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62 Cards in this Set

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blood glucose; control reduces complications of diabetes
excessive thirst related to dehydration
excessive hunger related to cellular starvation…along with weight loss
high blood fat levels; treatment essential to prevent complications of diabetes
high blood glucose level; chronic forms are the main feature in diabetes; causes fluid and electrolyte imbalances which result in the classic symptoms of diabetes which are polyuria, polydipsia, and polyphagia
protein made up of 51 amino acids in two peptide chains; insulin is like a key to open cell membranes to glucose by binding to insulin receptors on the cell membranes…liver is the first to be reached by blood insulin…..glycogenesis and glycogenolysis occurs; pancreas secretes about 40 to 50 units of insulin daily directly into liver circulation in a two-step manner….low levels when fasting (basal insulin secretion) and
increased levels after eating (prandial)
pertaining to a meal
early burst of insulin secretion occurs 10 minutes after eating….insulin increasingly released as long as hyperglycemia present
normal blood glucose levels?
68 to 105 mg/dL (3.6 to 5.8 mmol/L) which supports brain functions
frequent and excessive urination resulting from an osmotic diuresis caused by excess glucose in the urine….resulting in sodium, chloride, and potassium excreted in urine…water loss severe…dehydration results…polydipsia (excessive thirst) occurs
ketone bodies?
small acids formed from abnormal breakdown of fat due to inability of insulin receptors on cell membranes to let blood glucose be transported from outside cell to the inside of the cell; the body’s secondary attempt at maintaining homeostasis…primary attempt is getting blood glucose across cell membrane
increased blood volume
decreased blood volume
thick, concentrated blood
decreased circulation; ex: tissues
poor tissue oxygenation
Kussmaul respiration?
metabolic acidosis possibly caused by insufficient secretion of insulin may trigger the respiratory center in the brain which increases the rate and depth of respiration in an attempt to excrete more CO2 and acid; ACETONE is exhaled, giving off a “FRUITY” odor
acute complications, 3 glucose-related emergencies in diabetics?
diabetic ketoacidosis;
hyperglycemic-hyperosmolar-nonketotic syndrome;
chronic complications of diabetes?
microvascular and macrovascular changes; most are related to vascular changes and constrictions caused by too much sugar in the blood…patient can be a poor surgical risk because of vascular problems and impaired healing…..since diabetes is a systemic disease, most body systems can be affected by it
nonproliferative diabetic retinopathy, NPDR?
causes structural problems in retinal vessels, but growth of new blood vessels is not stimulated; mild form…capillaries balloon and form pouches….swelling can affect the center of the retina and cause vision loss
small capillary wall dilations in retinal vessels; form through the eye
venous beading?
abnormal appearance of retinal veins in which areas of swelling and constriction along a segment of vein resemble links of sausage
proliferative diabetic retinopathy, PDR?
growth of new retinal blood vessels; develops over years….blood vessels become damaged and close off….new blood vessels grow in the retina…weak and often leak blood blocking the client’s vision
a general term used for disorders of the retina…linked to fasting blood glucose levels above 129 mg/dL; hyperglycemia ri blurred vision with glasses…hypoglycemia ri double vision
Prevention of Retinopathies?
keep blood sugar under control
keep bp under control
quit smoking (smoking can increase blood sugar, and blood pressure and it also constricts blood vessels)
see an ophthalmologist once a year to have eyes dilated
Type 1 DM?
caused by autoimmune destruction of insulin-secreting beta cells of the pancreas….results in nearly complete insulin deficiency….without getting exogenous insulin, it’s rapidly FATAL!!...has rapid onset…used to be called juvenile diabetes..usually diagnosed in children or young adults…makes up 5 to 10% of all diabetics….pancreas produces NO insulin….1 in 400 to 1 in 1000 are at risk for developing….greatly increases for those who have at least one parent with diabetes….the range rises to 1 in 20 to 1 in 50
Type 2 DM?
results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion; insulin may be used….specific cause is unknown….progressive disorder in which the pancreas makes less insulin over time…reduced ability of most cells to respond to insulin (insulin resistance)….most are obese adults….most common form of diabetes….most common after 55….used to be called “adult onset” diabetes….makes up 85-90% of all diabetics…with treatment plan compliance, individuals can usually be managed with diet, exercise, and oral meds
viral infections?
mumps, congenital rubella, and coxsackievirus infection appear to trigger autoimmune destruction which is Type 1
may result in blurred vision with glasses
may result in double vision
cardiovascular complications of diabetes?
increased risk of heart attack and stroke due to narrowing of vessels and slowing of blood flow
visual changes associated with DM?
nonproliferative diabetic retinopathy
venous beading
proliferative diabetic retinopathy
vision loss
corneal scarring
changes in lens shape or clarity
open-angle glaucoma
most common complication of diabetes; lessens ability to feel pain, heat, and cold sensations; progressive deterioration of nerves that results in loss of nerve junction; may result in pain or loss of sensation; late complications include foot ulcers and deformities; may be focal or diffuse, but both lead to nerve damage or nerve death
pathologic change in kidney that reduces kidney function and leads to renal failure; DM leading cause of end-stage renal disease (ESRD) and renal failure in U.S.; early sign is microalbuminuria (very small amounts of albumin in urine)
body mass index?
