Diabetes Flashcards
(36 cards)
The risk for death among people w/diabetes is about ____ that of people of
similar age without diabetes.
twice
- may be underreported only ~35-40% of people w/diabetes
What are the risk factors for type 2 diabetes development?
- Obesity – >80% are overweight
- > 30 yo
- Family Hx
- Hx of gestational diabetes; Delivering a baby weighing > 9lbs
- Stress of an injury, or illness
- Steroid therapy
- Native American, Hispanic, Asian or African American Decent
- UNEXPECTED RISK FACTOR: SLEEP!
- both short (5-6hrs) and long (8-9hrs); difficulty initiating and maintaining
Characterized by elevated blood glucose levels due to metabolic defects in insulin
production, insulin action or both
diabetes
What’s the difference between type 1 and 2 diabetes?
1 = insulin deficient; AI destruction of insulin producing cells in the pancreas 2 = insulin resistant; reduced amount of insulin and cells don't use available insulin efficiently
What are the symptoms of diabetes?
- Polydipsia
- Polyuria
- Weight loss
- Nocturia
- Fatigue
- Blurred Vision
- Recurrent fungal infections
- Poor wound healing
Insulin exerts an [stimulatory/ inhibitory] effect on hepatic glucose production. Glucagon [stimulates/ inhibits] hepatic glucose production.
inhibitory; stimulates
How is diabetes diagnosed?
- Symptoms + FPG >126mg/dl or RPG >200
- Asymptomatic: 2 FPG >126 …….or RPG >200 (subsequent days) or 2 hr OGTT >200
- v A1c**:
- 6.5% or higher = diabetes
- 5.7% - 6.4% = pre-diabetes
What is the average blood glucose at the A1c 6-13%?
6% = 126 7% = 154 8% = 183 9% = 212 10% = 240 11% = 269 12% = 298 13% = 326
How does diabetes cause atherosclerosis?
- Endothelial cell dysfunction → atherosclerosis - glucose can pass freely through the endothelial cell membrane resulting in intracellular hyperglycemia and vascular damage that leads to microvascular complications
- Glycosylation of proteins → inflammatory changes in arterial cell walls → atherosclerosis
- Glycosylation of LDL → oxidation → formation of foam cells → atherosclerosis
What are the macrovascular complications of diabetes?
- MI
- Stroke
- Peripheral Arterial Disease
What are the microvascular complications of stroke?
- Retina (diabetic retinopathy) = #1 cause of blindness; also early cataracts
- Glomerulus (diabetic nephropathy) = #1 cause of ESRD; dialysis
- Nerves (diabetic neuropathy) = #1 cause of lower extremity amputations; diminished sensation, pain, amputations
What are lifestyle modifications can be made that will prevent or delay onset of diabetes?
- diet modifications - reduce carb intake; reduce calorie intake by 250-500
- activity and exercise - modest weight lost (5-10% BW); modest physical activity (30 mins 5-7 days/week) is most important
What is the primary management component athletes is important for sustained improvement in glycemic control?
exercise
Why does exercise balance out glucose?
exercise increases glucose uptake
- decrease in exercise can lead to hyperglycemia
- suppressed insulin levels lead to hypoglycemia`
What are the potential risks of exercise for people with diabetes?
- Hypoglycemia
- Hyperglycemia
- Ketosis
- Cardiovascular Event
- Musculoskeletal Injury
- Vitreous Hemorrhage or 7. Retinal Detachment
- Foot Ulcers
What are the benefits of exercise?
- Reduction in Plasma Glucose
- Improved Functioning of CV System
- Improved Strength and Endurance
- Reduction in Cholesterol, LDL and Triglycerides
- Increase in HDL
- Increased Insulin Sensitivity
- Improved Quality of Life and Self-Esteem
- Reduced Psychological Stress
Prior to exercise, what complications do you need to determine a pt may have from diabetes?
- Autonomic Neuropathy
- Peripheral Neuropathy
- Retinopathy
- Nephropathy or Microalbuminuria
- Heart Disease
- Hypertension
- PVD
What practices are encouraged for diabetes pts in terms of nutrition and exercise?
- Eat a meal 1-3 hours prior to exercise
- Check blood glucose before exercise
- Check BG every 30-60 min during exercise
- Check BG immediately after exercise and 2-4 hours following.
What carb intake/ other action is recommended for a pre-exercise BG level < 90 mg/dL?
15-30 grams of fast-acting carbohydrate prior to start of exercise
- May require additional carbohydrate for prolonged activities
What carb intake/ other action is recommended for a pre-exercise BG level 90-150 mg/dL?
Start consuming carbohydrate at onset of most exercise (depending on type of exercise and amount of active insulin
What carb intake/ other action is recommended for a pre-exercise BG level 150-250 mg/dL?
Initiate exercise and delay consumption of carbohydrate until blood glucose levels are < 150mg/dL
What carb intake/ other action is recommended for a pre-exercise BG level 250-350 mg/dL?
Test for ketones. Do not perform exercise if moderate-to-large ketones are present
Initiate mild-to-moderate intensity exercise.
- Intense exercise should be delayed until glucose is < 250mg/dL
What carb intake/ other action is recommended for a pre-exercise BG level >350 mg/dL?
Test for ketones. Do not perform any exercise if moderate-to-large ketones are present
- If ketones are negative (or trace), consider corrective insulin before exercise
- Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease
What are acceptable activities in pts with CVD complications from diabetes? discouraged activities?
Acceptable: any
Discouraged: Limitations on intensity should be dictated by cardiac status
