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Community And Wellness > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the definition of diabetes Mellitus?

A

Hyperglycemia
-elevated blood sugar

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2
Q

What can cause diabetes Mellitus?

A

Inability to produce insulin (Type I)
Insulin resistance, cells fail to respond to insulin properly (type II)

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3
Q

What are the characteristics of DM type I

A

Requires insulin
-Due to autoimmune process that destroys beta cells
-Presents in children/young adults <30 yoa

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4
Q

What are the characteristics of type II DM?

A

Combination of
1. Insulin resistance
2. Relative impairment of insulin secretion (insulin deficiency)
-lose beta cell function over time
-90% of diabetics are overweight

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5
Q

When is type II DM most common?

A

> 40 yoa

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6
Q

What are the most important risk factors of type II DM?

A

Race
African American
Hispanic

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7
Q

What are the risk factors for type II diabetes?

A

Delivering a baby over 9lbs
Gestational DM
Impaired glucose tolerance
-A1C >5.7%
PCOS

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8
Q

What are the DM related vascular complications? (Micro)

A

Micro vascular complications=small vessels
-Retinopathy
-Nephropathy
-Neuropathy
(Hands, feet GI)

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9
Q

How can diabetic nephropathy happen?

A

Protein molecules spill in to the urine because of damage of capillary wall

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10
Q

What are DM related vascular complications? (Macro)

A

Macrovascular complications=Large vessels
-Atherosclerosis
-MI, CAD
-Stroke
-Peripheral vascular disease

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11
Q

What are the clinical presentations of DM?

A

Most asymptomatic
Classical symptoms
-Polyuria
-Polydipsia (excessive thirst)
-Polyphagia (excessive hunger)
-weight loss

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12
Q

If someone is diagnosed with DM when should they schedule a doctors visit?

A

H&P every 3-6 months
-Patients with diabetes require ongoing evaluation for diabetes-related complications

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13
Q

What are some specific history components to evaluate for someone with DM?

A

Evaluate BS log
Evaluate for hypoglycemia
-review medication usage, side effects
-review food plan
-evaluate signs/symptoms of micro or macro complications
*Dizziness, leg pain, foot numbness

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14
Q

What is the goal of blood pressure for someone with DM?

A

130/80mmHg

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15
Q

What medication can be provided for someone with DM?

A

Angiotensin-converting enzyme (ACEI) inhibitor
-provides renal protection
-reduces protein leakage
-slows diabetic nephropathy disease progression

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16
Q

What is diabetic retinopathy?

A

Diabetes is the leading cause of blindness in adults 20-74
-Painless deterioration of small retinal vessels
-can cause permanent vision loss

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17
Q

What eye problems are related to refractive errors?

A

Cataracts
Glaucoma
*more prevalent in diabetic patients

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18
Q

When should a dilated eye examination be conducted?

A

Annually

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19
Q

What is the clinical presentation of diabetic retinopathy?

A

Asymptomatic (vital to the examine)
-floaters
-blurred vision
-distortion
-progressive visual acuity loss (central vision loss)

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20
Q

What is diabetic nephropathy?

A

Slow progressive kidney deterioration leading to albuminuria
-in functioning kidneys albumin is not in the urine

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21
Q

Where is albumin usually found?

A

In the blood

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22
Q

What is the first sign of kidney issue?

A

Albuminuria

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23
Q

What is the test to detect DM nephropathy?

A

Albumin to creatinine ratio (ACR)

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24
Q

What is the levels for moderately increased albuminuria?

A

<30mg/g
-earliest indicator of kidney involvement

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25
Q

What is the range for severely increased albuminuria?

A

<300mg/g

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26
Q

What is the most common cause of end stage renal disease?

A

DM
-HTN is second most common, increase BP accelerates renal deterioration

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27
Q

What is a better estimate of glomerular filtration?

A

EGFR <60mL/min
-annually screened

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28
Q

What is the initial gold standard for protein detection in urine?

A

24 hours urine collection
-if + screen timed early morning urine collection testing albumin concentration is also acceptable

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29
Q

What is the first method to detect elevate protein levels?

A

Albumin-to-creatinine ratio (ACR)
-normal is <30mg/day

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30
Q

What is the levels of moderately increased albuminuria?

A

30-300mg/day

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31
Q

What is the levels of severely increased albuminuria?

A

> 300mg/day

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32
Q

What can the urinary albumin-to-creatinine ratio detect?

A

DM nephropathy 5 years before routine protein urine tests

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33
Q

What is the prevalence of moderately increased albuminuria of patients with type 2 DM?

A

25-40%

34
Q

What can diabetic neuropathy damage?

A

Damage nerves in legs and feet
-stocking and glove

35
Q

What is sensorimotor?

A

Paresthesia, abnormal gait, decreased proprioception, “stocking glove pattern”, pain, decreased deep tendon reflexes

36
Q

What are some autonomic neuropathy complication of DM

A

Orthostatic hypotension, gastroparesis, nausea, vomiting

37
Q

What are some cranial nerve III palsy complications of DM?

A

Pupil size remains normal unlike other causes of CN III palsy

38
Q

When should a comprehensive foot examination be done?

A

Annually

39
Q

What are some risk factors for foot ulcer and amputation?

A

Previous foot ulcerations
neuropathy
Foot deformity
Vascular disease

40
Q

What is the most common reason for hospital stays for DM patients?

A

Foot ulcers
-often painless

41
Q

What are the 3 parameters that the “3 minute foot exam” covers?

