Diabetes Flashcards by Kamryn Ordes

Criteria for diagnosing DM

Fasting blood glucose 126 mg/dL or more
Casual glucose exceeding 200 mg/dL
A1C equal to or > 6.5% (48 mmol/mol)

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What occurs with Type I Diabetes?

insulin is not secreted from pancreas

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Risk factors for Type I diabetes

early-onset, familial, genetic predisposition, possible immunologic or environmental (viral toxins)

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How are insulin-producing beta cells in the pancreas destroyed?

by genetics, immunology, and environmental factors

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Type 1 diabetes results in

decreased insulin production
unchecked glucose production by the liver
fasting hyperglycemia

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What % of diabetic adults are affected by type 1?

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What occurs in type II DM?

Deficiency in insulin’s action

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risk factors for DM2

obesity, age, previous identified, impaired fasting glucose or impaired, glucose tolerance, hypertension ≥140/90, mm Hg, HDL ≤35 mg/dL or triglycerides, ≥250 mg/dL, history of gestational, diabetes or babies over 9 pound, Microvascular versus macrovascular complications

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DM2 results in

Insulin resistance and impaired insulin secretion

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What % of diabetic adults are affected by DM2?

95%

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DM has an average onset of

over 30 years

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DM 2 is increasing in children

r/t obesity

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This condition is slow, progressive glucose intolerance and may go undetected for years

DM2

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Macrovascular complications result from

changes in medium and large blood vessels

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What occurs during microvascular complications?

Walls thicken, sclerosis, and plaque build up

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What are the top 3 macrovascular complications

Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease

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Microvascular complications are a result of

capillary basement membrane thickening

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What two areas are affected by microvascular complications?

eyes and kidneys

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Examples of microvascular complications:

Diabetic retinopathy

Nephropathy

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ORAL DIABETIC MEDICATIONS: glipizide is an example of a

second generation sulfonylurea

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ORAL DIABETIC MEDICATIONS: metformin is an example of a

Biguanide

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DKA occurs when a patient is diabetic and has

•Intoxication
•Infection
OR
•Insulin deficit

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insulin deficit results in

abnormal metabolism of carbohydrate, protein, and fat

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The three clinical features of DKA are:

Hyperglycemia
Dehydration
Acidosis

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blood glucose levels in DKA:

>300 to 1000 (Severity of DKA not only due to blood glucose level)

What does ketoacidosis in DKA include?

low pH; low Bicarb, low PCO2, | •Ketone bodies in blood and urine

Electrolyte imbalances in DKA

vary according to degree of dehydration •HyperKalemia •increase in creatinine, Hct (dilutional), BUN

Treatment of DKA

Rehydration with IV fluid IV continuous infusion of regular insulin reverse acidosis and restore electrolyte balance Note: Rehydration leads to increased plasma volume and decreased K; insulin enhances the movement of K+ from extracellular fluid into the cells - montior K levels and replace as needed. monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload

management of DKA is aimed at:

correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin

What distinguishes HHS from DKA?

ketosis and acidosis generally do not occur in HHS, partly because of differences in insulin levels

In DKA, no insulin is present, and this promotes:

the breakdown of stored glucose, protein, and fat, which leads to the production of ketone bodies and ketoacidosis

In HHS, the insulin level is too low to prevent hyperglycemia (and subsequent osmotic diuresis), but it is high enough to

prevent fat breakdown

Patients with HHS do not have the ketosis-related gastrointestinal symptoms that lead them to seek medical attention. Instead, they may:

tolerate polyuria and polydipsia until neurologic changes or an underlying illness (or family members or others) prompts them to seek treatment.

In DKA, fluid replacement enhances the excretion of:

excessive glucose by the kidneys (the patient may need as much as 6 to 10 L of IV fluid to replace fluid losses caused by polyuria, hyperventilation, diarrhea, and vomiting)

Which fluid is given for treatment of DKA?

Initially, 0.9% sodium chloride (normal saline [NS]) solution is given at a rapid rate, usually 0.5 to 1 L per hour for 2 to 3 hours. Half-strength NS (0.45%) solution (also known as hypotonic saline solution) may be used for patients with hypertension or hypernatremia and those at risk for heart failure

When BG's in DKA being treated by fluid replacement reach 300 mg/dL (16.6 mmol/L) or less, the IV solution may be changed to

dextrose 5% in water (D5W) to prevent a precipitous decline in the blood glucose level

Which fluid is used to treat HHS?

