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150 Cards in this Set
- Front
- Back
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a disorder which exibits defective or deficient insulin secretory response - glucose underutilization and hyperglycemia.
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diabetes mellitus
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who has a higher incidence and present earlier in life of diabetes
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african americans and hispanics
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diabetes is a MAJOR contributor to morbidity - a top ten cause of death
t/f |
true
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what are the leading causes of diabetes mellitus
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blindness
end stage renal disease below knee amputaiton |
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a hormone that originates in the beta islet cells of the pancrease (anabolic storage)
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insulin
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what allows for storage of energy into cells
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ANABOLIC STORAGE
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long term _____ can create diabeetes (copd)
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steroids
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insulin is continuously released into bloodstream in small amounts with increased release w/ food injestion...when does it peak
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insulin peaks in 1-2 hours before PE
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where does insulin originate
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in the BETA islet cells of pancrease
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without insulin, what does not enter the intracellular environment
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glucose
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where does glucose remain
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in the EXTRA cellular fluid
ex) blood |
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do cells get glucose?
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no
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insulin is necessary for survival, without it results in
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staravaation and widespread cell dysfunction
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IDDM stands for
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insulin dependant
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NIDDM stands for
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non insulin dependant
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5-10 percent, previously IDDM or insulin depenendant, juvenile is
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type 1
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90 percent, previously NIDDM or non insulin dependant, ADULTS are
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type 2
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child obesity is leading to an increased risk for
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diabetes
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onset or disvovery of diabetes during pregnancy is called
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gestational diabetes
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diabetes caused by medical condition or medis such as corticosteroids, dilantin, thiazides are called
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secondary diabetes
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medication used to treat seizures but can also be a cause of diabetes (secondary diabetes)
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dilantin
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hypertension, hyperthyroidism can be treated with
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Thiazides
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Diabetes POLYTRIAD
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Polyuria (hungry)
Polydipsia (thirsty, drinkin alot) Polyphasia (urinating alot) |
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diabetes/lack of insulin caused by destruction of beta cell function by T cells, islet cell antibodies and insulin autobodies present
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Type 1 Diabetes Melitus
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insulin produced outside of the body , insulin replacement, is known as
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exogeneous insulin
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type 1 a type 1 B - how much percent of insulin reduction before symptoms occur
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80-90percent
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rapid onset of symptoms
usually occur before age 30 and peaks 11-12 year old - increase in growth and sex hormones during puberty - stresses pancrease |
symptoms of type 1 DM
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cells are starving - THIN , growth failure, weight loss =
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catabolic
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cells are hungry, osmotic effects of INCREASED glucose causes
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POLYTRIAD - polyphagia, polydyspia, polyuria
hungry, thirsty, urinating |
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what is caused by too little insulin, high carb intake, physical or emptional stress - most likely in Type 1 DM
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Diabetic Ketoacidosis , DKA
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in DKA glucose builds up in
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ECF
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what is the byproduct of fatty acid breakdown
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ketones
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IN DKA - cells starve and body enteres starvation mode, fat breakdown and hunger results
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In DKA fat breaks down into fatty acids or ketones.
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In DKA fat breaks down into Fatty acid or KETONES and causes
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metabolic acidosis (KETOACIDOSIS)
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Ketones in urine =
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ketonuria
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in diabetics, breath may smell sweet and fruity - ketones may be in urine causing it to be sticky and syrupy- this is knwon as
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ketonuria
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when there is a profound DECREASE in INSULIN = what results
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DKA or DIABETIC KETOACIDOSIS
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ECF high glucose causes high osmotic concentration in blood and
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fluid shifts
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during starvation, the LIVER tries to help - what breaks down to give more glucose in ECF
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glucogen (stored form of glucose)
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HIgh glucose in blood stream casues
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osmotic concentration gradient
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what happens in the osmotic concenrtration gradient
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cells give up H20 to EC spacefor fluid homeostasis
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when cells give up H20 to extacellular space for fluid homeostasis (osmostic concentration gradient) what happens
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cells shrink (thirsty)
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should there be glucose in the urine
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NO
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glucose in bloodstream is filtered where? filtrate has a high glucose concentration
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kidneys
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high glucose concentration is knwon as
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glycosuria
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glucose in kidney filtrate causes an OSMOTIC DIURESIS which causes a
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loss of electroltyes NA , K
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Majority of diabetic deaths are due to
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ketoacidosis
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what leads to ketoacidosis ?
