- ^ cellular reactions of glucose ______-- Decr insulin effectiveness at stimulating glucose uptake by ______ ^ secretion of insulin to maintain normal ______ levels-- Beta cells ______ -- ^ demand of _____. ^ BG-- type 2 DM. |
Sensitivity metabolism tissues BG Overworked Insulin |
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Clinical S&S of T2DM ie Hyperglycemia: (3) |
1. Polyuria 2. Polydipsia 3. Polyphasia |
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Family History Obesity Ethnicity Age >45 Baby > 9lb Hypertension (>140/90) HDL < 35 TG >250 History of disease |
Risk factors for DM type 2 |
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DIAGNOSTIC: *these apply when done on 2 diff. occasions and on 2 or more days. Random BG level Fasting BG 2 hr Post Prandial BG |
> 200 >126 >200 |
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Geriatric Considerations: BG ____ with age _________ complications develop Causes: _____ diet physical _______ decrease in lean ____ _____. Altered _____ secretion. Insulin ______. |
^ Macro vascular (Heart, Legs, Brain) Poor Inactivity Body Mass Insulin Resistance |
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Management of Geriatric Considerations: (5) |
1. Nutrition 2. Exercise 3. Monitoring BG 4. Pharmacologic Treatment 5. Education |
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Goals associated with Geriatric Patients: (3) |
1. Normalize insulin activity 2. Normalize blood glucose levels 3. Prevent vascular and neuropathic complications |
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DAILY NORMALS: Random BG: Fasting BG: 2 hr post prandial BG: |
>140 70-109 >140 |
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IMPAIRED BG #s: Random BG Fasting BG 2 hr Post Prandial BG |
140-199 110-125 140-199 |
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Intensive treatment with multiple insulin injections Decr long term complications Adverse effect = Hypoglycemia |
DCCT (DM Complications & Control Trial) |
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Nutrition Goals (5) *Strive for consistency in amt of calories, amt of CHO, and time btwn meals. This prevents hypoglycemia reactions-- Controls BG. |
1. Proper diet 2. Weight Control 3. Meet energy needs 4. Prevent wide BG fluctuations 5. Decr serum lipid levels |
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Obese patients (usually type 2) decr calories= ____ _____ BMI 20% above ideal body weight =_______, which causes an ^ in insulin ________/ Decr in insulin ______. In type 2 with wt loss # of insulin receptors on cells increase thereby allowing _____ to better enter cell. Weight loss may _____/_____ need for po/sq meds. Encourage pt to lose ___-__% of total weight. Encourage _____ therapy, group support, nutrition ______ for long term ________. |
Weight loss Obese Resistance Sensitivity Glucose Reduce/Eliminate 5-10 Behavior Counseling Adherence |
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Calorie Requirements & meal planning: 1. Obtain thorough diet _____ 2. Identify eating _____/lifestyle 3. Determine need for weight ____/_____/______. |
1. history 2. habits 3. loss, gain, maintenance |
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Goal of Meal Planning: 1. Control of total ______ intake. 2. Attain/Maintain acceptable ____ _____. 3. Control _____ level. How to develop a meal plan: (3) |
Caloric Body weight BG 1. calculate pt calorie requirements 2. Activity factor determined calories needed for weight maintenance 3. Distribute CHOs, proteins, fats, and develop meal plan. |
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1995 Exchange List for Meal Planning: SOLUTION: develop ______ & _______ meal plan for patient r/t eating habits and lifestyle. |
Realistic Individualized |
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% of calories from CHOs, fats, and protein ^ Consumption of CHOs = ^ _____ |
Calorie Distribution PPBG |
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Greatest effect of BG level--Quick Digestion-- Rapid conversion to glucose. What percent of calories in diet? *Starches--bread, cereal, pasta, rice are ____? *Fruit, sugars, sucrose in moderation to avoid fat empty calories. are _____? |
Carbohydrates 60% Complex Simple |
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Fat accounts for ____-____ % diet cals. Saturated fat <____% Cholesterol < ____ mg/day Protein accounts for _____- ____ % of diet. Protein sources: |
20-30 10 300 10-20 Meats, nuts, legumes |
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Decr total cholesterol Decr LDLs Improves BG |
Fiber |
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2 types of fiber Sources Insoluble-- best if added _______ may require insulin/po med adjustments |
1. Soluble 2. Insoluble 1. Soluble- Legumes, oats, fruits, decr BG, decr lipid levels 2. Insoluble- Whole grain breads, cereals, vegetables, ^stool bulk, ^ satiety |
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SE of Intake of Fiber (5) |
1. Abdominal Fullness 2. Nausea 3. Diarrhea 4. Flatulence 5. Constipation |
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Food Classification Systems: (3) |
1. Exchange lists 2. Food Guide Pyramid 3. Glycemic Index |
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Glycemic Index: 1. combine starchy foods with _____. Fat foods slows ______ ie Decr ______ response. 2. Raw/whole foods-- Decr glycemic response r/t ______, pureed, ___ foods. 3. Whole Fruit-- Decr glycemic response r/t ____ ____. 4. Eating _____ sugar foods with ____ absorbed foods-- Decr Glycemic response. |
