chronic exam 1-diabetes Flashcards Preview

chronic > chronic exam 1-diabetes > Flashcards

Flashcards in chronic exam 1-diabetes Deck (72):
1

beta cells produce

insulin

2

alpha cells produce

glucagon

3

functions of insulin

lowers blood glucose by:
regulates rate of CHO metabolism
promotes glycogen storage
inhibits fats breakdown
inhibits protein breakdown

4

functions of glucagon

raises blood sugar by promoting conversion of glycogen to glucose

5

name of type 1 diabetes

IDDM (insulin dependent diabetes mellitus)
previously called juvenile diabetes

6

name of type 2 diabetes

NIDDM (non-insulin dependent diabetes mellitus)
previously called maturity onset diabetes

7

type 1 diabetes is characterized by

a total lack of insulin production
suggests an autoimmune process that destroys beta cells

8

type 2 diabetes is characterized by

an inadequate production of insulin or increased cellular resistant to the body's own insulin

9

type 1 diabetes onset

faster onset
usually before 30yo but can occur at any age
tend to be normal weight

10

type 2 diabetes onset

slower onset
usually 35+ years but can occur at any age
tend to be obese

11

% of diabetics that are type 1

10-15%
insulin required by all

12

% of diabetics that are type 2

85-90%
increased familial predisposition
insulin required for 20-30%

13

clinical manifestations

1. three P's
2. weight loss-cant breakdown glucose so it'll breakdown fat
3. fatigue/weakness
4. blurred vision
5. frequent infections-glucose harbors bacterial growth

14

three P's

polydipsia-excessive thirst
polyphagia-excessive hunger
polyuria-excessive urination

15

fasting blood sugar

70-110 mg/dL
Diagnosis= FBS>126 on 2 different occasions

16

glycoslyated hemoglobin

Hgb A1C
Hgb molecules combine with glucose to from glycohemoglobin which is stored by red blood cells
the percentage of "glycosylated hemoglobin" can be measured by a blood test (4%-6%)
indicator od an individual's glucose level for the previous three months

17

6 food groups

Starch/Bread
Protein/Meat
Dairy/Milk
Fruits
Vegetables
Fats

18

distributions of calories

50-60% Carbs
20-30% Fats
20% protein

19

dietary considerations

special foods are not necessary
alcohol promotes hypoglycemia
dont skip meals
do strive for regular meal times
do control fat
do use sugar substitutes (equal splenda etc)

20

net effect of exercise

lower blood sugar by transporting glucose into the muscle cell (must be aerobic exercise)

21

controlling type 2 diabetes

may be controlled with diet and exercise alone, or in combination with oral hypoglycemics

22

original source of insulin

beef and pork pancreas

23

persons using synthetic insulins....

have a lower risk of insulin resistance

24

rapid acting types

Humalog (lispro)
Novalog (aspart)

25

Short Acting types

regular

26

Intermediate acting types

NPH (cloudy)

27

Long acting types

Glargine (Lantus)
Detemir (Levemir)

28

onset peak duration of Rapid Acting

Onset: 10-15 min
Peak: 1 hr
Duration: 2-4 hr

29

onset peak duration of Short Acting

Onset: 1/2 hr-1 hr
Peak: 2-4 hr
Duration: 5-7 hr

30

onset peak duration of Intermediate Acting

Onset: 2-4 hr
Peak: 6-12 hr
Duration: 18-24 hr

31

onset peak duration of Long Acting

Onset: 3-4
Peak: none for lantus; 3-14 hr for detemir
Duration:24-36 hr

32

insulin preparation

cloudy
clear
clear
cloudy

33

insulin storage

keep vial at room temp
refrigerate spare vials
protect from extreme heat, freezing

34

injection teaching

more rapid absorption from abdomen, then arms, then legs

35

lipohypertrophy

fat accumulation which occurs at sites of frequent insulin injection

36

injection rotation

rotate within each site, spacing injections 1 inch apart
do not se a site longer than a month

37

sulfonylureas

Glucatrol, Glimepiride
Stimulates beta cells to produce insulin; increase cellular receptivity

38

Meglitinides

Prandin
stimulates beta cells to produce insulin

39

Biguanides

Glucophage
Increase cellular receptivity to insulin; decrease hepatic production of glucose