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hyperglycemia
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DKA typical Blood Glucose is
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> 300
causees vomiting, ab pain, ketones on breath, hyperventilattion KAUSMALS, dehydration. |
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what causes a profound loss of H20 and electroltyes leading to the POLYTRIAD and fat breakdown (ketones)...eventually shock, renal failure , coma
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ketacidosis
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to treat DKA
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IV fluids for dehyrdation ISOTONIC
IV Insulin - WORKS QUICK correct electorltye imbalance - K+ IV D5 Glucose to preven Hypoglycemia |
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D5 = Dextrose =
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sugar glucose and water
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serum glucose level > 70 , confusion, irritability, termors, hunger causing weakness, visual distrubances, tachycardia, diaphoresis, coma
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HYPOGLYCEMIA
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WHAT Kind of IV solotion do you give for DKA
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ISOTONIC
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to treat Hypoglycemia
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15-20 carbs, 15 min check glucose, meal snack , check glucose, glucagon IM or SQ, IV dextrose
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MAJOR difference between Type 1 and Type 2 DIABETES
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prescence of ENDOGENOUS INSULIN which can prevent DKA
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Type 2 diabetes is primary a disease of
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OBESITY
92 PERCENT at time of Dx |
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type 2 diabetics have impaired insulin release. a decreased number of insulin receptors in tissues found especially in obesity .
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insulin resistance
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Type 2 DM have what type of onset?
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insiduous
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tYPE 2 DM is usually adult, recently more children that are overweight. what signs and symtpoms do they show
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POLYTRIAD
slow wound hearing unexplained weakness, fatigue visual changes |
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what occurs if there is enough insulin to prevent DKA ...some insulin will prevent fat breakdown which helps to prevent DKA
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Hyperglycemic Hyperosmolar NONKETOSIS HHNK
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what causes extreme dehydration, fluid shifts from ICF to ECF
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non-ketonic hyperosmolar response
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HHNK casues what two major symptoms
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NEURO symptoms such as somnolence, seizures, hemiparesis and coma, and DEHYDRATION
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Severe dehydration can cause death, to treat HHNK you need
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ALOT more fluids than DKA
IV insulin Electrolyes |
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Older patients that are less tolerant of fluids may develop HYPERVOLEMIA and are at risk for
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Congestive Heart Failure
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small vessels of cardiovascular system - type 1 > type 2
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type 1 = MICROANGIOPATHY
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large and med vessels of cardiovascular system Type 2 > type 1
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Type 2 = MACROANGIOPATHY
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Increased glucose in circulating blood will
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damage cell over long period of time
GLUCOSE IN CELL = BAD |
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Glucose that binds to what is DAMAGING
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PROTEIN
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the ELDERLY have buildup of damaged cells and biproduct, the cells breakdown. this is caused by
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Increased Glucose
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The thickening of basement membranes in cappilaries and arterioles effecting hte SMALL vessels
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MICROANGIOPATHY
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what is the leading cause of blindness?
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diabetic retinopathy
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microangiopathy can cause (TYPE 1)
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clotting abnormalities, infection, gangrene, amputations....normally occuring 15-20 years after onset in TYPE 1 DIABETES
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What are some ACUTE complications of Diabetes
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HYPOGLYCEMIA
DKA HHNK |
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What is one way to decrease MICROANGIOPATHY
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Tighter GLUCOSE control, keep BBM in range!
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a chronic complication of diabetes
kidney damage is known as |
nephropathy
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a chronic comp of diabetes, nerve damage is known as
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neuropathy
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after 15 years, what percent of diabetes have retina change
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80 percent
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capillaries in retina are damaged and clotting abnormalities begin, 4th leading cause of blindnes
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diabetic retinopathy
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clotting, starting in lower smaller vessels moving to larger is found in what type
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type 1
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10 percent of TYPE 2 DIABETES have
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lower ext amputaiton
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what accounts for MAJORITY of diabetic deaths (infection, gangrene, strokes, pe)
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macroangiopathy TYPE 2
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insulin resistance, hyperlipedima and HTN causes
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metabolic syndrome
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altered lipid metabolism, metabolic syndrome increased platelet adhesiveness (CLOT FORMS) are causes of
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macroangiopathy TYPE 2
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Type 2 - buildup of fat along blood vessels is known as
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atherosclerosis
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type 2 - building of calcium - stiffens artery is
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arterosclerosis
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atherosclerosis and arterosclerosis , cerebrovascular, cardiovcascular and pvd occur at an early age in type 2 diabetes =
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macroangiopathy
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what is the leading cause of end stage renal disease in US - 35-45 percent are type 1 diabeteics
the kidneys STOP working |
nephoropathy
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what is importatant to prevent the progression of renal damage (keep low and under control)
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HYPERTENSION
70 percent of DM have HTN |
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what is the most severely damaged organ in DM
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KIDNEYS
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what can control the progression of damage of kidneys
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keeping a tight GLYCEMIC CONTROL
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major problem of DEATH in diabetics is
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MACROANGIOPATHY / CLOTTING
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What devvelops in 70 percent of DM, mild protein in urine
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proteiinuria
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Protein in Urine is ____________ AND INDICATES PROBLEM
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ABNORMAL!
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Neuropathy is nerve damage and starts WHERE?
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IN THE FEET and moves UP ...pt is unaware of this!
moves PROXIMALLY up extremeties |
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decreased nerve conduction and demyinization causing nerve damage is called
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neuropathy
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Neuropathy causes a dsyfunctional ....
