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AH-Lewis Ch. 49
Diabetes Mellitus
| Question | Answer |
|---|---|
| Diabetes Mellitus is? | a chronic disease r/t abnormal insulin production, impaired insulin utilization, or both |
| Dibetes is the _____ leading cause of death? | 5th |
| What makes diabetes a devastating disease? | long term complications |
| What are diabetes the leading cause of? | blindness, renal disease, and amputations |
| 73% of adults with diabetes have? | hypertension |
| Current theories link the cause of diabetes to? | genetics, autoimmune, viral and environmental factors |
| Where is insulin produced? | B cells |
| Where are B cells? | in the inslets of langerhans of the pancreas |
| What are the counterregulatory hormones that oppose effects of insulin (raise BG)? | Glucagon, epinephrine, GH, and cortisol |
| How do the counterregulatory hormones raise BG levels? | stimulating glucose production and ouput by the liver, and by decreasing glucose movement into the cells |
| What is a good indicator of B cell function? | presence of C peptide in serum or urine |
| Insulin promotes glucose transport from the? | bloodstream across the cell membrance and into the cytoplasm of the cell |
| Insulin is known as the anabolic or? | storage hormone |
| What have specific receptors for insulin? | skeletal muscle and adipose tissue |
| What are the insulin dependent tissues? | skeletal muslce and adipose tissue |
| Type 1 diabetes occurs in what age group? | young people |
| What happens in Type 1 diabetes? | Body's T cells attack pancreatic B cells |
| When diabetes is caused by an immune mechanism the disease is known as? | Type 1A |
| What type of diabetes is causes by nonimmune factors of unknown etilogies? | Type 1B |
| Predisposition of type 1 diabetes is believe to be related to? | HLA |
| What are the classic symptoms of Type 1 diabetes? | Polydipsia (thirst), polyphagia (hunger), and polyuria |
| What is diabetic ketoacidosis? | life threatening condition resulting in metabolic acidosis |
| A newly diagnosed diabetes pt will often have? | honeymoon period |
| What is prediabetes (impaired glucose tolerance, impaired fasting glucose)? | condition where BG levels are higher than normal, but not high enough for the diagnosis of diabetes |
| What is the most prevalant type of diabetes? | type 2 |
| Ppl with type 2 diabetes usually are how old? | over 35 years |
| what is exogenous insulin? | outside source |
| What is endogenous insulin? | self made insulin |
| What type 2 diabetes is there any insulin made? | yes but it is either insufficient for the needs or is poorly utilized |
| What is the greatest risk for type 2 diabetes? | obesity |
| How many metabolic abnormalities have a role in the development of type 2 diabetes? | 4 |
| What is insulin resistance? | body tissues do not respond to the action of insulin |
| Where are most insulin receptors? | skeletal muscle, fat, and liver cells |
| What happens in the early stage of insulin resistance? | the pancreas makes too much insulin |
| What is the 2nd factor in the development of type 2 diabetes? | the ability of the pancreas to produce insulin (B cell mass is lost) |
| what is the 3rd factor in the development of type 2 diabetes? | inappropriate glucose production by the liver |
| What is the 4th factor in the development of type 2 diabetes? | alteration in the production of hormones and cytokines by adipose tissue |
| What are the two main adipokines believed to affect insulin sensitivity? | adiponectin and leptin |
| What is metabolic syndrome? | cluster os abnormalities that act synergistically to greatly increase the risk of heart disease and diabetes |
| How long in pregnancy does it take for gestational diabetes to be detected? | 24-28 weeks |
| Women with gestation diabetes have higher risk for? | cesarean delivery, death and complications |
| What is the first line therapy for gestational diabetes? | nutrtional therapy |
| What is secondary diabetes? | diabetes that occur in a person because of another medical condition |
| What is the onset of type 1 diabetes? | rapid |
| What are the most common manifestations associated with type 2 diabetes? | fatigue, recurrent infections, yeast infections, prolonged wound healing, and visual changes |
| What are the three methods to diagnose diabetes? | Fasting plasma glucose level, random, or casual, plasma glucose measurment, two hour OGTT, fasting plasma glucose |
| What is fasting BG ? | no caloric intake for at least 8 hours |
