Diabetes Mellitus

Question 1

what is insulin

Answer 1

hormone produced and secreted by the pancreas

Question 2

function of the insulin

Answer 2

allows sugar into the cells

Question 3

Prediabetes

Answer 3

• diagnosed by IFG or IGT tests
• high risk for developing Type II DM
• symptoms: 3 p’s
• modifications need to be started ASAP to prevent DM

Question 4

Type 1 (IDDM)

Answer 4

• immune-mediated
• caused by genetics or viral exposure
• manifestations don’t appear until beta cell destruction is severe
• quick onset of symptoms
• needs exogenous insulin to survive

Question 5

Type II

Answer 5

• gradual onset, diagnosed by accident
• pancreas still makes some insulin but the insulin is either insufficient to meet needs, poorly utilized by tissues, or insufficient in amount to bring in glucose into the cell

Question 6

risk factors of Type II Diabetes

Answer 6

• family history
• obesity
• race/ethnicity
• age (usually ≥ 40)
• bp (>140/90)
• HDL (≤ 35 mg/dl)
• Trig (≥ 250 mg/dl)
• hx of gestational DM or babies born 9 lbs or greater)
• metabolic syndrome

Question 7

Metabolic Syndrome

Answer 7

• cluster of conditions that can lead to DM
• central obesity, high blood pressure, high triglycerides, low HDL- cholesterol
• can be fixed by diet, lifestyle changes, and/or medications

Question 8

Manifestations of Type I DM

Answer 8

• Rapid onset, acute symptoms
• The classic 3 P’s
• Weight loss
• Weakness, fatigue
• Later, possibly ketoacidosis

Question 9

Manifestations of Type II DM

Answer 9

• insidious, non-specific
• may experience 3 Ps
• fatigue
• recurrent infections
• recurrent vaginal yeast infections
• prolonged wound healing
• visual changes

Question 10

how DM is diagnosed

Answer 10

• Hb A1C ≥ 6.5%
• Fasting Plasma Glucose (FPG) ≥ 126 mg/dl (on two separate days)
• Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dl
• random glucose ≥ 200 mg/dl plus manifestations of DM

Question 11

Glycosylated Hemoglobin (HbA1C)

Answer 11

• Evaluates long-term control of BS
• Best indicator of average serum glucose level over 2-3 mos. Tells the % of Hgb to which the glucose has attached.
• Normal is 4-6%
• ADA target for diabetics is < 7%
• American College of Endocrinology recs < 6.5%
• Elevated levels indicate inadequate control for last few months

Question 12

Goals of Treatment for Dm

Answer 12

• reduce symptoms
• prevent acute complications of hyperglycemia
• prevent or delay long-term complications
• control glucose

Question 13

Goals for Patients with DM

Answer 13

• be proactive in managing disease
• few or no episodes of hyper/hypoglycemic emergencies
• maintain normal or near-normal blood glucose levels
• prevent, minimize, or delay complications
• adjust lifestyle to accommodate DM regiment with minimal stress

Question 14

5 Components of Diabetic Management

Answer 14

• nutrition/ weight management
• exercise
• self monitoring blood glucose (SMBG)
• pharmacologic therapy (insulin, oral agents)
• education

Question 15

nutrition management

Answer 15

• Maintain BS levels as close to normal as possible
• Reduce risk of CV disease through normal lipid levels and blood pressure
• Slow rate of development of chronic complications
• Individualized, flexible plans based on pt’s cultural and personal preferences
• Pleasurable eating with multiple food choices

Question 16

Diet Education

Answer 16

• Fiber decreases insulin requirements
• Special or diabetic foods such as “sugar free” or “sucrose free” are not carbohydrate free! Need to be counted in diet.
• Sweeteners (Saccharine, aspartame, etc) in moderation
• Limit saturated fats to < 7% of calories
• Limit ETOH. And be HONEST about intake

Question 17

weight management

Answer 17

major preventive factor for development of DM

Question 18

exercise management

Answer 18

• lowers blood glucose
• increases uptake of glucose by muscles
• improves insulin utilization
• recommend 10-15 gm CHO snack before exercising or exercise 1 hour after a meal
• avoid vigorous activity if BS > 250 with ketones

Question 19

SBGM diabetic vital signs

Answer 19

• normal serum glucose: 70-100 mg/dl
• ADA target 70-130 mg/dl or 180 mg after meals
• frequency of testing
• continuous glucose monitoring

Question 20

Ketone Testing

Answer 20

-test for ketones in urine
-warning of deteriorating control of BS
- done when:
BS are persistently elevated
During illness
pregnancy
glycosuria is present

Question 21

education

Answer 21

• teach s/s of hyper/hypoglycemia
• foot care
• how to administer/store insulin, use insulin pumps, take PO meds, etc,
• sick day rules

Question 22

sick day rules

Answer 22

• Sugar: check blood glucose every 2-3 hours
• Insulin: always take insulin when sick to avoid DKA
• Carbs: take enough carbs and drink enough fluids; if glucose is high drink sugar-free drinks; if glucose is low, drink carb-containing drinks
• Ketones: check blood or urine ketone levels every 4 hours; take rapid acting insulin ketones are present; drink lots of water to flush out ketones

Question 23

Call MD if

Answer 23

• BS > 240 (may vary widely)
• Vomiting persistently
• Temp > 102 with Tylenol
• Persistent diarrhea
• Disorientation/confusion
• Unable to tolerate liquids
• Rapid breathing (Kussmaul’s)
• Illness lasts longer than 2 days

Question 24

if have to be hospitalized

Answer 24

-replace fluid and electrolytes