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autonomic nervous system
(poor circulation, macro/micro angiopathy |
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diabetes can't feel the effects of _____________ due to neuropathy
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HYPOGLYCEMIA
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delayed gastic emptying, diareah uncontrolled, post hypotension, resting tachycardia, painlaess m.i (heart attack) ....this all occours in the
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autonomic nervous sytem
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neuropathy has what kind of nerves and circulation
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poor nerves and circulation
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bladder is enlarged (uti infection) not emptying bladder enough puts stress on the kidneys
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neurogenic bladder
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foot changes such as foot drop, pt walks differently, is called
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neuropathic arthropathy
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PT must do what themselves daily
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INSPECT FEET
TIGHT GLYCEMIC CO0NTROL |
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WHAT LEADS TO AN INCREASE OF BLOOD SUGAR (HYPERGLYCEMIA)
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INFECTION
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diabetics have difficulty fighting infection - infection is a decreased mobilazation of
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inflammatory cells
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wat makes it more likely for a pt to have a UTI
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glycosuria (sugar in urine)
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what type of diabetes goes every OTHER generation
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TYPE 1
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impairment of WBC Phagocytosis occurs in
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inflammation
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what increases tissue resistance to insulin
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ALCOHOL!
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what is the best nutritional status test
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24 HOUR RECALL
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ketones in urine are indicative of
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DKA
diabetic ketoacidosis |
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WHAT IS THE MOST IMPORTANT THING OT PAY ATTENTION TO IN PHYSICAL ASSESSMENT OF DIABETIC
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EXTREMITIES!
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what is the primary symptoms of diabetes?
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POLYTRIAD
polyphagia - hunger polydipsia - thurst polyuria - peeing |
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What is a 90 day lab test of glycosylated hemoglobin called
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HGB A 1C
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in a 24 hour creatine clearance test, you do what to first urine
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throw away
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what test is best to test for ketones and microalbuminaria
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Urinalysis
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to do a fasting blood glucose you must
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fast for 7 hours and confirm 2x
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long term look back at glycemic control - 3 MONTH PERIOD / 90 DAYS ...
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HGB A1C test
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glucose remains attached to hemoglobin for the life of the cell which is how many days
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120 DAYS
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what is an ideal HGB A1C test?
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less than 6%
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WHAT IS THE IDEAL PERCENTAGE FOR HGB A1C IN DIABETICS
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6.5- 7 PERCENT
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what is the dangerous Hgb A1C percentage
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over 10 percent
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glucose out of control , which is extremely dangerous is known as
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hypoglycemia
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asking patient if they are on ____________ is good for a physical ssessment
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steroids
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if a fasting glucose is greater than what, the pt is a DIABETIC
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Greater than 126
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a random glucose that is 200 OR ABOVE you should
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repeat test
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A1C NORMALS REVIEW
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6% IDEAL
6.5-7% IDEAL DIABETIC OVER 10 - DANGEROUS |
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an eventual diabetic, that has levels not normal can be tested with what test
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IFG impaired fasting glucose
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when the blood glucose level is below 70 what occurs
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hypoglycemia
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VALUES FOR HEALTHY CLIENTS 65 an older may be shifted upwards .....
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80 ABOVE GIVE GLUCOSE
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the most important nursing diagnosis for diabetses is
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EDUCATION about disease
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WHEN DO YOU BEGIN SCREENINGS IF RISK FFACTORS ARE PRESENT
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30 years
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what are high risk groups for diabetics
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african americans, native americans, hispanic, asian , OBese , hyptensive
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a baby weighing what has a chance for diabetes
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> 9 lbs
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Alcohol - drinking 2 drinks a day - is mosre likely to develop what kind of diabetes
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TYPE 2 DIABETES - ALCOHOL
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symptoms with increased what needs treatment immediately
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increased blood sugar
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nutritionally , you should balance what with insulin or oral agent pills as well as activity level
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FOOD INTAKE
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what type of diabetes do you have a EQUAL DISTRIBUTION OF CARBS, adjustment for activity level, meals at consistent times, SNACKS
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TYPE 1 = HIGH CARB!!!!!!
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Obsese, heavier...control food portions, low fat, NO SNACKS...SUPPLEMENT FOR EXERCISE , to decreasee blood glucose level
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TYPE 2 = EXCERCISE!
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what is more improtant than weight loss
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blood sugar control
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Thinner, DO NOT skip meal , what type of diabetes
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type 1 diabetes - THIN
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a high percent of intake comes from _____ in type 1 diabetes
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CARBS!
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what is most important for type 2 diabeties
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EXCERCISE!
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WHAT OCCURS AT THE PEAK OF INSULIN
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HYPOGLYCEMIA
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The difference between insulins is
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how long it takes to peak
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what is the best place ot give insulin, rotate areas
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ABDOMEN
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most used oral agent is
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METFORMIN (glucophage)
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NO ALCOHOL with
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metformin
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a buildup of scar tissue is called
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LIPODYSTROPHY
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what insulins can be given IV
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rapid (humalog/analog) clear
short (Reguloar) |
