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PPC3 Exam 2 > Diabetes 2 > Flashcards

Diabetes 2 Flashcards

1
Q

Diabetes and Exercise (5)

A
  1. Promotes cardiovascular fitness, control weight, enhance self-esteem
  2. Children with diabetes should not be excluded from participation in sports activities
    a. Coaches educated about diabetes; glucagon available
  3. Physical activity guidelines same – 60 minutes/day
  4. Challenge – control of blood glucose levels during and after exercise
    a. Blood glucose monitoring – before, during and after exercise
    b. Snacks around the time of exercise
    c. Adjustment of insulin dosing to counterbalance effect of exercise
  5. How exercise affects glucose levels varies by type, duration and intensity of exercise
    a. Aerobic → Generally will lower blood glucose levels pretty quickly
    b. Anaerobic (ex: weight lifting) → May increase BS in short term and then lower BS several hours after
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2
Q

Blood Glucose Instability: Hypoglycemia (5)

A

a. Too much insulin
b. Delayed meal or snack
c. Failure to eat all of meal or snack
d. More active than usual
e. Gastroenteritis

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3
Q

Blood Glucose Instability: Hyperglycemia (5)

A

a. Too little insulin
b. Too much food
c. Decreased activity
d. Stress
e. Sick

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4
Q

Ongoing Clinical Management – Visits q3-4 Months (7)

A
  1. Visit tailored by age and developmental stage
  2. Blood glucose records, hypoglycemia frequency
  3. HbA1c
  4. Physical activity
  5. Emotional adjustment
  6. School and social issues
  7. Eating issues; Diabulemia – insulin decreased/omitted to lose weight
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5
Q

Ongoing Clinical Management: General (8)

A
  1. Growth and weight gain
    a. Expect them to be growing normally
    b. If their weight is growing a lot more than their height → are they eating healthily? Exercise? Figure out what is going on
  2. Blood pressure
  3. Stage of puberty
  4. Injection site assessment
  5. Assessment for other autoimmune disease
    * Thyroiditis, celiac disease
  6. Continued well child health supervision and appropriate immunizations, e.g. flu vaccine
  7. Monitoring for complications
  8. Referral to nutritionist, Communication with school personnel
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6
Q

T2DM Pathophysiology (6)

A
  1. Genetic predisposition
  2. Insulin resistance
    a. Growth hormone
    b. Pubertal hormones
  3. Impaired beta cell function
  4. Inadequate insulin secretion
  5. Generally insidious onset
    * Often recognized at routine visit
  6. Small number of children present in DKA (8% in one study)
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7
Q

Epidemiology of T2DM (5)

A
  1. Emerged concurrently with rising prevalence of overweight and obesity in American youth
  2. One third (31.8%) of American children are either overweight or obese (Ogden, 2014)
  3. Minority children have higher prevalence rates for overweight and obesity
    * 36.1% African American girls and 37.0% Latina girls overweight or obese compared to 29.2% of non Hispanic white girls
  4. Type 2 diabetes better recognized
  5. Comorbidities more likely to be present at time of diagnosis
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8
Q

T2DM In Youth (2)

A
  1. Today approximately 50% of youth diagnosed with diabetes during adolescence have T2DM
  2. T2DM disproportionately affects disadvantaged children
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9
Q

Evidence Based Treatment Options for T2DM in Adolescents and Youth (5)

A

Safety and efficacy of 3 treatments

  1. Metformin 500-1000 mg bid
  2. Metformin (500-1000 mg bid) + rosiglitazone (4 mg bid)
  3. Metformin + intensive lifestyle intervention

Enrollment target
4. 750 children age 10-17 years

  1. Outcome: time to treatment failure defined as HbA1c>8%
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10
Q

T2DM Treatment Goals (6)

A
  1. Promote weight loss
  2. Normalize glycemia and HbA1c
  3. Prevent/control hypertension and hyperlipidemia
  4. Increase exercise capability
  5. Reduce acanthosis nigricans
  6. BEHAVIOR CHANGE!!
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11
Q

T2DM Treatment Recommendations at diagnosis (4)

A
  1. Initiate insulin therapy for youth with T2DM who are ketotic or DKA or when type of diabetes is unclear
  2. Initiate insulin therapy for youth
    * Random venous or plasma BG ≥250 mg/dl OR A1c >9%

Otherwise
3. Lifestyle modification including nutrition and physical activity

  1. Start metformin
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12
Q

T2DM Treatment and Management with Goals (7)

A
  1. Metformin alone inadequate to treat T2DM
    * You need to make the blood glucose environment amenable to Metformin first; lower it to an amenable level
  2. Metformin–first line drug
    a. Reduces A1c
    b. Minimal risk of hypoglycemia
    c. Effect on reducing LDL cholesterol
  3. Monitor A1c q3months; intensity treatment if A1c goals are not being met
    a. Target A1c goal <7%
    b. If monotherapy fails can add additional oral hypoglycemic agent or insulin
  4. Fingerstick blood glucose monitoring
    a. Taking insulin or other meds with hypoglycemia risk
    b. Initiating or changing diabetes treatment regimen
    c. Have not met treatment goals
    d. Intercurrent illness
  5. Fingersticks should be performed ≥3 times daily when using multiple insulin injections or insulin pump therapy
    * Fasting goal 70-130 mg/dl
  6. For less-intensive therapy, finger-stick BG monitoring may be useful as a guide to the success of therapy.
  7. To achieve postprandial glucose targets, postprandial finger-stick BG monitoring may be appropriate.
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13
Q

