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Adult Test 4 (DM)

Who has the highest rate of DM? Native Americans
In WV, DM affects ______% of the population by age 65. 25%
DM is the _____ leading cause of death in US seventh
DM is higher in which gender? men
DM is the leading cause of ______ and _____ in adults. new blindness and new cases of renal failure
DM is responsible for ____% of non traumatic amputations. 50-70%
What is DM? a chronic disease in which the body does not produce and/or properly utilize insulin and includes relative or absolute insulin deficiency and insulin resistance and results in long term complications
for glucose to enter the cell it must be attached to what? insulin
the pancreas is an endocrine and _____ gland. exocrine
The islets of Langerhans contains alpha cells which produce _____ and beta cells which produce _______ and delta D cells which produce _______ glucagon, insulin, somatostatin
what does somatostatin do? oppose insulin
The ____ changes food into glucose; glucose enters the _____; the pancreas makes little or no _______; little or no insulin enters the _______; ________ builds up in the bloodstream stomach, bloodstream, insulin, bloodstream, glucose
what happens when there is a lack of insulin? glucose builds up
What does a C-peptide level indicate? active insulin in the body
what is insulin synthesized as? preproinsulin
when the blood sugar is low, the ______ is stimulated to produce _________, and then the liver stimulates glucagon breakdown which _______________ pancreas, glucagon, increases blood sugar
Type I diabetes is usually diagnosed in _______ and is not associated with _______ childhood, obesity
what are thought to be some causes of type I diabetes? autoimmune, genetic, viral
With type I diabetes what kind of insulin is extremely low or nonexistant? endogenous
does type I diabetes respond to oral hypoglycemics? no, they rely on exogenous insulin
what medical problem is related to type I diabetes? DKA
Type 1 DM often has an ____ onset but may occur in the _____ and they are usually lean with a recent _______ abrupt, elderly, weight loss
how long do people sometimes go without being diagnosed with Type II diabetes? 9-12 years
Is type II diabetes curable? No, it is progressive.
What age are people usually diagnosed with type II DM and what is it associated with? over 40 years old, associated with obesity and a strong family history
Does type II diabetes respond to oral hypoglycemics? yes
what is acanthosis nigricans? brown, velvety ring around neck that looks like dirt; occurs with type II diabetes
What does metformin (Glucophage) do? increases insulin sensitivity
what are some causes of type II diabetes? obesity, high fat and cholesterol levels, sedentary lifestyle, HTN, smoking
What is impaired glucose homeostasis related to? impaired fasting glucose (chronic complications) or impaired glucose tolerance (borderline)
With type 2 DM there is increased BS and increased insulin and the two do not match up because _______ insulin is damaged or non-functional
What are some types of DM other than type 1 and 2? pancreatic disease, genetic syndromes, drugs like steroids, and psychotropic drugs
All adults over ____ should be tested for DM every ___ 45, 3 years; sooner with risk factors
What are risk factors for DM? obesity, aging, AA race, genetic, diet, viruses, stress, drugs, sedentary, HTN, HDL above 35, triglycerides above 250, polycysistic ovarian, history of gestational DM or baby above 9lbs, vascular disease, hypothyroidism, AIDS, psych drugs
What are the three things to look for with metabolic syndrome? obesity, HTN, and hyperlipidemia; triglycerides above 150, HDL above 50, fasting glucose above 110, and abdominal obesity of of over 40 for males and 35 for females
what are three things that metabolic syndrome can lead to? type II diabetes, insulin resistance, coronary heart disease
What are s/s of insulin resistance? fatigue, inability to lose weight, fatigue after meals, constant hunger, craving for sugar, aches and pains, upper abdominal obesity; increased fat storage, high cholesterol and triglycerides, low thyroid, and hormonal imbalances
with insulin resistance sugar is stored as? fat
What is considered fasting? NPO except water in 8 hours
What HgbA1C level is considered diagnostic of DM? >6
What HgbA1C level is indicative of controlled diabetes? <7
what fasting glucose levels are indicative of diabetes? fasting >126 on two occasions or a random glucose of >200 with classic symptoms, or >200 at two hours
what is considered a normal fasting glucose level? <110 or <140 at 2 hours
With impaired glucose homeostasis there is a FBG greater than _____ and less than ______ 110, 126
With impaired glucose tolerance the two hour BG is greater than ____ but less than _____ 130, 200
What are the three classic s/s of DM? polyphagia, polydipsia, and polyuria
What are s/s of type 1 DM? the three classic s/s, unusual weight loss, fatigue, and irritability
What are s/s of type 2 DM? all of type 1 s/s, infections, cuts and bruises that heal slowly, tingling in hands and feet, recurring infections (skin, gums, vagina, bladder), acanthosis nigricans, sexual problems, blurring vision, dry skin
Nutritional considerations with DM counting carbs, keep BG levels as near normal as possible, attain optimal BP control, optimal lipid levels, adequate calories for maintaining desirable weight
How do you determine caloric needs? BMI or desired body weight
how do you determine desired body weight for women? Women get 100 pounds for the first 5 feet and for ever inch over that they get 5 pounds
how do you determine desired body weight for men? Men get 106 pounds for the first 5 feet and 5 pounds for every inch after.
