Diabetes Mellitus

Question 1

What is the most common cause of Diabetes

Answer 1

Obesity

Question 2

How many people have Type II diabetes

Answer 2

25.8 million

Question 3

What is the function of Insulin?

Answer 3

Stimulates storage of glucose in the liver and muscle as Glycogen
Insulin brings glucose into the cell from the blood
Low basal rate of insulin if everything is functioning normally

Question 4

What is the function of Glucagon?

Answer 4

Inverse relationship with glucose= Glucose goes up-Glucagon goes down

Question 5

What is the percentage of Type II diabetes compared with other cases of diabetes

Answer 5

90-95%

Gestational Diabetes puts you at higher risk for developing Type II Diabetes later

Question 6

How did Diabetes Type II develop originally

Answer 6

Typically occured over age 30 and obese
Childhood obesity is increasing likelihood of early onset diabetes
First priority is diet and exercise
Hypoglycemic agents can be used to treat initially, but conversion to insulin is usually necessary
Pancreas secretes Insulin but the body has become resistant

Question 7

Pathogensis of Type II diabetes

Answer 7

Secretes insulin but isn’t enough or body is resitant to insulin
Muscle not absorbing glucose due to decreased stimulation from insulin

Question 8

Risk factors for Type II diabetes

Answer 8

Diabetes in parents or siblings
Overweight- BMI greather than or equal to 25
Asian Americans-BMI>23
History of gestational diabetes
Polycystic ovary syndrome-difficult to get pregnant-take metformin even without elevated glucose
Metabolic Syndrome-Abdominal fat, HTN, Hypercholesterolemia, Hyperlipidemia

Question 9

Clinical Manifestations of Type II diabetes

Answer 9

Have it for years-most diagnoses are accidental
Feet might feel numb, slow wound healing, eye exams are common places for accidental diagnosis
Hyperglycemia usually isn’t as big of a deal at it is in Type I
Polydipsia (increased thirst), Polyuria (increased urination), not usually Polyphagia
FEET NUMBNESS BIG
FOOTCARE TEACHING

Question 10

History and physical exam info that is important to record

Answer 10

How much exercise patient performs
Eating habits-a lot of times they will not tell the truth
Family History of Diabetes
Episodes of Hypoglycemia/Hyperglycemia-S+S’s
Family history of Vascular problems, HTN, CVA, Renal failure
Dependant Edema-Edema that occurs when sitting up and legs hand and swell
Feet-Pulses, Sensations, and reflexes

Question 11

Diagnostic tools for Diabetes

Answer 11

Symptoms of Hyperglycemia+Plasma glucose over 200
HBG A1C>6.5% -gives blood sugar over 120 day period
Fasting glucose over 126 is considered diabetic
Oral glucose tolerance test- 2hr test, if glucose level higher than 200 after 2 hrs diabetic

Question 12

Levels of Fasting Plasma glucose

Answer 12

Normal=<100
Impaired= greater than 100 and less than 126
Diabetes diagnosis= greater than 126

Question 13

Diagnostic tools for Diabetes-Diabetes Management monitoring

Answer 13

HGB A1C
Microalbuminuria-test for albumin and ketones in urine, if positive they will do 24hr profile
Fasting Lipid Profile
ECG-check for heart defects-diabetes and heart disease closely related

Question 14

Treatment of Diabetes

Answer 14

Start with Diet and exercise

Question 15

What are Dietary Management Goals?

Answer 15

10% weight loss can decrease need for diabetic meds
Maintain BP=HTN causes stress which increases glucose
PACE FOOD INTAKE=3 small meals, 3 small snacks
Maintain pleasure with eating

Question 16

Meal planning with diabetic patient

Answer 16

Keep diet journal
Distribute calories throughout the day
Carbs should make up 50-60%
Fat-20-30%
Protein-10-20%
Fiber=at least 25g

Question 17

Keys to maintaining good glycemic index

Answer 17

Eat whole fruits instead of juice-fiber lowers sugar index
Combine starchy foods with protein
Raw or whole foods tend to lower glycemic index
adding food with sugars may lower glycemic index if eaten with slowly absorbed foods

Question 18

What are other dietary concerns for diabetics?