| What is casual BG ? | defined as any time of day without regard to the time of the last meal |
| How is a fasting plasma glucose test confirmed? | by repeat testing on another day, preferred method |
| What represents an intermediate stage between normal glucose homeostatis and diabetes? | IGT (Impaired glucose tolerance), IFG (impaired fasting glucose) |
| Hemoglobin A1C is useful in determining? | glycemic levels over time, monitor success of treatment, and changes treatment |
| How does hemoglobin A1C work? | by showing the amount of glucose that has been attached to hemoglobin molecule increases and remains attached to the hemoglobin molecule over their life span |
| What is ideal A1C? | 7.0% |
| What are the goals of diabetes management? | reduce symptoms, promote well being, prevent acute complications and long term complications |
| What are the 2 major types of glucose lowering agents? | Insulin and oral agents |
| Although type 2 diabetes is treated by diet, and excercise what may be needed later? | insulin |
| In the past insulin was made from? | beef and pork pancreas |
| Today what kind of insulin is used? | people |
| How do insulins differ? | onset, peak action and duration |
| What are insulins categorized by? | short, rapid, intermediate and fast acting |
| All insulin preparations start with? | regular insulin as a base |
| What are added to make insulin intermediate acting? | zinc and protamine |
| What exogenous insulin is most like insulin production? | basal bolus regimen |
| What are rapid acting synthetic insulin? | lispro, aspart, and glulisine |
| What should rapid insulin be injected? | 0-15 min before a meal |
| What is the onset of action for short acting insulin? | 30-60 min |
| When should short acting insulin be injected? | 30-45 min before meals |
| What are long acting insulin? | lantus and levemir |
| Do long actin insulin have peak action? | no |
| What is reduced with long acting insulin? | hypoglycemia |
| What can not be mixed with other solution? | Glargine and detemir |
| Short and rapid insulin can be mixed with? | intermediate insulin |
| What 2 types of insulin must be administered seperatly? | Long and rapid acting |
| What does heating and freezing do to insulin? | alter molecules |
| How long can insulin be left at room temp? | 4 weeks |
| Insulin should be stored in the? | fridge |
| How long do prefilled syringes last? | 30 days |
| Insulin is inactivated by? | gastric juices, cannot be taken PO |
| Insulins should not be mixed if they differ in? | purity |
| Where is the fastest apsorption of insulin? | abdomen |
| Why do you rotate anatomic injection sites? | to prevent lipodystrophy |
| What does lipodystrophy produce? | lumps and dents in the skin from repeated injections in the same spot |
| What is an insulin pump? | A small dvice that resembles a pager |
| Where is the tube inserted for an insulin pump? | subQ tissue of the abdominal wall |
| What is intensive insulin therapy? | multiple daily insulin injection and frequent BG monitoring |
| What is a type of inhaled insulin? | Exubera |
| What is a side effect of exubera? | hypoglycemia |
| Exubera should not be used when? | they are smokers |
| What is somogyi effect? | rebound effect in which an overdose of insulin induces hyperglycemia |
| What does the somogyi effect usually occur? | at night |
| What happens in the morning after the somogyi effect? | hyperglycemia in the morning |
| If a pt has somogyi effect they may complain of what? | headaches in the morning |
| What is the dawn phenomenon? | hyperglycemia that is present on awakening in the morning due to the relases of counterregulatory hormones in the predawn hours |
| OA's work on the 3 defects of type 2 diabetes? | insulin resistance, decreased insulin production, and increased hepatic glucose producation |
| What are the five types of OA to control BG? | Sulfonylureas, meglitinides, biguanides, a Glucosidase inhibitors, thiazolidinediones |
| What is a frequently used OA? | sulfonylureas |
| What do sulfonylureas do? | increase insulin production from the pancreas |
| What do meglitinides do? | increase insulin production fro mthe pancres |
| Meglitinides have reduced potential for? | hypoglycemia |
| Meglitines should be given when? | 30 min before meals or at the meal |
| What is metformin? | a biguanide |
| What does metformin do? | reduces glucose production by the liver, increase glucose going into the cells |
| What are known as starch blockers? | a glucosidase inhibitor |
| What do starch blockers do? | slow down the absorption of carbs in the small intestine |
