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42 Cards in this Set
- Front
- Back
Pancreatic hormones of the pancreas are produced by what two groups of cells?
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Alpha Cells
Beta Cells |
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Alpha Cells produce this hormone
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Glucagon
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Beta Cells produce this hormone
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Insulin
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What counterregulatory hormones are produced in the body and what is their action?
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Counterregulatory hormones are hormones that work in opposition to the action of insulin. These are Growth hormone, catecholamines, and cortisol.
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What is gluconeogenisis
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The conversion of amino acids to glucose.
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Insulin is:
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the principle regulator of the metabolism and storage of ingested CHO's, fats and proteins. Insulin facilitates glucose transport across cell membranes in most tissues.
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Number one minority group affected by Diabetes Mellitus
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Native American Population
2)HIspanic 3)African American 4) Asian |
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Characteristics of Type I Diabetis Mellitus (the typical presentation)
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Onset 11-13 years of age (but can occur at any age), lean body type(but can occur in over weight), 5-10% incidence, long preclinical period but rapid onset, positive antibody in islet cells, severe insulin deficiency
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Auto antibodies that destroy the pancreatic beta cells
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Tpe I
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Type II characteristics
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> 90% of the population, onset usually > 40yrs old, associated with obesity, insidious onset, insulin resistance but still produces insulin
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what type of diabetes is characteristic here:
polydipsia polyuria polyphagia |
Type I
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Weight loss and fatigue are characteristics of which diabetes?
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Type I
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Insulin deficiency is a characteristic of what diabetes?
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Type I
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Pancreas continues to produce some endogenous insulin, diabetes____?
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Type II
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Type II may have the three p's plus other non-specific s/s. Please name the three p's and four other s/s.
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polyphagia.
Recurrent infections, genital pruritus, visual changes, paresthesis |
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As the blood stream becomes more hypertonic from increased b/g what pathophysiological changes take place (circulatory, uro)?
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Water is pulled from the cells causing an increase in blood volume, causing diuresis. Pt. becomes polyuric then they are thirsty(polyphagic).
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What metabolic changes of the cells take place in the presence of diabetes?
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Glucose does not enter the cells so hunger persists in an effort to get more 'food' to the cells, pt. has fatigue because sugar does not enter the cell.
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What methods are used to test for and diagnose Diabetes Mellitus>
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1) FPG- fasting plasma glucose > = 126mg/dl (If overt s/s 3p's are present, second OGTT may not be needed for diagnosis)
2) Random or casual , plasma glucose measurement =>200mg/dl 3)Two hour OGTT level => 200 mg/dl using a glucose load of 75g. |
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The normal FPG range, prediabetic range:
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normal: 70-100
impaired: 101-125 |
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Normal OGTT or random range:
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Normal should be < 140
Impaired is 140-199 |
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What does the Glycolylated Hemoglobin (HgA1C) test and what is the normal range versus the goal for a diabetic patient?
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The glucose attaches to the RBC and stays attached throught the life cycle of the cell, Hg A1C tests the average blood glucose for 90-120 days. Normal is 4-6%, the goal of a diabetic patient is 6.5-7%.
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True or false HgA1C is used as a diagnostic tool for testing Diabetes Mellitus?
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False, it is only used once the diagnosis has been made to track the glucose control the patient is achieving with their blood sugar control.
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Urine tests used in Diabetes?
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There is a glucose uria test but renal thresholds for glucose differes among individuals, so this is not a great method of testing.
Also a ketoneuria test is used in Type I. |
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When is the ketoneuria test performed?
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During acute illness
BG > 250 Pregnancy s/s ketoacidosis |
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2 main s/s on ketoacidosis
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n/v & abd pain
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When the diabetic patient has n/v and abd pain what steps should be taken to insure their safety?
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They should go to the hospital immediately, this indicated the presence on ketones, pt. is already breaking down their fat.
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describe DKA pathiophysiology
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when the circulating supply of insulin is insufficient and glucose cannot enter the cell for the body's energy, the body breaks down fat stores as a secondary source of fuel. Keytones are acidic by-products of fat metabolism that can can alter the pH of the blood. (see pg 1279)
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The compensatory response to metabolic acidosis (DKA) is to ___ CO2 excretion from the ___. The patient often develops ___ ___. In addition the kidneys attempt to excrete additional ___.
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increase, lungs, Kussmaul respiration (deep, rapid breathing), acid
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What test is used to check health status of kidneys in diabetic pt. What does it check for?
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24 hour creatinine clerance test to check for protiens in the urine. Protien should not be in urine.
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who should use the SMBG testing?
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All pts. with diabetes especially those on exogenous insulin.
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When should pts. use SMBG?
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When there:
1) Any changes in therapy 2)Ilness/pregnancy 3) s/s of hypo or hyper glycemia 4) 4 'befores'--before breakfast, lunch, dinner, bedtime |
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True/false:
Alcohol wipes should be used at home for finger sticks. |
False: use only soap and water to cleanse finger or other area when at home SMBG testing.
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If tested + for Islet Cell Antibody there is a __ chance in developing Type ___.
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10%, Type I
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Time frame for diabetes testing and screening in the life span.
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OGTT or fasting at 45 yrs and if normal repeat q3yrs. If child is obese and family hx do earlier. Do earlier and more often if high-risk.
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who is high risk for diabetes?
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family history
obese women with macrosomic babies >9 lbs or GDM hypertensive and/or hyperlipidemic American Indian, Hispanic, African American Impaired FG or glucose tolerance |
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primary goal of diabetes care
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to keep b/s levels in normal limits, to try to make as normal as possible
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what is the best approach formaintaining the goals of diabetes care?
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proper nutrition, exercise, medication, education, monitoring
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Normal values for:
FBS HS glucose HgbA1C |
FBS: 80-120
HS glucose:100-140 HgbA1C- 6.5-7% or lower |
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3 cornerstones for diabetic treatment
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meds, diet, exercise
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what should the goals of the diabetic patient be for achieving optimum serum lipid levels?
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Reduce current weight by 10%, moderate caloric restriction works best, focus on polyunsaturated fats (avacado), eliminate saturated fat.
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draw the visual tool on the dinner plate helpful in teaching patients a basic guide in what to eat
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1/2 plate non starchy veggies and fruits, 1/4 proteins, 1/2 CHO (complex)
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proteins should comprise what % of the diet?
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15-20%, or 10% if + for diabetic nephropathy (when kidney tests + for protein)
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