1. Protein Absorption Glycemic 2. Chopped Cooked 3. Fruit Juice 4. Simple Slowly |
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Moderation is the key with _______ & ________. Use caution with food ______. *sugarless, sugar-free, dietetic, health foods |
Alcohol Sweeteners Labels |
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Alcohol causes _________( worse with type 1) -- gluconeogenisis Wt gain Hyper______ Hyper______ Instruct ____ intake with alcohol. Incorporate _____ from alcohol into meal plan. |
Hypoglycemia Hyperlipidemia Hyperglycemia Food Calories |
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Nutritive Sweeteners-- contains ______ *fructose, sorbitol, xylitol, provide cals similar to sucrose, less ^ in BG, "sugar-free" foods. Non Nutritive -- contains few or no ______ *saccharine, aspartame, sunnette, sucrolose, minimal or no ^BG. |
Calories Calories |
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Diet Teaching: INITIAL: 1. ______ eating habits with common foods. 2. Relationship of foods to _____ & ____ meds. 3. Individualized meal plan-rigid= __________ FOLLOW-UP: 1. In depth ________ skills- restaurant, food labels, exercise and _____ adjustments. *Do not _____, know pt limits, simplify, repeat, allow ______. |
Consistent Insulin & Meds Unsuccessful Management Illness Overwhelm Practice |
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Benefits of Exercise (9): |
1. Decr BG 6. Incr Glucose Uptake 2. Decr Cardio risk 7. Incr Insulin Utilization 3. Decr TC 8. Incr Weight Loss 4. Decr Stress 9. Incr HDL 5. Decr TG |
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Pt with >250 and + ketones-- Eat 15 gm CHO with protein and exercise-- Exercise when peak BG levels... when?? Hypoglycemia many hours P exercise: Snack P _____ & at ____. Monitor BG closely. |
No exercise until ketones negative and BG WNL Type 1 Patient 30 min- 1hr after meals exercise HS |
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Extended exercise: CK BG when? Eat CHO snacks when? Make sure others are aware of diagnosis. |
a/during/p a/during/p |
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OBESE TYPE 2 & EXERCISE: No snack a/p exercise unless ? ^ Insulin ______ ^ Glucose ______ Decr ______ Decr need for po/sq meds Exercise same time/same amt q day ______ exercise best; ______. Slow ______ increase in length |
S&S Decr BG Sensitivity Metabolism Weight Regular Walking Gradual |
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Pt > 30 years old with 2+ risk factors needs exercise stress test..
Risk Factors: (7) |
1. HTN 5. Abn ECG 2. Obese 6. Smoker 3. Sedentary 7. Family History 4. Hyperlipidemia |
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Self monitoring of BG (allows: ) *q 6-12 mo compare BG machine with lab venipuncture *Instruct proper usage and observe return demo. |
Glucometer adjustment of treatment regimen better BG control detect prevent decr/incr BG reduces long term complications |
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Cost Visual Acuity Fine Motor skills Cognitive Ability Technology Willingness |
Cons of Glucometer |
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1. Type 1 pts with ac/hs inj 2. Pt. with severe ketosis/hypoglycemia 3. unstable DM 4. Decr BGs warning signs/symptoms 5. abnormal renal glucose thresholds 6. periods of illness or ^ activity level. *keep record book *know parameters to notify MD |
Candidates for SBGM (Self blood Glucose Monitoring) |
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Glycosylated Hemoglobin/ Hemoglobin A1C avg. _________ A1C of 6 represents _____ Define: |
BG over last 3 mo. 120 Measure of glucose bound to Hgb. |
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Urine Glucose Testing: Actual BG not reflected at time of test Renal Threshold is ? WNL? Urine Ketone Testing: Body breaking down ____ _____ Impending _____ Reagent strip changes color with ? |
180-200 0-180 stored fat DKA Positive Ketones |
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Rapid acting: Onset: Peak: Types: *fork in hand insulin *watch for shaky, sweating, tachycardia (hypo) during peak. |
5-15 min 1 hr 1. Lispro 2. Glulisine 3. Aspart |
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Short Acting: Onset: Peak: Types: |
30 min- 1 hr 2-3 hr Regular Insulin |
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Intermediate Acting: Onset: Peak: Types: * Watch for hypo 8 hrs into peak. |
3-4 hrs 4-12 hrs Isophane/ NPH |
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Long Acting: Onset: Peak: Types: |
6-8 hrs 12-16 hrs Ultralente |
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Continuous Acting: Onset: Peak: Types: *Watch for hypo ALL day. |
30 min - 1 hr 24 hr Glargine |
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Local Allergic reaction Systemic allergic reaction Lipodystrophy Resistance Morning Hyperglycemia |
Insulin Complications |
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mimic normal pattern of insulin secretion use results of glucometer to adjust |
Insulin Regimens |
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Methods of insulin delivery (6) |
1. syringe 2. pen 3. Jet injector 4. insulin pump 5. inhalent insulin (OFF MARKET) 6. Transplant of pancreas or islet cells. |
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Amylinomimetic Used in _____ with insulin Do not mix in same syringe for which type? Dosed in mcgs Admin with ____ time insulin doses |
Conjunction Type 1 & 2 Meal |
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Incretin Mimetic Causes ____ _____ For which type? Dosed in mcgs Admin ____ with 2 largest meals. |
Weight loss Type 2 only BID |
