Chp 14 Diabetes

Question 1

As of 2015 - percent of the US with DM

Answer 1

9.4%

Question 2

2012 - US DM costs total

Direct

Indirect

Answer 2

$245 billion

$176 B direct

$69 B indirect

Question 3

5 counter regulatory hormones to insulin

Answer 3

1) glucagon
2) epinephrine
3) norepinephrine
4) growth hormone
5) cortisol

Question 4

Elevated depressive sx and/or depression affect how many pts?

Answer 4

1 in 4

Question 5

Diabetes distress

Answer 5

emotional issues related to worries and burdens living with chronic disease – in the ABSENCE of depression

Question 6

Hyperglycemia sx

Answer 6

Increased thirst, excessive urination, unusual fatigue, unexplained hunger, rapid weight loss, slow healing cuts and infections

Question 7

What % of people have T1DM

Answer 7

5-10%

Question 8

What % loss of body weight can reverse insulin resistance?

Answer 8

5-7%

Question 9

Insulin resistance, 3 factors

Answer 9

1) overweight/obesity
2) physical inactivity
3) poor diet

WHR increased = 2.5x risk

Question 10

Pre-diabetes defn

Where does it occur primarily, i.e. tissue

What percent Americans with it?

Answer 10

A state of relative insulin resistance

Muscle - limited capacity to store CHO

38%

Question 11

DX criteria for DM - A1c, fasting glucose, oral GTT

Pre-diabetes A1c criteria

Answer 11

6.5% or higher
>126 mg/dL
2 hour value >/equal to 200

Pre-DM: 5.7-6.4%

Question 12

Fasting glucose normal

Pre-DM levels

Answer 12

70-99 mg/dL

Pre-DM: 100-125 mg/dL

Question 13

GTT pre-DM values, 2 hour post prandial

Answer 13

140-199 mg/dL

Question 14

US Preventive Services Task Force recs for screening glucose (age related)

Answer 14

As part of a CV risk assessment, ages 50-70, AND overweight/obese

Question 15

What tissues do DM meds target?

Answer 15

pancreas - increase insulin release

liver - decrease glucose output

muscles - more responsive to insulin

gut - slow down absorption of CHO and glucose

kidneys - releasing excess glucose in urine

Question 16

Basal insulin meets what need in context to food?

Answer 16

covers NON food related insulin needs – covers background need through the day

Question 17

Health and wellness goals for DM and preDM revolve around 4 points

Answer 17

Self mgt to —> lower insulin —> manage BG levels —> result in wt loss —> assist in keeping weight off

Question 18

Other factors affecting BG

Answer 18

stress, hydration, hormones, and illness

Question 19

Exercise - safety recs:

BG levels

Threshold (elevated) and warning signs

Answer 19

Range of 80-180

Above 250 okay IF no ketones are present

Question 20

Stipulations for >300 mg/dL while exercising…..

Answer 20

no ketones present

CAN use caution at mild to moderate intensity until BG decreases

Question 21

How to decrease risk for DM

Answer 21

1) weight control
2) physical activity @ least 150 minutes per week
3) medical nutrition therapy
4) f/u counseling

Question 22

Losing ____ pounds improves insulin action, lowers systemic inflammation, reduces A1c, enhances HDL and lowers LDL, reduces risk of T2DM

What % of starting weight applies here?

Answer 22

10 pounds

5-7%

Question 23

Rec activity levels

Answer 23

Duration: 150 minutes at least per week/ 75 minutes more intense (aerobic) —– 8-10 exercises, 1-3 sets, 10-15 reps (resistance)

Frequency: 3-7 days/week (aerobic) —– 2-3 days (strength)

Question 24

When to refer

Answer 24

Evaluation and diagnosis info
Annual assessment
New cx factors
Transition of care

Question 25

Lowering inflammation and risk of developing metabolic diseases…..(2 things)

Answer 25

1) eating more fiber
2) being active