Dietary Recommendations to Reduce Calorie Intake and Promote Weight Loss (9)

A
  1. Eat regular meals and snacks
  2. Reduce portion sizes
  3. Choose calorie-free beverages, except for milk
  4. Limit juice to 1 cup per day
  5. Increase consumption of fruits and vegetables
  6. Consume 3 or 4 servings of low-fat dairy products per day
  7. Limit intake of high-fat foods
  8. Limit frequency and size of snacks
  9. Reduce calories consumed in fast- food meals
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14
Q

Screening for T2DM (4)

A
  1. Children 10 years of age or older
  2. BMI >85th percentile with ≥2 risk factors:
    a. + family history of Type 2 in 1st or 2nd degree relatives
    b. Race/ethnicity: higher in ethnic minorities
    c. Signs of or conditions associated with insulin resistance
    i. Acanthosis nigricans
    ii. Hypertension
    iii. Dyslipidemia
    iv. Polycystic ovary disease
  3. Screen q3 years with fasting plasma glucose
  4. Yearly glucose screens for obesity (95th%ile and above)
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15
Q

Maturity Onset Diabetes of the Young (MODY) (7)

A
  1. Group of autosomal dominant single gene disorders that resemble type 1 or type 2 diabetes
  2. Impaired insulin secretion without significant defects in insulin action
    a. Similar to type 1 but it isn’t autoimmune, it’s really a gene disorder
  3. Lack pancreatic autoimmunity
  4. Lower insulin requirements than someone with T1DM would have
  5. Positive family history of diabetes
  6. Younger, less likely to be overweight or obese, less likely to be from an ethnic minority group
  7. Treatment varies and can include insulin, sulfonylureas, etc.
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16
Q

PNP Role in Health Provisions (5)

A
  1. Optimize insulin/pharmacologic therapy dosing
  2. Optimize blood glucose values
  3. Promote normal growth and development
  4. Anticipate/ deal with developmental issues
  5. Promote positive child/family adaptation to chronic illness
17
Q

Recommended Screening for Youths with T1DM (9)

A
  1. Glycemic control: measure HbA1c every 3 months
  2. Thyroid disease: check antibodies and TSH at diagnosis and every 1-2 years
  3. Celiac Disease: check TTG-IgA, IGA at diagnosis, 2 and 5 years later, and as clinically indicated
  4. Dyslipidemia: check fasting lipids with + history, at diagnosis or at 10 years
  5. Nephropathy: check random urine albumin to Cr ratio 5 years after diagnosis then yearly
  6. Hypertension: check BP yearly
  7. Retinopathy: do dilated eye exam anually once age 10 or puberty AND diabetes duration 3-5 years
  8. Neuropathy: do foot exam anually once age 10 or puberty and diabetes duration of 5 years
  9. Pyschosocial: screen for emotional well being at each visit
18
Q

Recommended Screening for Youths with T2DM (9)

A
  1. Glycemic control: check HbA1c every 3-6 months
  2. Thyroid disease: N/A
  3. Celiac Disease: N/A
  4. Dyslipidemia: check fasting lipids at diagnosis and routinely at age 10 years
  5. Nephropathy: check random urine albumin to Cr ratio at diagnosis and yearly
  6. Hypertension: check BP yearly
  7. Retinopathy: do dilated eye exam at diagnosis and yearly
  8. Neuropathy: do foot exam yearly
  9. Pyschosocial: screen for emotional wellbeing at each visit
19
Q

Complications of Diabetes (7)

A

Acute

  1. Severe hypoglycemia
  2. DKA

Chronic secondary to poor glycemic control

  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
  4. Depression
  5. Atherosclerosis and early cardiovascular disease
20
Q

Diabetes self-management education in Infancy (4)

A
  1. Period of trust vs. mistrust
  2. Providing warmth and comfort measures after invasive procedures is important
  3. Feeding and sleeping or nap routines
  4. Vigilance for hypoglycemia
21
Q

Diabetes self-management education during play age (3-5 years old) (5)

A
  1. Reassurance that body is intact, use of Band-Aids and kisses after procedures
  2. Identification of hypolgycemic signs and symptoms (temper tantrums and nightmares)
  3. Include child in choosing injection and finger-prick sites
  4. Positive reinforcement for cooperation
  5. Begin process for teaching child awareness of hypoglycemia
22
Q

Diabetes self-management education during school age (6-12 years old) (5)

A
  1. Integrate child into educational experience
  2. Determine skill level
  3. Identify self-care skills
  4. Determine roles and responsibilities
  5. Communication with peer sand school staff- who and when to tell about diabetes
23
Q

Diabetes self-management education during adolescence (12-18 years) (9)

A
  1. Begin transition care planning
  2. Personal meaning of diabetes
  3. Determine roles and responsibilities in care
  4. Social situations and dating
  5. Who or when to tell about diabetes
  6. Driving
  7. Sex and preconception counseling
  8. Alcohol and drugs
  9. College and career planning
24
Q

Transitioning from Pediatric to Adult Care (4)

A
  1. Transition from pediatric to adult care associated with increased risk of poor glycemic control at follow up
  2. Teens/young adults need additional support when moving to adult care
  3. Best practices remain elusive
  4. Systematic review of 18 studies that examined transition
    a. Average age of transfer was 17.7years
    b. All reported stability or improved control at transfer to adult care
    * Meta-analysis of studies that had control group–no differences
    c. Programs that included coordinator as well as transition clinic seemed most effective
    d. Social media and/or Internet based connectivity surprisingly not employed

PPC3 Exam 2 (11 decks)

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