| What are known as insulin sensitizers? | thiazolidinediones |
| What are insulin sensitizers? | actos and avandia |
| Thiazolidinediones are most effect in ppl with? | insulin resistance |
| What do thiazolidinedions do? | increase insulin sensitivity, transport, and utilization at target tissues |
| What are DDP4 inhibitors? | galvus and januvia |
| What do DDP4 inhibitors do? | inhibit the action of DDP4 then slowing the inactivation of incretin hormones |
| What is amylin? | a hormone secreted by the B cells of the pancreas in response to food intake |
| What is symlin? | syntheti analog of juman amylin |
| What is pramlintide? | adjunct to insulin therapy |
| By what 3 ways does pramlintide work? | slows gastric emptying, reduces postprandial glucagon secretion, and increase satiety |
| What is byetta? | synthetic peptide that stimulates the release of insulin from the pancreatic B cells, mimics incretin |
| What are the mechanisms of action for byetta? | suppress of glucagon secreation from the pancreatic B cells, reduction offood intake, slow gastric emptying |
| Diabetes is a general metabolic disorder involving what nurtients? | carbs, fats and proteins |
| In diabetic diets what should you eat the most of? | carbs |
| What are foods containing carbs? | grains, fruits, vegies, and low fat milk |
| What is glycemic index? | The rise in blood glucose levels after a person has consumed a carb containing food |
| What are foods that have high GI? | potatoes, white bread |
| High GI foods cause? | major increase in BP |
| How much fat should there be in a diabetic diet? | 25-30% |
| How much protein should there be in a diabetic diet? | less than 10% |
| What intake should be decrease for diabetic pts? | protein |
| What is the plate method? | Where there is a plate and one half should be filled with nonstachy, one forth filled with a starch, and one forth protein |
| What is the cornerstone of diabetic management? | self monitoring of blood glucose |
| How many times to ppl with type 1 diabetes usually test? | 4x a day |
| Testing is most often done? | before meals |
| You should check BG before and after? | excercise |
| When is pancreas transplantation used? | In pt's with type 1 diabetes |
| What 2 transplants are often done together? | kidney and pancreas |
| What are the 3 reasons a pancreas would be transplanted alone? | hisotry of metabolic complications, Problems with insulin therapy, consistant failure of insulin based management |
| What do ppl with transplantations have to have? | lifelong immunosuppression to prevent rejection |
| Who have high risks for diabetes? | AA, hispanic, and native americans |
| What are the overall goals for a pt with diabetes? | to be an active participant in the managment, to experience no acute symptoms, to maintain BG levels, and adjust lifestyle |
| You should have screening for diabetes after when? | overweight over 45 |
| What are acute situations with diabetes? | hypoglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic syndrome |
| What are assistive devices for insulin? | syringe magnifiers, vial stabilizers, and dosing airds for the visually impoared |
| What determines the most appropriate OA for a pt? | pt mental status, eating habits, environment, attitue, and med hx |
| When having diabetes you should always wear? | a bracelet saying so |
| What is the empowerment approach to education? | imformed decision making on the part of the pt |
| What is a serious threat if not taken care of? | hypoglycemia |
| What is diabetic ketoacidosis (diabetic acidosis, diabetic coma)? | is caused by deficiency of insulin and is characterized by hyperglycema, ketosis, acidosis, and dehydration |
| What does ketosis do? | alters the pH balance |
| What is ketonuria? | ketones excreted in the urine |
| What are s/s and diabetic ketoacidosis? | poor skin turgor, dry mucous membrane, tachycardia, and orthostatic hypotension |
| What are kussmaul respirations? | rapid, deep breathing (bodys attempt to reverse metabolic acidosis) |
| What is the primary thing to do when a pt has ketoacidosis? | start IV for F&E replacement |
| What is an important thing with DKA that is avoidable? | hypokalemia (potassium) |
| What is Hyperoxmolar hyperglycemic syndrome? | syndrome that can occur in the pt with diabetes who is able to produce enought insulin to prevent DKA but not enough to prevent hyperglycemia, diuresis, or extracellular fluid depletion |
| HHS often occurs in? | type 2 |
| What is the major difference of HHS and DKA? | in HHS the pt has enought insulin to prevent ketoacidosis |