40

Thiazolidinediones (TZDs)

Avandia, Actos
Decrease insulin resistance by increasing receptor sensitivity

41

Alpha-glucosidase Inhibitors

Precose
Delay digestion of complex carbs

42

Incretin Mimetics

decrease glucagon secretion from pancreas, increase insulin release

43

DDP-4 Inhibitors

Inhibit enzyme that inactivates incretin

44

Diabetic Ketoacidosis

usually occurs in type 1 diabetes
As a result of severe insulin deficiency, the body resorts to breakdown of fats and proteins since it cannot utilize glucose

45

DKA pathophysiology

ketone production (incomplete fat metabolism)
acidosis
profound dehydration (due to osmotic diuresis)
Hyperkalemia (potassium shifts out of the cells)

46

DKA causes

undiagnosed Diabetes
omitting insulin especially on sick days
not enough insulin in relation to a physical stressor

47

DKA stressors

cause a sympathetic response which mobilizes glycogen from the liver resulting in hyperglycemia
surgery
infection
trauma
illness

48

DKA clinical manifestations

3P's
dehydration
tachycardia
hypotension
warm, dry skin
n/v
fruity breath
Kussmaul Respirations

49

Kussmaul Respirations

increases rate and depth to blow off CO2 and raise pH

50

DKA diagnostics

pH 350 mg/dL
positive serum acetone
positive ketonuria
potassium >5.0

51

DKA management

IV fluids
IV insulin (regular only, continuous low dose)
IV K+ prn (as pH improves, K levels drop)

52

DKA complications

hypovolemic shock
coma
death

53

HHNK

hyperglycemic, hyperosmolar Nonketotic Coma
primarily occurs in T2Diabetes
insufficient insulin prevents ketoacidosis but not severe hyperglycemia

54

HHNK causes

often the same precipitating factors as for DKA

55

HHNK clinical manifestations

severe hyperglycemia (>1000mg/dL)
severe dehydration
hypotension
tachycardia
hypovolemic shock leading to coma

56

HHNK Management

Rapid IV fluid replacement to correct fluid deficit
continuous low dose infusion of regular IV insulin

57

hypoglycemia (insulin reaction)

Most common type one diabetic's related to insulin therapy with the rapid onset

58

Causes of hypoglycemia (insulin reaction)

Excessive insulin, delayed or skipped a meal, alcohol usage, excessive exercise without calorie supplementation

59

Clinical manifestations of hypoglycemia (insulin reaction)

Shakiness, palpitations, dizziness, anxiety, hunger, headache, confusion, irritable, fatigue, diaphoresis, may appear as if person is drunk

60

management of hypoglycemia (insulin reaction) in conscious

orange juice
jam, honey
hard candy
"regular" soda

61

management of hypoglycemia (insulin reaction) in unconscious

glucagon subQ
dextrose 50% IVP

62

microvascular disease

Disease of the small blood vessels; more common in type one diabetics; includes retinopathy, nephropathy, and neuropathy

63

Retinopathy

Diabetic retinopathy increases the risk of glaucoma (increased intraocular pressure) and cataracts

64

Management of retinopathy

Slow the onset and progression buy near euglycemia (near normal blood glucose levels)
photocoagulation (laser therapy) to coagulate bleeding

65

Nephropathy

Damage blood vessels become leaky allowing proteins to form deposits in the vessels
deposits decrease oxygenation resulting in death of kidney cells

66

Management of nephropathy

Euglycemia ("normal" blood sugar levels)
dialysis or kidney transplant for end-stage renal disease

67

Neuropathy

Deterioration of nerves due to nerve hypoxia

68

sensorimotor neuropathy

bilateral and distal paresthesias characterized bu numbness, tingling, burning pain, or weakness

69

autonomic neuropathy

can affect CV, GI, Urinary, or other function

70

atherosclerosis

damage to blood vessels due to increased lipid and cholesterol levels with fatty plaque formation, increasing risk of coronary heart disease, HTN, MI

71

home blood glucose monitoring

test 1-4 times a day (before/after meals)
keep diary of results
stress good control of FBS

72

Sick Day care

test BS q4hr
sip fluids q1hr
if vomiting, take regular soda or easily tolerated foods
if BS> 300mg/dL, test urine for ketones
DO NOT skip insulin or oral medication