a MCPHS- Provider I- Ch 41- Assessment & Management of Pts w/DM
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| Group of diseases characterized by hyperglycemia | Diabetes Mellitus
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| Hyperglycemia can be d/t defects in | Insulin secretion, Insulin action, Both
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| Insulin functions r/t glucose | Transport, Metabolism, Stimulates storage, Inhibits breakdown, Signals liver to stop release
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| Storage sites of glucose | Liver & muscles
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| Other functions of insulin | Enhances storage of dietary fat in adipose tissue, Transport of amino acids into cells, Inhibits breakdown of protein and fat
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| Type 1 DM d/t | Autoimmune destruction of Beta cells in pancreas
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| 2 factors causing Type 2 DM | Decreased sensitivity to insulin (resistance), Impaired beta cell function
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| DM that can be controlled by diet | Type 2 DM
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| Fasting blood glucose > | 126 mg/dL
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| Random glucose > | 200 mg/dL
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| Three P's r/t Clinical Manifestation of DM | Polyuria, Polydipsia, Polyphagia
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| Polydipsia vs. Polyphagia | Dip:excessive thirst, Phagia:excessive eating
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| Dietary goals r/t DM | Optimal nutrition, Meet energy needs, Reasonable weight, Prevent wide glucose fluctuations, Decrease serum lipids
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| Diabetic ketoacidosis(DKA) caused by | Type I diabetes
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| Main causes r/t DKA | Noncompliance w/insulin regimen, Illness/infection, Undiagnosed/untreated diabetes
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| Hyperglycemic Hyperosmolar Nonketonic Syndrome(HHNS) caused by | Type II diaetes
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| Complication r/t Diabetes can occur in anyone w/ | Type I and Type II diabetes, Not only Pts using insulin
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| Glucagon function | Stimulates liver to release glucose
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| Pathophysiology effects r/t Type I diabetes | Decreased insulin production, Rampant glucose production by liver, Fasting hyperglycemia, Glucose not stored in liver
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| Ketone bodies are byproducts of | Fat breakdown
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| S/Sx r/t DKA | Abd pain, N/V, Hyperventilation, Acetone breath(fruity odor)
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| Insulin problems r/t Type II diabetes | Insulin resistance, Impaired insulin secretion
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| Primary treatment r/t Type II diabetes | Weight loss
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| Main goal r/t Diabetes treatment | Normalize insulin activity and blood glucose levels, Reduce development of complications
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| Glycated hemoglobin(A1C) reflects | Average blood glucose levels over the last 2-3 months
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| A1C binds to | RBC's for the cells entire life
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| Rapid-acting vs. Short-acting vs. Intermediate-acting vs. Very long-acting r/t Insulin names | R:Lispro, S:Regular, I:NPH, V:Lantus
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| Rapid-acting vs. Short-acting vs. Intermediate-acting vs. Very long-acting r/t Onset period | R:15 min, S:30 min, I:2 hrs, V:1 hr
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| Insulin regimens goal | Mimic normal pattern of insulin secretion d/t food intake and activity patterns
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| Pt requirements r/t Complex insulin regimens | Commitment, Intensive education, Close follow-up w/health care team
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| Complications r/t Insulin therapy | Local/systemic allergic reactions, Insulin lipodystrophy, Insulin resistance, Morning hyperglycemia
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| 3 types of Morning hyperglycemia | Dawn phenomenon, Insulin waning, Somogyi effect
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| Alternative methods r/t Insulin delivery | Insulin pen, Jet injector, Insulin pump, Implantable insulin delivery, Pancreatic cell transplants
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| First skills taught r/t Newly diagnosed diabetics | Needle insertion & insulin injection
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| Absorption rates(Fastest to slowest) r/t Injections sites | Abd(fastest), arm, thigh, hip(slowest)
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| Hypoglycemia r/t Blood glucose level | Less than 60 mg/dL
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| Hypoglycemia causes | Too much insulin or physical activity, Too little food
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| Mild vs. Moderate vs. Severe hypoglycemia r/t Manefestations | Mild:adrenergic symptoms(sweating, tremor, tachycardia, hunger), Moderate:adrenergic symptoms plus some CNS impairities, S:extremely impaired CNS function(Pt needs assistance)
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| Immediate treatment r/t Hypoglycemia | 15g fast-acting concentrated CHO
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| Emergency treatment r/t Hypoglycemia | 1 mg glucagon
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| Time r/t Snacking | Peak insulin activity
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| 3 main clinical feature r/t DKA | Hyperglycemia, Dehydration/electrolyte loss, Acidosis
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| DKA treatment factors that reduce serum K levels | Rehydration, Insulin administration
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| Precipitating events r/t HHNS | Acute illness, Medications exacerbating hyperglycemia, Recent history of polyuria w/adequate fluid intake
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| Ketosis & acidosis r/t HHNS | Generally do not occur
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| Manifestations r/t HHNS | Hypotension, Severe dehydration, Tachycardia, Variable neurologic signs
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| Initial treatments r/t DKA & HHNS | Fluid replacement, Correct electrolyte imbalances, Insulin administration
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| Cause r/t Diabetic retinopathy | Changes in blood vessels of retina
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| Autonomic neuropathy r/t Adrenergic symptoms of hypoglycemia | Symptoms are diminshed/absent
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| Subtle sign r/t Hypoglycemia | Numbness around mouth, Difficulty concentrating
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| Manifestations r/t Sudomotor neuropathy | Decreased/absence of sweating in extremities, Increased upper body sweating
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