| HHS is often connected to? | impaired thirst, or inability to replace fluids |
| HHS requires greater? | fluid replacement |
| What is a useful aid in monitoring hypokalemia? | Cardiac monitoring |
| What erquires a constant supply of glucose to function? | brain |
| What happens with hypoglycemia? | confusion, irritable, diaphoresis, tremors, hunger, weakness |
| What is hypoglycemic unawareness? | where a person does not experience the warning signs and symptoms of hypoglycemica |
| Glucagon stimulates a strong? | hepatic response to convert glycogen to glucose |
| What is angiopathy? | damage to blood vessels |
| What are the 2 types of chronic blood vessel dysfunctions? | macrovasular complications, and microvascular complication |
| What are macrovascular complications? | dieseases of the large and medium size blood vessels that occur with greater frequency and with an earlier onset in ppl with diabetes |
| Tight glucose control may help? | delay the atherosclerotic process |
| Smoking is harmful to ppl with? | diabetes |
| What are microvascular complications? | result from thickening of the vessel membrances in the capillaries and arterioles in response to conditions of chronic hyperglycemia |
| Microvascular complications differ from macrovascular because? | It is specific to diabetes |
| What areas are most affects by microangiopathy? | eyes, kidneys, and skin |
| What is diabetic retinopathy? | damage to the retina as a result of chronic hyperglycemia in pt's with diabetes |
| Diabetic retinopathy leads to? | blindness |
| What is nonproliferative retinopathy? | most common, partial occlusion of the small blood vessels in the retina (retinal edema, hard exudates( |
| What is proliferative retinopathy? | severe form, involves the retina and the vitreous |
| What is neovascularization? | where the retinal capillaries become blocked and the body forms new ones |
| What are the most common forms of treatment for diabetic retinopathy? | photocoagulation of the retina, cryotherapy, and vitrectomy |
| What is cryotherapy? | used to treat peripheral areas of the retina that cannot be reached with lasers |
| What is vitrectomy? | aspiration of blood, membrane and fibers from the inside of the eye through a small incision just behind the cornea |
| What is diabetic nephropathy? | microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney |
| With nephropathy what is detected in urine? | microalbuminuria |
| What is diabetic neuropathy? | nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus |
| What is sensory neuropathy? | loss of protective sensation in the lower extremities |
| What are the 2 categories of diabetic neuropathy? | sensroy neuropahty, and autonomic neuropathy |
| What is sensory neuropathy? | most common, effects hands or feet, Stocking glove neuropathy |
| What are characteristics of sensory neuropathy? | sensation, abnormal sensations, pain, and paresthesias |
| The pain felt by sensory neuropathy usually is? | cramping, crushing or tearing, worse at night |
| What can control sensory neuropathy? | BG |
| What is autonomic neuropathy? | affects all body systems and lead to hypoglycemic unawareness, bowel incontinence, diarrhea, and urinary retention |
| What is gastroparesis? | delayed gastric emptying, complication of autonomic neuropathy that can produce anorexia, N&V, reflux and fullness feeling |
| Autonomic neuropahty causes? | posteral hypotension |
| Diabetes can affect what in men and woman? | sex |
| A neurogenic bladder may develop as sensation in the inner? | bladder wall decreases, causing urinary retention |
| What is the main cause for hospitilizations for diabetics? | foot prob |
| what is amjor risk factor for lower extremity amputation in the person with diabetes? | sensory neuropathy |
| Peripheral arterial disease increases the risk for amputation by causing? | a reduction in blood flow to lower extremeties |
| What is used to determine in the pt has PAD? | doppler instrument |
| What is apligraf? | a human skin equivalent that is used to accelerate the closure of nonhealing wounds |
| What is charcot food? | ankle and foot changes that ultimately lead to joint dysfunction and footdrop |
| Neupropathic ulcers resemble a? | BB shot or punched out wound |
| What is acanthosis nigricans? | dark coarse thickened skin seen in flexures and on the neck |
| what is necrobiosis lipoidica diabeticorum? | red yellow lesion with atrophic skin that becomes shiny and transparent revealing tiny blood vessels |
