diabetes/some review stuff
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| Insulin is secreted by the beta cells in the pancreas as blood levels rise and goes where? | to blood stream then to body tissues then binds to receptors that allow some glucose to get into the cells so we can use it for energy.
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| Once the glucose is in the cells what can happen? | -Burn it to produce ATP - Store it as glycogen or fatty acids which are triglycerides.
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| Where is glycogen stored? | liver and skeletal muscles
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| Where are triglycerides stored? | adipose tissue
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| Description of Type 1 DM | -# of people are staying the same - Beta cells are destroyed - no insulin is being made - formally called juviniele diabetes
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| Risk factors for type 1 DM | Idiopathic, much less common than type 2, increased risk with a family history
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| Tx for type 1 diabetes | -Insulin injections 3-4 times per day at meals and night time snacks(insulin pump)-calorie control(especially carbs)-monitor blood sugar, could be 2-4 times per day(adjust insulin and calories based on results)
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| Description of type 2 dabetes | Problem with how the body responds to insulin -Problem not in the pancreas-Insulin resistant- Receptors are less sensitive-Most common form-# of people are rising
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| Risk factors for type 2 DM | Ideopathic-increased risk is obesity
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| Tx tor type 2 DM | Lifestyle changes(diet and exercise and loose weight)-Oral hypoglymics(decrease blood sugar)-Insulin injections(only if oral meds and diet and exercise do not control) -Monitor (usually 2-4 times daily) and adjust meds and calories based on results
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| What are the three different responses of the body to oral medications? | -Make body respond to insulin that they have already - cause body to make more insulin - affect how digestive system processes or absorbes glucose
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| Upon injury, the local acute immune response is... | Chemicals are released as mediators of inflammation (P.H.O.L.K- Prostaglandins, Histamine, Opson, Leukotrienes, Kinias)
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| Immediate changes from chemical mediators | -Arterioles dilate
-Pain
-Leukocytosis
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| Type 3 DM | Gestational Diabetes - more simular to type 2 DM
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| Classic S/S of DM | Hyperglycemia - increased appitite-increased thirst-increased urination-Glucoseuria(glucose appears in urine when BS level is over 180mg/dl)
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| Diagnosis for DM | Fasting BS (12 hour fast) = single draw testing for glucose(over 125mg/dl is positive for DM)-OGTT oral glucose tolerance test
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| OGTT procedure | 12 hour fasting glucose is drawn -Drink glucose solution(75 mg of glucose or 100 mg of glucose if testing for gestational diabetes -test for glucose 2 hours after drinking solution
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| Results of OGTT | -less than 140mg/dl = normal - 140-200mg/dl = glucose intolerant(at risk for diabetes) - greater than 200 = positive for DM -Must have more than one positive result to confirm DM
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| Functions/purposes of the inflammatory response | Pain- To keep you from using it and causing more damage
Swelling- Helps with delivery and removal of WBCs
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| What are the monitoring therapies for DM | Home glucose monitor - Hemoglobin A1c - Microalbumin
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| Home glucose monitoring | To help adjust to keep tight control on a day to day basis
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| Stage 1/Prodromal stage of HIV | Occurs within two months of infection
-Lasts up to 2 weeks, although usually less than a week
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| Stage 2/Asymptomatic stage of HIV | Lasts 6-10 years
-No symptoms or visible signs
-Clinical signs include viremia and a presence of HIV antibodies
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| Stage 3/AIDS of HIV | -CD4 count has dropped to 200 or less OR opportunistic diseases have developed (TB, salmonella, pneumocystis carinil, kaposi's sarcoma)
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| Opportunistic diseases of AIDS- Pneumocystis carinil | Fungal pneumonia caused by normal lung flora
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| Opportunistic diseases of AIDS- Kaposi's Sarcoma | Cancer of blood vessels, affects lung, skin, and GI lining
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| Etiology of systemic lupus erythematosus | Idiopathic- young women mostly, age 20s to 30s
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| Signs/Symptoms/Diagnosis of systemic lupus erythematosus | -Inflamed skin (Photosensitivity)
-Joints (Arthritis)
-Inflamed mucus membranes
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| Photosensitivity | Aggrevates skin and brings on red rashes on the face
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| Inflamed mucus membranes | Nose/mouth/throat ulcers, lung inflammation, pericarditis, glomerulonephritis, ecephalitis, bone marrow
-False positive for syphilis
-Positive LE prep (abnormal WBCs)
