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medsurg exam 2
diabetes pt 1
| Question | Answer |
|---|---|
| Diabetes is a life-long chronic, progressive disease but | it is manageable |
| Most people with diabetes can | lead a normal life with appropriate diabetes therapy and self-management |
| goal for someone with diabetes | optimize glycemic control and minimize complications. |
| how many people does diabetes affect in the US | Diabetes affects 40.1 million people in the US |
| Diabetes is the | 7th leading cause of death in the United States because it causes end organ damage |
| diabetes increases the risk of | Rate of a heart attack 1.8 times higher Rate of stroke 1.5 times higher The #1 cause kidney failure and non-traumatic lower-limb amputations |
| Emergency Room visits in 2021: | 253,000 hyperglycemic crisis 192,000 hypoglycemic crisis |
| 27.6% of adults are estimated as un Dx unless | levels are very high or very low! |
| as obesity rates rise, | so does T2D |
| glucose control is a balancing act because | you need to balance between insulin/exercise which decrease BGL and food/stress hormones which increase BGL |
| insulin is produced by | pancreatic beta cells |
| DM is a chronic multisystem disease due to | Defects in insulin production Defects in insulin action Both |
| 4 Clinical Classifications of DM | Type 1 Diabetes Type 2 Diabetes Iatrogenic - brought on by medications Gestational Diabetes - due to pregnancy |
| Diagnostic Criteria for DM | Fasting blood glucose > 126 mg/dL Random Serum Glucose > 200 mg/dL + Symptoms of hyperglycemia Glucose Tolerance Test> 200 mg/dL 2 hr post 75 gram load (non-pregnant) HbA1C ≥ 6.5% |
| diagnostic tests that require two testing occasions | Fasting blood glucose > 126 mg/dL Glucose Tolerance Test> 200 mg/dL 2 hr post 75 gram load (non-pregnant) HbA1C ≥ 6.5% |
| what does Hemoglobin A1C show you | a trend on how well the pt is managing their DM |
| type 1 diabetes is | insulin dependent, beta cells not making any insulin |
| prevalence of T1D | 5-10% all cases |
| cause of T1D | cellular mediated autoimmune destruction of pancreatic B cells |
| onset of T1D | children or over 50 - bimodal distribution peak age is 12 |
| risk factors for T1D | autoimmune, viral/environmental triggers |
| T1D CMs | fatigue, frequent urination, sudden weight loss, wounds that won't heal, sexual problems, always hungry, blurry vision, n/t in hands/feet, always thirsty, vaginal infections (increased BG in urine), vision changes, weakness, dry skin, recurrent infections |
| the 3 P's | polydipsia, polyuria, polyphasia |
| polyuria | excessive urination related to DM |
| polyuria due to | hyperglycemia that leads to high filtered load of glucose which exceeds reabsorption capacity so there is glucose in the urine which causes polyuria |
| glucose is | an osmotic molecule, draws H2O into the urine by osmosis |
| polydipsia | excessive thirst due to cellular dehydration |
| polyphagia | excessive hunger due to cellular starvation, decreased cell storage of carbs and lipids not typically seen in T2D |
| treatment of T1D | insulin |
| without insulin treatment for T1D, | DKA will occur which is life threatening |
| T2D occurs when | fat/muscle cells fail to respond to insulin |
| T2D has a | gradual onset |
| T2D is associated with | weight gain |
| T2D CMs | fatigue, frequent urination, sudden weight loss, wounds that won't heal, sexual problems, always hungry, blurry vision, n/t in hands/feet, always thirsty, vaginal infections (increased BG in urine), vision changes, weakness, dry skin, recurrent infections |
| T2D is treated with | lifestyle modifications, oral agents or combination |
| T2D don't need | insulin |
| T2D hallmark | insulin resistance |
| T2D prevalence | 90% of all cases |
| T2D onset | older than 45 years old, obesity is increased children so there is therefore an increase in T2D |
| T2D risk factors | obesity, weight gain Hx racial/ethnic predisposition pregnancy decreased physical activity |
| central adiposity | excess fat stored around the abdomen and visceral organs increased FFA at liver than muscle |
| what increases with obesity | FFA |
| FFA are | regulators of glucose metabolism |
| FFA inhibit | glucose uptake and glycogen synthesis |
| natural course of T2D | progressive: insulin resistance and deficiency |
| T2D: 6 years post Dx | >50% will require insulin |
| B cell failure | 50% at disease onset |
| increased risk of diabetes could be | pre diabetes |
| pre diabetes | Blood glucose levels higher than normal but not high enough to be diagnosed with diabetes |
| FPG level for pre diabetes | 100-125 |
| 2 hr PG level for pre diabetes | 140-199 |
| 2 hr PG test | glucose tolerance test |
| A1C value for pre diabetes | 5.7-6.4% |
| pre diabetes is associated with | cardiometabolic factors like obesity, HTN, high triglycerides, low HDL |
| diabetes screening: when to test | Overweight (BMI > 25) and/or having other risk factors: yearly Normal weight and having no risk factors: Every 3 years starting at age 45 |
| diabetes screening: risk factors | Physically inactive 1st degree relative w/ DM High-risk ethnic group Delivered baby >9 lbs Hypertension HDL <35 &/or triglycerides > 250 A1C ≥5.7% CVD Insulin resistance |
| diabetic complications: macrovascular | disease of large/medium size blood vessels CAD, PVD, CVD, erectile dysfunction |
| primary prevention of macrovascular | <130/80, LDL <100, triglycerides <150, HDL >40 men/>50 women, aspirin <80 |
| microvascular complications: retinopathy | Microvascular damage to retina increase in retinal detachment if diabetic increased cause of blindnes |
| microvascular complications: retinopathy screening | primary prevention BG control, annual screening with dilation |
| microvascular complications: nephropathy caused by | caused by chronic hyperglycemia which leads to damage to the glomerular microvasculature |
| microvascular complications: nephropathy symptoms | albumin in urine |
| microvascular complications: nephropathy screenings yearly | for albumin in urine |
| microvascular complications: nephropathy primary prevention | control BP |
| ESRD is leading cause of | 50-65% of death in TID |
| microvascular complications: neuropathy is caused by | diabetes/poor blood sugar control |
| microvascular complications: neuropathy is worse | at night |
| microvascular complications: neuropathy can cause | loss of sensation in feet 50% of lower limb amputations |
| microvascular complications: neuropathy is | peripheral vascular disease |
| foot ulcers | 50% of all lower limb amputations occur mostly associated with diabetic foot neuropathy |
| primary prevention of foot ulcers | Daily foot inspection, careful foot and nail care, and annual foot exam by health care professional |
| if a pt is obese and has diabetes, | they can't see the bottom of their feet so need to involve OT |
| monofilament determines | tactile sensitivity |
| pts with diabetes need to be tested for | perception |
Created by:
leh195