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NURS 2055 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

what is diabetes mellitus?

A

multisystem disease related to:

1) abnormal insulin production
2) impaired insulin utilization
3) both

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2
Q

what is insulin

A

hormone produced by the beta cells in the islets of langerhans of the pancreas

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3
Q

what is the normal range for insulin?

A

4-6 mmol/L

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4
Q

what hormones counteracts insulin?

A

1) glucagon
2) epinephrine
3) growth hormone
4) cortisol

how do they work? by increasing blood glucose levels by stimulating glucose production and output by the liver and decreasing the movement of glucose into the cells

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5
Q

what does insulin do after meals?

A

it increases and stimulates storage of glucose as glycogen in liver and muscle

  • it also inhibits glycogenesis
  • enhances fat deposition
  • increases protein synthesis
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6
Q

what tissues are insulin-dependent

A

skeletal muscle and adipose tissue

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7
Q

which tissues aren’t insulin dependent?

A

brain, liver, blood cells

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8
Q

who does type 1 diabetes mellitus usually affect?

A

usually occurs in younger people < 30yrs

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9
Q

what type of body is it usually seen in type 1 DM?

A

lean bodies

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10
Q

What happens in type 1 DM?

A

progressive destruction of pancreatic beta cells due to an autoimmune process. pt will require exogenous insulin (outside source so basically human engineered insulin) to sustain life if not DKA

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11
Q

What is the onset for type 1 DM?

A

autoantibodies to islet cells cause a reduction of 80-90% of normal beta-cell functioning before hyperglycemia and other manifestations occur.

these manifestations occur when pancreas can no longer produce insulin

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12
Q

what are these manifestations from onset of type 1 DM?

A

1) They are RAPID

2) pt presents with emergency ketoacidosis

3) classic symptoms; polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger)

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13
Q

how is pre diabetes testing done? including the ranges

A

basically you have to fast OR have a 2 hour plasma glucose lever higher than normal.

PRE-DIABETIC range for impaired FASTING glucose = 7.1- 7.11 mmol/L

PRE-DIABETIC range for impaired GLUCOSE tolerance = 6.1- 6.7 mmol/L

note: they also test hemoglobin A1C and regular blood glucose

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14
Q

discuss type 2 DM aka what?

A
  • MOST prevalent
  • people> 35yrs old
  • most POWERFUL risk is OBESITY aka lose weight if you big
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15
Q

what is another additional factor thats important to remember about type 2 DM?

A

Metabolic syndrome: abdominal obesity, hypertension, dyslipidemia, insulin resistance, dysglycemia

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16
Q

what happens in type 2 DM?

A

Pancreas continues to produce some insulin but it is either insufficient or poorly utilized or both.

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17
Q

what are 4 major metabolic abnormalities in type 2 DM?

A

1) insulin resistance

2) decreased ability of the pancreas to produce insulin as beta cells become fatigued from compensatory overproduction of insulin or when beta-cell mass is lost

3) inappropriate glucose production by the liver

4) alteration in the production of hormones and cytokines by adipose tissue

18
Q

what is the onset for type 2 DM?

A

gradual onset. may go many years with undetected hyperglycemia (asymptomatic)

usually caught doing routine lab

19
Q

discuss gestational diabetes

A
  • develops during pregnancy
  • detected at 24-28 weeks of gestation usually via glucose tolerance test
  • glucose levels usually regulate themselves at 6 weeks post party

THERAPY: FIRST-nutrition, SECOND- insulin therapy

20
Q

discuss secondary diabetes

A

treatment of a medical condition that causes abnormal blood glucose level and usually resolves once the medical condition is fixed

  • some conditions using can be schizophrenia, hyperthyroidism or some medications
21
Q

does type 2 DM have islet cell abnormalities?

A

no

22
Q

what are the 4 methods to diagnostic studies?