which body shape is higher risk for diabetes? android (apple)
How do you increase metabolism? increase activity and break large meals into smaller meals
To determine caloric needs what do you do? Couch potato- DBW X 10 moderate activity- DBW X 12 very active- DBW X 15
one pound equals ____ calories 3500
carbs = ___ cal, protein = ____ cal, alcohol = ____ cal, fat = ______ cal 4, 4, 7, 9
How is the plate method set up half the plate is a low calorie vegetable, one fourth is starchy food (potatoes, peas, corn, past, and rice), and one fourth is protein (meat, eggs, cheese)
On a food label, every ____ grams of carbs equals one carb. 15
A patient with DM should have _____ carbs at every meal 3-4
What are total calories based on? needs
what are current ADA recommendations for carbohydrate diabetes meal planning? 10-20% of calories from animal/vegetable protein, 60-70% of calories from carbs and monosaturated fats, less than 10% from saturated fats, no more than 10% from polyunsaturated fats, 20-35 grams of fiber
how much cholesterol should they have in a day? 200 mg
should they use artificial sweeteners? yes
What should sodium in the diet be? <3000 mg or less, 2400 mg or less with HTN
1 tsp of salt= _______mg 2300 mg of sodium
how does alcohol affect diabetes? augments the action of insulin, inhibits release of glucose from the liver, causes possible hypoglycemia if consumed without food, hypoglycemic effects can last 8-12 hours, raises tryglycerides
type 1 diabetes nutritional management? plan meals based on usual intake, integrate insulin therapy, eating disorders may develop especially in young people because when they start taking insulin they will begin to gain weight
type II diabetes nutritional management? weight loss, improve eating habits, caloric restrictions, space out meals, increase activity, keep records
what is the primary side effect of exercise? hypoglycemia
exercise recommendations for type II diabetes? 60-75% of max heart rate, 20-45 minutes at a time or 10 minutes after every meal, at least three days a week, talk test (shouldn't get so winded they can't talk while exercising)
what are some benefits of exercise? increased CV functioning, improved efficiency of skeletal muscle tissue, improves strength, decreased risk factors, improve glucose tolerance, increased insulin sensitivity, modifies body compensation, helps control HTN
exercise guidelines? warm up and cool down, wear well fitted shoes, 1-1.5 hours after meals, not at insulin peak times, wear ID bracelet, carry snacks with CHO, keep log, not in extreme heat or cold, if blood sugar is >300 or <100 do not exercise
what are some tests used to monitor diabetes? urine testing, glycosalated hgb, glycosalated albumin, and self monitoring
urine testing? tests for glucose, acetone, proteinuria, and microalbuminuria
how often should microalbuminuria be checked? yearly until it is positive
what does a positive microalbuminuria mean? breaking down protein in their kidneys, leading to kidney disease
gylcosalated hgb (hgbA1C) glycemic control for last 3-4 months, less than 7 is the goal
glycosylated albumin (fructosamine) similar to hgbA1C, reflects glycemic control of last 1-3 weeks, useful in gestational DM
what is the most important part of self monitoring? logging your glucose readings for the provider
what are some travelling considerations for people with DM? careful planning, carry insulin on person (avoid heat and cold), may need letter from MD for syringes
what are some issues with dental care? often overlooked, have accelerated periodontal disease
why is hygiene/skin care important? increased risk for infection/fungal especially, moisturizing lotion but keep between toes dry, use sunscreen
what does smoking do to a person with diabetes? increased BG and insulin resistance
what BG reading begins to cause hypoglycemic effects? hypoglycemic levels are relative to the patient. some people get sick at <100 some get sick at <20.
