Diabetes (Part1) Flashcards
(85 cards)
1
Q
Risk factor of gestational diabetes?
A
overweight
2
Q
What does maternal hyperglycaemia increase the risk for?
A
- macrosomia
- Stillbirth
- Fetal hypoglycemia
- Preeclampsia
3
Q
What is macrosomia?
A
- Excessively large baby also known as large for gestational age (LGA)
- Can lead to increased risk for caesarean section/ difficult delivery
4
Q
What is preeclampsia?
A
- dangerous during pregnancy
- causes high BP and organ damage
5
Q
What is done at a community diabetic clinic?
A
- teach classes
- interdisciplinary includes a team to help manage care of client with diabetes
6
Q
What classes are taught at a community diabetic clinic?
A
- diabetes management
- drug therapy
- blood glucose monitoring
- nutrition
7
Q
What interdisciplinaries are included on a team to help manage care of client with diabetesat at a community diabetic clinic?
A
- RN
- NP
- physician
- dietician
- social workers
8
Q
What are some diets that have been proven to help people with diabetes?
A
- DASH diet
- Mediterranean
- Vegan
- Vegetarian
9
Q
self-monitoring of blood glucose (SMBG) should be individualized, people taking insulin should do what?
A
- take blood glucose as often as insulin is administered
- take insulin 3-4 times/day
- take insulin 1-2 times/day
- use insulin pump
10
Q
in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe taking insulin 3-4X/day
A
- test before meals
- periodically at other times too
- helps get a sense of pattern of their BG levels
11
Q
in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe taking insulin 1-2X/day
A
- test at various times (before/after meals, bedtime)
- helps get a sense of their BG level pattern
12
Q
in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe if they are on insulin pumps
A
- get insulin constantly throughout day
- test BG at least 4X/day due this
1. before meals/ bedtime
2. periodically throughout day
3. helps get a sense of pattern of their BG levels
13
Q
in regards to self-monitoring of blood glucose (SMBG) should be individualized, describe what the person should do if they have type 2 diabetes and they’re taking non-insulin medications
A
- test blood at least once a day at various times
- get a sense of pattern of there blood glucose levels
14
Q
What happens if someone who is taking corticosteroids has type 1 or 2 diabetes and they are sick?
A
- increase frequency of checking blood
- when sick body produces more cortisol causing body to break down glycogen into glucose > blood glucose levels increase and person can develop hyperglycaemia
15
Q
What are new types of blood glucose monitoring systems? Give examples
A
- flash blood glucose monitoring (FGM)
ex. FreeStyle - continuous blood glucose monitoring (CGM)
ex. Dexcom
16
Q
in regards to new types of blood glucose monitoring systems, describe flash blood glucose monitoring (FGM)
A
- monitor applied q 2 weeks
- sensor in a little disk attaches to skin with adhesive
- sensor checks glucose level q 15mins/ stores data
- touch handheld device to sensor to see current/ last 8hrs of data
17
Q
in regards to new types of blood glucose monitoring systems, describe what happens when the flash blood glucose monitoring (FGM) is initially applied
A
- needle that inserts the thin sensor into subcutaneous tissue
- needle removed after application
18
Q
in regards to new types of blood glucose monitoring systems, describe continuous blood glucose monitoring (CGM)
A
- similar to flash monitoring
- transmits data to a display device
- can be set to send alerts to client’s device (or caregiver/ family) when BG levels to high/low
19
Q
What is pre-prandial testing?
A
checking BG levels before meals
20
Q
What are different urine tests that people with diabetes need to do regularly? What do they mean?
A
glucosuria
- glucose in urine
proteinuria
- protein in urine
ketonuria
- ketones in urine
21
Q
in regards to different urine tests that people with diabetes need to do regularly, describe glucosuria
A
- shouldn’t have in urine
- present when BG levels elevated and kidneys trying to get rid of excess glucose
22
Q
Why is having glucosuria dangerous for someone who is diabetic?
A
- glucose is osmotic (pulls water along with it)
- can result in person becoming dehydrated as water is being out of bloodstream
23
Q
in regards to different urine tests that people with diabetes need to do regularly, describe proteinuria
A
- shouldn’t have in urine
- large molecules that shouldn’t be able to get through glomeruli to reach urine
- indicate kidney damage which allows larger molecules to get through
- diabetes common cause
24
Q
in regards to different urine tests that people with diabetes need to do regularly, describe ketonuria
A
- when body switches to using fat for energy ketones produced
- can cause person to develop diabetic ketoacidosis (DKA) b/c ketones are acidic
- When person not feeling well should be taught to check urine for ketones
25
What it DKA a serious form of? When does it occur?