0.9% or 0.45% NS, depending on the patient's sodium level and the severity of volume depletion

In HHS potassium is added to IV fluids when:

urinary output is adequate and is guided by continuous ECG monitoring and frequent laboratory determinations of potassium

Insulin plays a less important role in the treatment of HHS because:

it is not needed for reversal of acidosis

In HHS insulin is usually given at a continuous low rate to treat?

hyperglycemia, and replacement IV fluids with dextrose are given (as in DKA) after the glucose level has decreased to the range of 250 to 300 mg/dL (13.8 to 16.6 mmol/L)

Hyperosmolar hyperglycemia (HHS) is caused by:

a lack of sufficient insulin

In HHS ketosis is?

minimal or absent

Hyperglycemia (in HHS) causes:

* osmotic diuresis * loss of water and electrolytes * hypernatremia * increased osmolality

Hypotension, profound dehydration, tachycardia, variable neurologic signs caused by cerebral dehydration are all manifestations of?

Hyperosmolar hypertension (HHS)

The mortality rate of HHS is:

high

Rehydration, insulin administration, and monitoring fluid volume and electrolyte status is used in the treatment of?

HHS

Prevention of HHS includes:

BGSM (blood glucose self-monitoring) •Diagnosis and management of diabetes •Assess and promote self-care management skills

deficiency of insulin results in?

diabetes

Why are older adults more prone to diabetes?

doesn't have as much muscle to store insulin (goes in bloodstream)

features of type I and II diabetes are both shown in what kind of diabetes?

Latent autoimmune diabetes

Three P's of diabetes (manifestations):

Polyuria, polydipsia, polyphagia

sudden weight loss occurs in type ___ diabetes

Hemoglobin A1C is an indicator of how well:

hemoglobin is saturating with glucose

nutritional therapy, exercise, monitoring, pharmacologic therapy, and education are all involved in

Diabetes management

diabetic diet

50-60% carbs, 30% fat, non-animal sources of protein

insulin lipodystrophy is the:

fatty hardening from giving insulin injections in same place (so rotate your sites)

Metformin is an oral drug for

Type II diabetes

Second-generation sulfonylureas and Biguanides are:

Oral drug classes for diabetes

insulin injection sites:

abdomen, thigh, upper arm, upper glutes

The abdomen is the pressed site for insulin section because:

it is absorbed more slowly and consistently than the other sites

Type I diabetes is associated with:

DKA

Type II diabetes is associated with:

HHS

A BG of 50-60mg/dL is

hypoglycemia

Symptoms of hypoglycemia:

hypoglycemia: | diaphoresis, increased pulse, restlessness, extreme hunger (DIRE)

DKA is triggered by:

Hyperglycemia

Glucose levels in HHS

>600 mg/dL

Glucose levels in DKA

>250mg/dL

The following are all diagnostics for which disorder? BG 300-800+ Acidosis (low pH, low bicarb, low PCO2) Electrolyte imbalance d/t water loss Increased BUN, creatnine & HCT

DKA

In _________ lack of insulin causes decreased utilization of glucose by muscle, fat, and liver. This leads to hyperglycemia and Increased breakdown of fat, increased fatty acids, and increased ketone bodies

DKA

Clinical manifestations of DKA include:

Hyperglycemia polyuria, polydipsia, fatigue, blurred vision, weakness, headache Volume depletion hypotension, rapid pulse Ketois/acidosis GI symptoms (N/V, abd pain ACETONE BREATH & KUSSMAUL RESPIRATIONS)

BG (600-1200 mg/dL) electrolytes, BUN, CBC, serum osmolality (>320 mOsm/kg) , ABG These are diagnostics for which disorder?

HHS

Metabolic disorder of T2D | Insulin deficiency; illness that raises the demand for insulin

HHS

Clinical manifestations of HHS include?

Hypotension Profound dehydration Tachycardia Variable neurologic signs caused by cerebral dehydration (lethargy, seizures, coma)

Treatment for ______ includes fluid replacement, correct electrolytes, insulin administration

HHS

Diabetes Flashcards

(74 cards)