| What is granuloma annulare? | autoimmune innature and froms partial rings of papules, dorsal surgace of hands and feet |
| What is normal BG? | 70-120 |
| What raises BG? | cortisol, GH, epinephrine, glucgon |
| What is type 1 characterized by? | beta cells are being destroyed in the pancrease, 11 years of age, immune system attacks beta cells, no insulin being made |
| What are the classical signs of type 1? | polyuria, polysypsea, and polyphasia |
| What are characteristics of type 2? | beta cells decrease, not working right, weakness, obesity, recurring infections, can conrol by diet |
| What is the cause of gestational diabetes? | change of hormones |
| What insulins are clear? | rapid, short, and long acting |
| What insulins are cloudy? | intermittent |
| What should be given with rapid acting insulin? | something to eat |
| What are types of rapid insulin? | novalog, humlong, (log-rapid) |
| How long does it take for rapid insulin to take effect? | 15 min |
| How long does rapid insulin last? | 3-4 hours |
| What is the peak for rapid action? | 60-90 min |
| How long does it take for short acting insulin to take effect? | 30-90min |
| What are types of short acting insulin? | RRRRRRRegular, humalin, novalin |
| How long does short acting last? | 1-3 hrs |
| What is the peak of short acting? | 2-3 hrs |
| How long does intermittent acting insulin last? | throughout the day, 10-16 hrs |
| What are types of intermittent acting insulins? | NPH, humulin N, Novalin N |
| How long does intermittent insulin take to have affect? | 2-4 hrs |
| What is the peak of intermittent insulin? | 4-10 hrs |
| How long does long acting insulin last? | over 24 hrs |
| What are the types of long acting insulin? | lantus, lyemir |
| Is there a peak for long acting insluin? | no |
| What can be mixed with long acting insulin? | NOTHING |
| Insulin is produced by? | b cells in islet of langerhans of the pancreas |
| What do counterregulatory hormones do? | increase BG, stimulate glucose production and output by liver, decrease the movement of glucose into the cells |
| What does insulin do? | promotes glucose transport, enhances fat deposits in adipose tissue, increase protein synthesis |
| What stimulates storage of glucose as glycogen in liver and muscles? | insulin |
| What inhibits gluconeogenesis? | insulin |
| What attacks B cells in type 1 diabetes? | T cells |
| What is the hx for type 1? | recent or sudden weight loss |
| What are the 4 major metabolic abnormalities? | insulin resistance (body doesn't respond to insulin) marked decrease in ability of pancreas to produce insulin, inappropriate glucose producetion by the liver, alteration in production of hormones and cytokines by adipose tissue |
| What are s/s of type 2? | fatigue, recurrent infection, yeast, long wound healing, visual change, may have classic signs |
| When in gestational diabetes detected? | 24-48 weeks |
| How is gestational diabetes treated? | nutritionally |
| What are the goals of diabetic management? | reduce symptoms, promote well being, prevent acute complication, prevent long term complication |
| How should insulin be stored? | room temp, refrigerator |
| How is insulin administered? | SubQ |
| What insulin can be given IV? | regular |
| What are 2 allergic reactions? | local inflammatory, lipodystrophy |
| What can cause somogyi effect? | excess carb intake |
| What is dawn phenomenon caused by? | nocturnal elevation of GH |
| How do you manage dawn phenomenon? | alter does and time of insulin |
| What do you educate clients on about insulin? | diet, AE, how and when to take it, how many to take, what to take with it |
| What do meglitinides do? | increase insulin production from pancreas rapidly |
| How much carbs should type 2 have? | 45-65% |
| How much fats should type 2 have? | 24-30% |
| How much proten should type 2 have? | less than 10% |
| What causes hyperglycemia? | illness, corticosteroids, too much food, no meds, inactivity, emotional stress |
| What causes hypoglycemia? | alcohol intake, to little food, to much meds, too much exercise, mads taken at wrong time, loss of weight |
| Cold & Clammy? | Need some candy |
| Hot & Dry? | Sugar is high |
| What is parsthesias? | tingling, burning, itching |
| Loss of sensation to touch? | foot injury and ulcerations without pain can cause atrophy of small muslces-deformity |
| What is sensory neuropathy? | loss of protective sensation, decreased blood flow dure to peripheral arterial disease |
Created by:
alicia.rennaker
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