- hyperglycaemia
| - occurs when body unable to transport glucose into body cells
26
What are the types of diabetes? describe their insulin production
type 1 diabetes (T1DM)
- pancreas stops producing insulin
- insulin injections must replace normal insulin production
type 2 diabetes (T2DM)
- Pancreas still produces some insulin, but not enough to meet needs
- Insulin regimen will vary depending on client needs
27
What happens in the body with normal BG and insulin levels?
- Blood glucose levels rise each time a person eats breakfast, lunch, dinner, snack
- Foods with high glycemic index (GI) cause blood glucose levels to rise more quickly/ have taller peaks
- Better way to control hunger is through foods with low glycemic index
- BG levels don’t go down to 0
- normal insulin levels
28
in regards to What happens in the body with normal BG and insulin levels, describe foods with high glycemic index (GI) cause blood glucose levels to rise more quickly/ have taller peaks
Satisfy hunger short term but metabolize quickly > BG levels drop fast and people are hungry again
Refined sugar and starches
- White bread
- White rice
- Mashed potatoes
- Surgery drinks
29
in regards to What happens in the body with normal BG and insulin levels, describe Better way to control hunger is through foods with low glycemic index
- Take longer to digest
- Release glucose more slowly
1. Whole grains
2. Legumes
3. Foods high in fibre (fruit/ veggies)
30
in regards to What happens in the body with normal BG and insulin levels, describe BG levels don't go down to 0
- Body’s need energy 24/7 to power vital organs
- If someone runs out of glucose they die
- When sleeping or not eating body breaks down glycogen stored in liver to make glucose
31
in regards to What happens in the body with normal BG and insulin levels, describe normal insulin levels
- Glucose levels rise (after we eat) pancreas releases more insulin
- Always have a small amount of insulin (basal level) in blood stream at all times > makes sure glucose can get into body cells
32
What does insulin help glucose with?
Insulin helps glucose get transported into body cells > causes glucose levels in bloodstream to drop down to baseline levels
33
Why are basal and bolus insulin administered?
- Administered to mimic normal insulin levels
| - Not quite the same as person’s normal insulin curve but close
34
describe basal insulin
- Long-acting insulin
- Usually injected at bedtime
- Provides low/ constant amount of insulin > help make sure glucose continues to get into body cells
- Doesn’t help with big spikes in glucose when we eat
35
describe bolus insulin
- Rapid-acting insulin
- Injected before each meal
- Helps pull glucose out of bloodstream and liver it into cells
36
What are the different types of insulin? What do they all have in common?
All have concentrations of 100 units of insulin in 1mL of solution
- rapid acting insulin
- short acting insulin
- intermediate acting insulin
- extended long acting insulin
- concentrated extended long-acting insulin
37
What is an example of rapid acting insulin
novarapid/ aspart
38
What is an example of short acting insulin?
regular insulin
39
what is an example of intermediate acting insulin?
NPH
40
What is an example of extended long acting insulin?
glargine
41
What is an example of concentrated extended long-acting insulin?
toujeo
42
in regards to the different types of insulin, describe rapid acting insulin
- Most common
- Used to provide bolus doses
- Rapid onset
- Take effect in 10-15mins
- Clients need to have food available when they take this > should have insulin before eating if they started eating though still ok to give
43
in regards to the different types of insulin, describe short acting insulin
- Most similar to natural insulin produced in pancreas
- First type of insulin ever used
- 30-60mins onset of action
- Longer duration about 5-7hrs
- Not commonly used anymore unless it’s for IV insulin infusion > Only done in hospital when people are severely sick
44
in regards to the different types of insulin, describe intermediate acting insulin
- Used to be used in old days to cover people’s basal insulin needs
- Onset of 1-2hrs
- Peaks in about 4-12hrs
- Duration of 18-24hrs
- Not used as commonly anymore
- If someone comes to hospital and they do use this regularly then hospital will use during their stay
45
in regards to the different types of insulin, describe extended long acting insulin
- Come so much closer to mimicking effects of basal insulin that body produces
- Slow onset just over 1hr
- Doesn’t have much of a peak
- Duration of up to 24hrs
- Some people only need one shot/day to cover basal needs
46
in regards to the different types of insulin, describe concentrated extended long-acting insulin
- 300 units of insulin in every 1mL
- Used to cover basal insulin needs for people who need large doses of insulin >Significant insulin resistance
- Might take up to 5 days of regular use to get a consistent glucose-lowering effect
- Onset of action ~6hrs
- Bot of peak in about 12-16hrs
- Duration of 24hrs
47
What are 2 conditions that can lead to morning hyperglycaemia?