A
  1. History
  2. Physical exam
  3. Patient education
    *consistent foot-care services in PC can reduce amputations in diabetic patients
42
Q

What is the history to obtain (1 minute)

A

Previous diabetic complications
Prior angioplasty or stent
History of prior foot ulcers
Lower limb bypasses or amputation
Presence of claudication or Hx of PVD
burning or tingling in legs of feet

43
Q

What are the components of the physical exam (minute 2)

A

Careful inspection of feet
*infection
*skin breakdown
*ulcer formation
*skin temperature changes
*inadequate vascular perfusion

44
Q

What is a rocker bottom deformity?

A

Charcot foot
-curvature of the plantar surface

45
Q

Should DM patients be barefoot?

A

No, wear shoes even indoors

46
Q

What are the 4 components of a rapid lower limb examination?

A

1.Dermatological
2. Neurological
3. Musculoskeletal
4. Vascular

47
Q

What are you inspecting for during the dermatological part of the foot exam?

A

Discolorations
Calluses
Wounds
Fissures
Macerations
Nail dystrophy
Paronychia

48
Q

What are you inspecting for during the neurological part of the foot exam?

A

Reduction in strength of Dorsi flexion and plantar flexion

49
Q

What is neuropathic damage?

A

Loss of protective sensation
-linked to 75% of al non-traumatic diabetic amputations

50
Q

When an ulcer forms in a DM patient what can happen?

A

Healing may be delayed or difficult to achieve
-especially if the infection penetrates to deep tissues and bone

51
Q

What are some of the signs of diabetic neuropathy?

A

Sweating is diminished or absent
-skin of feet are dry and become scaly
There will be shunting of blood from arteries directly to veins
-Foot feels warm

52
Q

What are the different types of screening tests for peripheral neuropathy?

A

Vibration sensation
Pressure sensation
Proprioception
Reflexes

53
Q

What is the vibration sensation of the screening test?

A

Tuning fork that is applied to the bony prominence at the dorsum of the first toe

54
Q

What is the pressure sensation part of the screening test?

A

Monofilament
-superficial pain or temperature sensation

55
Q

What is the proprioception part of the screening test?

A

Smoothness and symmetry of gait
*up down test

56
Q

What is the reflex part of the screening test?

A

Achilles’ tendon is most commonly used

57
Q

What is one of the earliest indications for neuropathy?

A

Diminished vibratory perception threshold (VPT)

58
Q

What are some alternative for predicting ulcer risk?

A

Monofilament and a 128Hz tuning fork

59
Q

What is the Ipswich touch test?

A

Use pointer finger
-patient will close his or hers eyes
-PA will rest the finger on the toes
-patient will determine if they feel the PA touch

60
Q

What are the Palpation points for Ipswich touch test?

A

1st
3rd
5th

61
Q

What are the two most important risk factors for developing foot ulcers?

A
  1. The presence and severity of diabetic neuropathy
  2. Presence of peripheral artery disease
62
Q

Leg pain assessment rating (sensation)

A

Burning (2)
Numbness (2)
Tingling (2)
Cramping (1)
Aching (1)

63
Q

Leg pain assessment location?

A

Feet (2)
Calves (1)

64
Q

Leg pain assessment (symptoms awake you)

A

Yes (1)

65
Q

Leg pain assessment: timing

A

night (2)
Day and night (1)
Day only (0)

66
Q

Leg pain assesment (how are symptoms relieved)

A

Walking around (2)
Standing (1)
Sitting/lying (0)

67
Q

What is the medication often used for treatment in diabetic patients?

A

Neurontin (gabapentin)

68
Q

What is the normal, pre diabetes, and diabetes category for A1C

A

Normal: less than 5.7%
Pre diabetes: 5.7% to 6.4%
Diabetes: 6.5% or higher

69
Q

What is the normal, pre diabetes, and diabetes levels for FPG? (Impaired fasting glucose)

A

Normal: <100
Pre diabetes: 100mg/dl to 125mg/dl
Diabetes: 126mg/dL or higher

70
Q

What is the normal, pre diabetes, and diabetes levels for OGTT?

A

Normal: < 140mg/dl
pre diabetes: 140 to 199mg/dl
diabetes: 200mg/dl or higher

71
Q

People with impaired fasting glucose are at an increased risk for what/

A

macrovascular impairements

72
Q

What age range should a diabetic be on statin therapy?

A

40-75 yoa

73
Q

What are the goal lipid ranges for diabetics?

A

LDL: <100g/dL (CVD <70)
Triglycerides: <150mg/dL
HDL: >40mg men, >50mg women

74
Q

When should A1C be re-tested?

A

Twice yearly: patients meeting treatment goals
Quarterly: not meeting goals

75
Q

What is a reasonable goal for A1C?

A

<7%

76
Q

What are some characteristics of DKA (diabetic ketoacidosis)

A

Fruity breath
*life-threatening body starts breaking down fat at a rate that is too fast

77
Q

What does the liver process fat into ?

A

Ketones
-the blood will become acidotic or ketoacidosis

78
Q

What should pre-prandial (before eating) glucose levels be?

A

80-130mg/dL

79
Q

What should post-prandial blood glucose goals be?

A

<180mg/dL at 1 hour

80
Q

What medication should be initiated with lifestyle intervention at T2DM?

A

metformin

81
Q

What is the MOA of metformin?

A

Lowers glucose by decreasing the amount of glucose produced in the liver
-GI side effects

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