Answer 18

Alcohol consumed on an empty stomach causes hypoglycemic effect
Alcohol decreases ability to absorb glucose and produce needed insulin
EMPTY SUGAR in ALCOHOL
Read labels

Question 19

Exercise in the diabetic patient

Answer 19

Lowers blood sugar
Can lower CV risks
May need to have something to eat before attempting strenuous exercise

Question 20

Insulin administration in Type II diabetic/or non diabetic patients

Answer 20

Make sure Insulin is at room temp, quick needle puncture, wait till alcohol dries
May require insulin when hospitalized-decreases risk of postop infection
Rotate sites

Question 21

Hypoglycemic agents

Answer 21

Treats Type II diabetes
Stimulates insulin secretion
Most are oral, some injectable
Increase stomach emptying
Most will be on ACE and Aspirin-325mg
4x more likely to die of CV event

Question 22

Acute Complications of Diabetes

Answer 22

Hypoglycemia
Hyperglycemic Hyperosmolar syndrome-HHS
Comparison of DKA and HHS

Question 23

Hypoglycemia

Answer 23

Abnormally low blood sugar (50-60) due to too much insulin, oral hypoglycemic agents, excessive physical activity, not enough food
Adrenergic symptoms-sweating, tremors, tachycardia, palpitations, nervousness, hunger
Central Nervous System- inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness
Severe Symptoms:disorientation, seizures, loss of consciousness, death

Question 24

Treatment of Hypoglycemia

Answer 24

Follow 15/15 rule-15g of rapid-acting sugar(half cup of juice, 3 glucose tabs, 8 oz. skim milk)/test blood glucose in 15 mins repeat if too low
Administer 50ml of D5 solution if not responding well
Glucagon SC, IM, IV
Not typically hospitalized, if hospitalized its because there is no adults available to monitor them at home

Question 25

Acute Complications: Hyperglycemic Hyperosmolar sydnrome

Answer 25

Severely Dehydrated-voiding just urine not electrolytes Blood glucose levels greater than 600 Infection and illness can cause initial dehydration Severe dehydration with increase in NA

Question 26

Symptoms of HHS

Answer 26

Seen in the elderly a lot Altered LOC, Neuro deficits, coma from cerebral dehydration Dry Skin and mucous membranes hypotension, tachycardia Correct with IV fluids and lower blood glucose

Question 27

Complications: Alterations in CV system

Answer 27

``` Macrovascular (big vessels) -Early onset atherosclerosis -CAD, PAD, Carotid endarterectomies Microvascular (small vessels) -Retinopathy -Nephropathy ```

Question 28

Diabetic Retinopathy

Answer 28

Increases risk for cataracts | Retinal ischemia and breakdown of blood-retina barrier can lead to blindness

Question 29

Diabetic Nephropathy

Answer 29

Thickening of basement glomeruli-imparis renal function Allows albumin to be lost in urine-microalbuminuria HTN accelerates Nephropathy-ACE inhibitors

Question 30

Complications continued: Peripheral Neuropathies

Answer 30

Distal Parasthesias-USUALLY IN FEET Impaired sensation of pain, temperature, light touch, and vibration CHECK FEET EVERYDAY ALL OVER FEET Wear closed toed shoes as much as possible-even in house make sure nothing is in shoes

Question 31

Autonomic Neuropathies

Answer 31

Sweating, Abnormal pupillary function, cardiac dysfunction, GI motility dysfunction, hypoglycemic unawareness, sexual dysfunction

Question 32

What are other chronic complications?

Answer 32

Alterations in mood-Risk of Depression and Anxiety Increased Risk of Dementia, Strains of living with complex self-care Increased Susceptibility to infection-Vascular, neurological impairments, Nephrosclerosis (destruction of kidneys), urinary retention, bacterial and fungal skin infections Periodontal diseases spread more rapidly-see dentist more frequently

Question 33

Complications involving feet

Answer 33

Ingrown toenails-medicare won't pay for medical bills of seeing podiatrist every month cracks, fissures from dry skin blisters, pressure