- dawn phenomenon
| - somogyi effect
48
in regards to conditions that can lead to morning hyperglycaemia, describe the dawn phenomenon
- Leads to gradual rise in BG levels in morning
- Caused by slow release of counter-regulatory hormones
1. Glucagon
2. Epinephrine
3. Growth hormone
4. Cortisol
- Cause body to start breaking down more glycogen > produce glucose in preparation for person to wake up/ have energy for morning (normal process)
49
What does the dawn phenomenon lead to for people with diabetes?
- elevated BG levels in morning
| - If they set alarm in middle of the night > find BG levels are normal or slightly high
50
in regards to conditions that can lead to morning hyperglycaemia, describe the somogyi effect
- Caused by taking too much insulin at bedtime > causes hypoglycemia during night
```
- Body experiences hypoglycemia also cause body to secrete same counter regulatory hormones > stimulates body to break down glycogen/ increase BG levels
• Glucagon
• Epinephrine
• Growth hormone
• Cortisol
```
- If person sets alarm to wake up in middle of the night > find BG levels to low
51
gestational diabetes increases risk of what?
developing type 2 diabetes
52
What types of blood glucose tests will you have to interpret the results for in regards to diabetic clients?
- fasting blood glucose test
- random glucose test
- oral glucose test (OGTT)
53
in regards to types of blood glucose tests, describe the fasting blood glucose test
- Taken first thing in morning
- Client hasn’t had any caloric intake for 8hrs or longer
- Glucose should always be <7mmol/L
54
in regards to types of blood glucose tests, describe the fasting blood glucose test ranges
<6 mmol/L
- Normal fasting blood glucose
5. 6-6.0 mmol/L
- Still normal but at risk for pre-diabetes
- Screened more frequently (every 6-12months)
6. 1-6.9mmol/L
- Impaired fasting glucose> Different than impaired glucose tolerance >Have higher BG levels when not eating
+7.0mmol/L (diabetes)
55
in regards to types of blood glucose tests, describe the random glucose test
- Taken at any time of day without regard to meals
- Should always be 11mmol/L or less at home
- When in the hospital want to keep it <10mmol/L if safe to do > Helps reduce incidence of complications
- If 11.1mmol/L or higher used to diagnose diabetes
56
in regards to types of blood glucose tests, describe how the test is done for the oral glucose tolerance test (OGTT)
- Person needs to fast for at least 8hrs
- Blood sample taken for fasting blood glucose
- Person then needs to drink 75g glucose drink
- Blood re-tested after 1-2hrs
57
in regards to types of blood glucose tests, describe the results for the oral glucose tolerance test (OGTT)
People only need one of the following to be out of normal range to be diagnosed with gestational diabetes mellitus
- Fasting blood glucose
- 1hr post glucose
- 2hr post-glucose
58
in regards to types of blood glucose tests, what is the oral glucose tolerance test (OGTT) used for?
Used to diagnose if someone has diabetes or prediabetes
59
in regards to types of blood glucose tests, describe the results for the oral glucose tolerance test (OGTT) people will have after 2hrs
2hrs after consuming drink person will have one of the following
1. glucose level <7.8mmol/L (normal)
2. Glucose level 7.8-11mmol/L
- Impaired glucose tolerance (IGT)
3. Glucose level +11.1mmol/L (diabetes)
60
What does impaired glucose tolerance (IGT) mean? What test is this from?
- body isn’t able to respond as quickly as it should to increased BG levels
- One form of pre-diabetes
- comes from the oral glucose tolerance test (OGTT)
61
What are signs/ symptoms of diabetes?
- Feeling unwell
- Polyphagia (Hungry)
- Polydipsia (Thirsty)
- Polyuria (frequent urination)
62
why is the hemoglobin A1c test helpful?
measures effectiveness of blood glucose control over 2-3 months bc average RBC lifespan is about 100-120 days
63
what does the hemoglobin A1c test do?
- measures % of hemoglobin in blood thats reacted with glucose
- everyone has small % of glycosylated hemoglobin
> percent goes up with diabetics (hard time managing BG levels)
64
What does glycosylated mean?
glucose in blood sticks to some hemoglobin
65
What are the 2 ways the hemoglobin A1c test is used?
- screen someone to see if they have diabetes or not
| - monitor how well person with diabetes is controlling BG levels
66
In regards to the hemoglobin A1c test what are the results that could come from it during the screening process? What do they mean?