one of the strongest indicators of diabetes; usually over 27 kg/m2 in 68% of diabetics and over 30 kg/m2 in 68% of diabetics; risk increases as weight increases
fasting blood glucose test?
obtain by venipuncture; fast for at least 8 hours (water permitted); draw blood before insulin or oral antidiabetic agents taken; diagnosed when two separate tests exceed 126 mg/dL; pp says considered abnormal if over 140
oral glucose tolerance test?
most sensitive test for diagnosing diabetes, esp for gestational diabetes; diagnosis of diabetes made if blood glucose is greater than 200 mg/dL at 120 minutes
glycosylated hemoglobin assays?
blood glucose permanently attaches to hemoglobin….when blood glucose level increases, hemoglobin becomes more glycosylated….so glycosylated hemoglobin is a good indicator of average blood glucose…rbcs turn over in 120 days…used to assesss long-term glucose control and predicts risks of complications….normal value is 4-6% of total hemoglobin….best indicator of average glucose levels
glycosylated serum proteins and albumin?
serum proteins and albumin become increasingly glycosylated with elevated blood glucose levels…proteins turn over in 14 days…used esp in pregnancies
3 urine tests for diabetes?
ketones, renal function, glucose
urine tests for ketones?
test used during acute illness or stress or following a weight loss program; presence of ketones may indicate ketoacidosis
urine testing for renal function?
presence of protein in urine; excretion rates of 20 to 200 g/min indicate microalbuminuria; if proteins detected, followup with creatinine clearance tests…increase in creatinine level normal range is 0.6 - 2 g/24 hr…related to poor blood glucose control and hypertension
urine testing for glucose?
less precise than blood testing….measured indirectly in the urine…less precise….fluid intake, urine concentration, time since last voiding, and certain drugs may affect results
preprandial blood glucose levels?
should be 80 to 120 mg/dL
bedtime blood glucose values?
100 and 140 mg/dL
sulfonylurea agents?
used only with some remaining pancreatic beta-cell function; stimulates insulin secretion;
less expensive….can be taken once daily…few side effects
meglitinide analogs?
Repaglinide (Prandin) similar adverse and actions to sulfonylurea agents…take before meals…rapid onset….limited duration of action
Nateglinide (Starlix) lowers blood glucose by triggering insulin secretion via interaction with ATP-sensitive potassium channel on pancreatic beta cells….rapidly absorbed….stimulates insulin secretion within 20 minutes of ingestion…major effect is hypoglycemia
Metformin (Glucophage) lowers glucose by decreasing liver glucose release and decreasing cellular insulin resistance…does not stimulate insulin release; has more GI side effects than sulfonylureas
alpha-glucosidase inhibitors?
reduces hyperglycemia after meals by slowing intestinal digestion and absorption of carbohydrate…inhibit enzymes in intestinal tract, delaying carbohydrate digestion…this reduces rate of glucose absorption and lowers blood glucose levels
Acarbose (Precose)…use low dose three times daily and increased slowly…must take BEFORE meals
Miglitol (Glyset) should be taken three times daily with first bite of each main meal
thiazolidinedione antidiabetic agents?
enhance insulin action; improve sensitivity to insulin in muscle and fat tissue and inhibit gluconeogenesis; can be combined with sulfonylureas or insulin
Rosiglitazone (Avandia
Pioglitazone (Actos)
an increased swelling of fat that occurs at the site of repeated insulin injections; treat by rotating the injection site among different body areas; increased fat deposits in the skin caused by not rotating injection sites
loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in beef or pork insulin; treat by injecting human insulin at the edge of the atrophied area; loss of fatty tissue, leaving an uneven appearance caused by not rotating injection sites
dawn phenomenon?
results from a nighttime release of growth hormone that causes blood glucose elevations at about 5 to 6 am.
Somagyi’s phenomenon?
morning hyperglycemia from the effective counterregulatory response to nighttime hypoglycemia
gestational diabetes?
occurs during pregnancy…usually disappears after birth…higher risk for development later in life for both mother and infant….must be controlled…2 to 3 times risk for congenital anomalies….diet, exercise and insulin balance it….causes difficult delivery
signs and symptoms of diabetes?
elevated blood glucose
blurred vision
numbness or tingling in hands and feet
chest pain
reoccurring infections
cuts that are slow to heal
FBS, fasting blood sugar?
normal is 80 to 120; considered abnormal if over 126 x 2
see your eyecare professional if?
vision is blurry
trouble reading books or signs
see double
one or both of your eyes hurt
continued eye redness
feel pressure in eyes
see floaters
peripheral vision decreases
foot care?
see podiatrist at least every 6 months
need well fitting socks and shoes
soak feet, but careful with water temp
wear 100% cotton socks
teach foot inspection
foot care don’ts?
DON’T go barefoot
use heating pads on feet
cut own toenails
use corn remover medicine
wear high heels
wear sandals
wear knee-highs
dental care?
needs good daily dental hygiene
prone to periodontal disease
should see dentist or periodontist q 3 months
diabetic diet components?
fats – 30%
<10% saturated fat
cholesterol 300 mg or less
complex carbohydrates 50 – 60%
proteins 10 to 20%