Diabetes Mellitus
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What are the classic clinical manifestations of Diabetes Mellitus? | *Polyuria *Polydipsia *Polyphagia
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What viruses can cause Diabetes Mellitus? | *Coxsackievirus B *Rubella *Mumps
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What does the liver convert to glucose? | glycerol and fatty acids
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What does the liver convert glucose to? | triglycerides as needed
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What does the liver store glucose as? | glycogen
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What are the ONLY organs that can use free serum glucose without insulin? | Brain and Kidneys
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What does the body of a PT with diabetes mellitus use for energy since Carbohydrates and Glucose can not be used properly? | Body’s fat and protein sources are broken down for energy
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What is Type-1 Diabetes Mellitus? | Little or no endogenous insulin produced (insulin dependent). Requires injections of insulin
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What causes Type-1 diabetes? | Progressive destruction of beta cell function
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What is Type-2 Diabetes Mellitus? | *Non-insulin dependent *Decrease tissue responsiveness to insulin *Decrease secretion of insulin from beta cells *Abnormal hepatic regulation
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What is Type-2 diabetes associated with? | Obesity (80% of cases)
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Type-2 diabetes is found primarily in who? | adults > 30 years old
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What are the cardinal manifestations of diabetes? | Glycosuria, polyuria, polydepsia, and polyphagia
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Which type of diabetes has Muscle wasting, weight loss, and thin PTs? | IDDM Type-1
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What common visual impairment will PTs with IDDM Type-1 experience? | Halos around lights
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Which type of diabetes involves slow wound healing, boils, and other infections? | NIDDM Type-2
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PTs with untreated NIDDM Type-2 will have a random blood glucose of what? | >200 mg/dL
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What is the normal fasting blood glucose? | 60-120 mg/dL
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How long must PTs fast before an Oral Glucose Tolerance Test? | 8 hours
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When is Blood and Urine collected during a Oral Glucose Tolerance Test (OGTT)? | 30 min, 1 hour, 2 hour, 3 hour
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What are the findings for a non-diabetic client following a Oral Glucose Tolerance Test (OGTT)? | *Blood glucose levels return to normal in 2 – 3 hours *Urine is negative for glucose
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What is a Postprandial blood sugar (PPBS) test? | Fasting client is given a measured amount of carbohydrate solution orally, followed by a blood glucose test 2 hours later to determine glucose metabolism.
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A blood Glucose of what following a Postprandial blood sugar (PPBS) test indicates Diabetes Mellitus? | Blood glucose > 160 mg/dl
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What does the Glycosylated hemoglobin (HbgA1c) test measure? | Measures the amount of glucose bound to hemoglobin within the RBC
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What is the normal % of glucose bound to hemoglobin? | 4% - 6%
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What is the average Glycosylated hemoglobin (HbgA1c) value in a hyperglycemic PT with a blood glucose of approximately 200 mg/dl? | > 8%
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What are the long term complications of Diabetes Mellitus? | *Renal disease *Neuropathy *Hypertension *Cardiovascular disease
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What percentage of the daily intake of kcals should come from protein in the diabetic diet? | 10 – 20 % total kcals from protein
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What percentage of the daily intake of kcals should come from fat in the diabetic diet? | No more than 30 % total kcals from fat
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What should diabetic PTs carry while excersizing? | Client should carry a form of “easy to eat” Carbohydrates in case hypoglycemia occurs during exercise
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Fill in the blanks: All PTs with _____ Diabetes require insulin. | Type-1 IDDM
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How must insulin be given for Type-1 IDDM? | Subcutaneously
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What are the types of insulin given? | *Beef *Pork *Biosynthetic
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Which type of insulin has a more identical action to that of human insulin? | Biosynthetic
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What are the short acting forms of insulin? | *Regular *Humulin *Novulin
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What is the intermediate acting form of insulin? | NPH
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What is the long acting form of insulin? | Lantus
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What is the only insulin that can be given I.V.? | Short acting
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What is the onset, peak, and duration of short acting insulin? | *(Onset: 30 – 60 min) *(Peak: 3 – 6 hours) *(Duration: 6 –8 hours)
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What is the onset, peak, and duration of intermediate acting insulin? | *(Onset: 60 –90 minutes) *(Peak: 8 – 12 hours) *(Duration: 24 hours)
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What is the onset, peak, and duration of long acting insulin? | *(Onset: 4 – 8 hours) *(Peak: 16 – 19 hours) *(Duration: 36 hours)
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What times during the day is NPH/Regular insulin taken? | *Usually take NPH/Regular insulin BID at Breakfast and Dinner *Regular insulin is used at lunch and bedtime to cover meal/snack
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In the case of mixed insulin, which insulin is ALWAYS drawn first? | Regular insulin
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What must the Diabetic PT have in order for oral hypoglycemics to be effective? | Client must have some functioning insulin production for these medications to be effective
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What do Oral Hypoglycemics do to reduce blood glucose? | stimulate the beta cells to produce insulin
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Why should regular insulin NOT be injected into the muscle? | enters the bloodstream too quickly and could cause hypoglycemia
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What subcutaneous injection site provides the fastest, least variable absorption? | Abdomen
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Rotating injection sites prevents what? | lipodystrophy
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True or False: Due to reduced nerve sensation and susceptability to infection, a PT with Type-2 diabetes should keep their feet dry and barefoot as much as possible to reduce blisters and stagnation. | False. Client should NOT go barefoot at any time.
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What is neuropathy? | Any abnormal condition characterized by inflammation and degeneration of the peripheral nerves
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In the PT suffering ketoacidosis, what kind of resperations are demonstrated? | Kussmaul respirations
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How quick is the onset of ketoacidosis? | Hours to days
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In the PT with diabetic ketoacidosis, medical management with insulin is done to maintain a blood glucose of what? | IV Insulin infusion to maintain BG 200 – 250mg/dl
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List 5 early S/Sx of ketoacidosis: | *Weakness *Drowsiness *Vomiting *Thirst *Abdominal pain *Dehydration *Hot, dry skin *Flushed cheeks *Dry mouth
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What is the initial Tx to restore glucose level in a unconsious hospitalized hypoglycemic PT? | IV bolus of 20 ml of 50% glucose or 50 ml of 20 % glucose
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