what are some causes of hypoglycemia? insulin excess, oral hypoglycemics, decreased intake, exercise, alcohol
what are some s/s of hypoglycemia? mild (pallor, diaphoresis, increased HR, palpitations, hunger, shakiness) moderate (confusion, slurred speech, irrational behavior, blurred vision, somnolence) severe (seizures, coma)
treatment of hypoglycemia? 10-15 g of CHO (6-10 life savers, 1/2 c fruit juice, 2-3 packs of sugar, 1/2 c regular soda), prepackaged glucose tabs, IV glucagon. when stable should follow up with something complex like a sandwich or crackers
what BG reading indicated hyperglycemia? >200
what are some causes of hyperglycemia? too much food, too little insulin, illness or stress
treatment of hyperglycemia depends on? the cause
what are some s/s of hyperglycemia? frequent urination, dry skin, extreme thirst, hunger, blurred vision, drowsiness, nausea
what is the dawn effect? early morning hyperglycemia; insulin waning so glucagon is released, 3 AM BG is normal, need bedtime insulin increased
what is the Somogyi phenomenon? early morning hyperglycemia caused by rapid decreases in BG causes release of hormones which results in hyperglycemia, 3 AM BG will be low, decrease evening insulin or give snack
what is the honeymoon phase? period of time shortly after the diagnosis of type 1 diabetes during which there is some restoration of insulin production by the pancreas. Need to be taught that it is temporary and diabetes is not cured.
what causes the honeymoon phase? insulin injected causes pancreas a break in producing insulin, rest period stimulated rest of beta cells to produce more insulin. the remaining beta cells will die and the honeymoon phase will be over causing body to revert back to insulin deficiency
what is DKA? caused by profound insulin deficiency, happens with type I diabetes
what happens to the body in DKA? presence of large amount of stress hormones, increases hepatic glucose production, release of fatty acids from fat cells, production of ketones by the liver, metabolic acidosis, osmotic diuresis, lyte depletion
what is the presentation of a patient with DKA? type I diabetes, BG 300-800, ketones, ph <7.35, serum osmolality increased, polyuria, polydipsia, weakness, lethargy, anorexia, N.V., blurred vision, HA, muscle ache, abdominal pain, kussmauls respirations, possible shock
treatment of DKA? IV fluids (NS), regular insulin IV, restore lytes, ICU setting, foley cath for I&O, oxygen, frequent BG readings, monitor
How to mix regular insulin get 100 mL bag of NS and draw up 100 units of regular insulin and inject it into the bag to form a one to one ratio and set the pump at mL/hr
hyperglycemic hyperosmolar nonketotic syndrome severe hyperglycemia (600-1200), dehydration, altered mental status, absence of ketosis, serum osmolality >350, type 2 DM, more often >60 years old, no metabolic acidosis, treatment same as DKA but may not need lyte replacement
what are the differences between DKA and hyperglycemic hyperosmolar nonketotic syndrome? no ketosis, happens in type 2, no metabolic acidosis, may not need replacement of lytes
what are some complications of chronic hyperglycemia? retinopathy, stroke, heart disease, nephropathy, autonomic neuropathy, peripheral neuropathy
macrovascular alterations large and medium sized vessels, hyperglycemia increases atherosclerosis (CAD, CVA, PVD), somatic/visceral neuropathies due to alterations in nervous system, gastroporesis
microvascular alterations small vessel disease, thickening of basement membranes, seen in all tissue but primarily eyes and kidneys, diabetic retinopathy, cataracts, open angle glaucoma
how often should diabetics get their eyes checked? yearly; with dilation!
diabetic neuropathy numbness and pain r/t small vessel damage, may need Neurotin, they lose the ability to feel when they step on things; 50% will develop it within 25 years of diagnosis, associated with pain that may be superficial, shooting/electric, or cramping/aching
charcot foot? A condition causing weakening of the bones in the foot that can occur in people who have neuropathy. bones are weakened enough to fracture, with continued walking the foot eventually changes shape. as it progresses the foot changes shape (rocker bottom)
visceral neuropathies sweat dysfunction, pupillary dysfunction, cardiovascular, GI, GU, and peridontal disease
foot care wash daily with warm water and mild soap, pat dry between toes, moisturizing lotion except between toes, check daily, change socks daily, well fitting shoes, always wear shoes, careful trimming of nails (may need to be done by podiatrist), check shoes
Created by: mcguirex3