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| Treatment of systemic lupus erythematosus | Steroid anti-inflammatory drugs, only on it during exacurbation
-Other issues are treated separately
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| Prognosis of systemic lupus erythematosus | Life long, variable
-Occasional to fatal
-Most cases fall somewhere in between
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| Prevention of colorectal cancer | A diet low in saturated fat and management of Inflammatory Bowel Disease
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| Diagnosis of colorectal cancer | Screening test- Fecal occult blood test beginning at age 40, and a colonoscopy beginning at age 50
Confirmation- Biopsy
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| Prevention of prostate cancer | No way to prevent it: depends on age
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| Diagnosis of prostate cancer | Screening test- Digital rectal exam or a PSA test (Prostate-specific antigen)
Confirmation- Biopsy
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| Prevention of lung cancer | Quit smoking and avoid respiratory irritants
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| Diagnosis of lung cancer | Screening test- Chest x-ray (Not very sensitive)
Confirmation- Biopsy
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| Prevention of breast cancer | Reduce or stop alcohol consumption, quit smoking, exercise, and get checked regularly
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| Diagnosis of breast cancer | Screening test- Breast self exam starting at age 30, mammogram starting at age 40
Confirmation- Biopsy
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| Prevention of cervical cancer | Use safe sex practices, do not have multiple partners
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| Diagnosis of Cervical cancer | Screening test- PAP smear
Confirmation- Biopsy
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| Hemoglobin A1c | Allows doctor to see how well you have been maintaining control for the last 3-4 months - Doctor can adjust meds accordingly
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| Microalbumin | Checking for protein in the urine. Checking for kidney damage
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| What is tight glucose control? | Keeping close to normal results - better control means decreased risk for complications.
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| What are the two types of insulin injections? | Rapid and Intermediate
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| Rapid insulin | starts working within minutes but is short acting-most common form= Regular Insulin, "R" on label
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| Intermediate Insulin | takes longer to work but lasts at least 6 hours (30 minutes to 6 hours approximaltely) - Most common form = NPH or Lente, "N" or "L" on lable
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| Most diabetics use what kind of insulin and where is it injected? | A blend of 70-30/ 70= rapid and 30=intermediate - it is injected in adipose tissue
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| Whate are the acute complications of DM and its treatment? | Hypoglycemia and Hyperglycemia
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| Etiology of Hypoglycemia | Blood sugar drops below 70 - skipped meal (too few calories) - Too much insulin or meds - More active than normal
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| S/S of hypoglycemia | Start when BS drops below 50 - Skin= moist cool clammy pale - Respirations= Slow, shallow - Behavior = Drunk, slurred speach, uncoordinated, combative
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| Tx for hypoglycemia | Give calories
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| Prognosis for hypoglycemia | -Normally BS and thinking get back to normal - If no treatment it can lead to Insulin shock which can be fatal
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| Etiology of hyperglycemia | Blood sugar higher than 180-200 - Forgot to take insulin or other meds - Too many calories - less active - infection or inflammation
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| S/S of hyperglycemia | skin = red warm and dry - Respirations = deep, fast, fruity smell on breath - Behavior = Stoned, lethargic, drowsey, non responsive
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| Tx for hyperglycemia | Take to ER. They need rapid acting insulin, will probably be admitted to get BS under control
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| Prognosis for hyperglycemia | If BS is not under control could lead to Diabetic Ketoacidosis which can lead to Diabetic coma which can be fatal
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| Diabetic Ketoacidosis | increase level of ketones leads to decreased pH. Ketones are a waste product from burning fat.
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| Chronic complications from DM | take years - Diabetics who are poorly contoled - can cause vascular damage, neuropathy, hyperlipidemia
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| Vascular damage complications of DM | Damage to capillaries can cause retinopathy, kidney damage, or poor peripheral circulation
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| Neuropathy complications of DM | Decreased sensivity of extremeties or Gastroparesis(paralysis of stomach)
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| Hyperlipidemia complications of DM | Atherosclerosis causing CAD(heart attacks), CVD(stroke) and PVD(amputation)
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| Prognosis for DM | Depends on how well blood sugar is controlled. Most common cause of death is heart attack or stroke.
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