A

1) glycated hemoglobin (A1C) >= 6.5%

2) fasting blood glucose >= 7mmol/L (no caloric intake for 8 hours)

3) random plasma glucose measurements >= 11.1 mmol/L (anytime of the day without regard to the interval since the last meal)

4) 2 hour plasma glucose level in a 75g OGTT >= 11.1mmol/L

repeated twice on a different day without hypoglycemia. if symptoms of hyperglycemia present = confirmatory test no required before treatment initiated

23
Q

discuss glycated hemoglobin as diagnostic studies

A

determines glycemic control over time

  • it shows the amount of glucose that has been attached to hemoglobin molecules, which are attached to the RNC for the life of the cell
  • indicates overall glucose control for the previous 90-120 days
24
Q

discuss medication therapy for insulin in terms of DM

A

type 1:
- always needs insulin and dose depends on the individual stress or illness

type 2: depends

25
Q

what are the 2 types of insulin

A

1) mealtime insulin (bolus)
2) long or intermediate-acting (basal) background insulin

26
Q

discuss mealtime insulin (bolus)

A

theres 2 types:

1) rapid acting
- Onset 10-15min
- Best mimics natural insulin secretion in response to a meal
- give 10-15 min before a meal and up to 15 min after a meal

2) regular
- give 30-45 min before a meal
- onset 30 - 60min

27
Q

what are some examples of rapid and regular insulin

A

1) rapid acting = humalog

2) regular = humulin R

28
Q

what are the 2 types of long and intermediate-acting (basal) background insulin?

A

1) Long-acting
- released steadily and continuously over 24-42 hours
- Does NOT have a peak of action

2) Intermediate-acting
- duration 10-16 hrs
- peak 4-10 hrs
- LESS risk for hypo-glycemia

29
Q

what are some examples of long and intermediate insulin

A

1) Long-acting = NPH

2) Intermediate = Lantus

30
Q

which route is insulin given? and why?

A

subcutaneously.

it is inactivated by gastric juices if taken orally

31
Q

which sites of injection have higher absorption from high to low?

A

1) abdomen
2) arm (back)
3) thigh and butt

32
Q

what are some cautions after administrating insulin?

A

1) do not exercise the area used for injection. this increases body heat and can increase rate or absorption and speed up insulin onset action

2) rotate sites to prevent lipodystrophy which is lumps and dents in the skin due to repeated injection in the same spot

33
Q

what are some forms of insulin administration tools?

A

1) insulin pen

2) insulin pump (the one on TikTok)
- subcutaneous insulin infusion
- the catheter in it delivers insulin 24 hours a day
- meal times require bolus insulin

34
Q

what are some complications with insulin therapy?

A

1) Somogyi effet
- insulin overdose cause hypoglycemia and usually during hours of sleep
-counter-regulatory hormones released
- rebound hyperglycemia and ketosis may occur

2) Dawn phenomenon
- hyperglycemia present on awakening in the morning usually bc of release of counter-regulatory hormones in predawn hours
- GH and cortisol possible factors

35
Q

discuss antihyperglycemic agents in terms of medication therapy

A

improves the mechanisms by which insulin and glucose are produced and used by the body

works on 3 defects of DM type 2:
1) insulin resistance
2) decreased insulin production
3) increased hepatic glucose production

36
Q

what is the nutritional therapy for type 1 DM

A
  • meal plan is based on individual usual food intake w/balance of insulin and exercise
  • may require increase caloric intake o achieve desired body weight and restore body tissue
  • equal distribution of carbs throughout meals or insulin activities
37
Q

what is the nutritional therapy for type 2 DM

A
  • emphasis on achieving glucose, lipid and blood pressure goals
  • reduction in caloric intake desirable for overweight or obese ppl
  • diet alone may be sufficient for glucose control
  • equal distribution of calories and LOW FAT diet
38
Q

what micronutrients give us more energy

A

carbs
fat
protein

39
Q

what does exercise of for diabetes management?

A

increase insulin receptor sites
lowers blood glucose
small carb snacks can be taken every 30 minute during exercise to prevent hypoglycemia

40
Q

what can fat ppl do for diabetes?

A

bariatric surgery

NURS 2055 (18 decks)

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