<5.5%
- Normal
- Do not have diabetes or pre-diabetes
5. 5-5.9%
- Normal but getting high
- Rescreen every 6-12 months
6. 0-6.4%
- Pre-diabetes
- To determine which type requires more testing
+6.5%
- diabetes
67
What are the oral and non-insulin injectable medications for Type 2 diabetes mellitus?
- biguanides
- insulin secretagogues
- alpha glucose inhibitors
- thiazolidinediones
- act on incretin hormones
- SGLT2 inhibitors
68
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe biguanides
- Reduce amount of glucose released by liver
- Only approved drug = metformin
- Prevents body from breaking down glycogen to release glucose
- makes tissues more sensitive to insulin, less is needed to help transport glucose into body cells
- first drug prescribed when someone is diagnosed with diabetes
- used for many years c few safety concerns
- effective at lowering BG levels
69
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe insulin secretagogues
- causes pancreas to put out more insulin
- Only drugs other than insulin that diabetes Canada have risk of causing hypoglycemia by themselves
- Sulphonylureas
- Meglitinides
70
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe alpha-glucose inhibitors
- slows absorption of carbohydrates from GI tracy
| - acarbose > only drugged in this class approved in Canada
71
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe thiazolidinediones
- Reduce insulin resistance
- Generic name ends in “-glitazone”
ex. Pioglitazone, rosiglitazone
72
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe act on incretin hormones
- Incretin produced by intestine throughout day
- Increased during meals
- Work similarly to insulin (lower BG levels)
- has 2 classes
1. GLP-1 receptor agonists
2. DPP-4 inhibitors
73
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe the first class of act on incretin hormones
GLP-1 receptor agonists
- Causes pancreas to put out more insulin
- Sometimes called incretin mimetics
- Self-administered as subcutaneous injection
- Generic names end in “-glutide”
ex. Liraglutide, Semaglutide, Dulaglutide
74
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe the second class of act on incretin hormones
DPP-4 inhibitors
- Increases production of insulin
- Block the enzyme that deactivates incretin hormones
- Generic names end in “-gliptin”
ex. Saxagliptin, linagliptin
75
in regards to oral and non-insulin injectable medications for Type 2 diabetes mellitus, describe SGLT2 inhibitors
- Causes kidneys to increase excretion of glucose
- Generic names end in “-glifozin”
ex. Canagliflozin, Dapagliflozin, Empagliflozin
76
when a diabetic is sick and dehydrated what should you hold? why?
```
S - Sulphonylureas
A – ACE inhibitors
D – diuretics, direct renin inhibitors
M - metformin
A – angiotensin receptor blockers (ARBs)
N – nonsteroidal anti-inflammatories (NSAIDs)
S – SGLT2 inhibitors
```
meds can cause decline in kidney function if continued while person is dehydrated
77
While a diabetic is in hospital what should their fasting or pre-prandial blood glucose targets be?
4. 0-7.0mmol/L - Healthy (at home)
5. 0-8.9mmol/L - Hospitalized but not critically ill
6. 0-10.0mmol/L - Critically ill
78
describe IVs and sick diabetics
Client who is eating
- IV fluids do NOT contain dextrose
- NS, RL
NPO clients
- IV fluids SHOULD contain dextrose
- D5NS, D51/2NS
If in doubt call doctor to clarify
79
describe how stress and illness causes elevated BG levels
- stress causes body to produce aldosterone and ADH
- increased retention of water and sodium
- produces epinephrine and cortisol > cause BG levels to rise
- elevated BG levels lead to osmotic diuresis > kidneys try to get rid of excess glucose in urine >glucose pulls water with it causing dehydration
80
What are the A1c targets for people who already have diabetes
<6.5% intensive glycemic control
<7.0% most type 1 and 2 diabetic clients
7.1-8.5% people at high risk of hypoglycaemia
81
in regards to the A1c targets for people who already have diabetes, describe <6.5%
- Intensive glycemic control
- Type 2 diabetes at high risk for developing:
- Diabetic nephropathy
- Retinopathy
- Client needs to keep BG levels lower > increases risk of causing hypoglycemic episodes (can be quite dangerous)
- Only want to recommend this to people at low risk of having hypoglycemic episodes
82
in regards to the A1c targets for people who already have diabetes, describe <7.0%
- Most type 1 and 2 diabetic clients
- Low enough to prevent/ slow development of diabetic complications
- Not so strict that people would be at high risk for experiencing hypoglycemia
- Good compromise
83
in regards to the A1c targets for people who already have diabetes, describe <7.1-8.5%
- people at high risk of hypoglycemia, or who don’t experience hypoglycemic symptoms
- frail elderly
84
What does nephropathy mean?
kidney disease
85
What does retinopathy mean?
eye damage
