Intro to Diabetes Flashcards
1
Q
What is Diabetes?
A
A chronic- multi system disease related to abnormal or impaired insulin utilization
2
Q
How is diabetes characterized?
A
Characterized by hyperglycemia (high blood sugar/glucose in the bloodstream) resulting from lack of insulin, lack of insulin effect, or both.
3
Q
The etiology and pathophysiology of diabetes is a combination of causative factors, what are these? 4
A
- Genetics; Heredity
- Autoimmune
- Lifestyle
- Absent or insufficient and/or poor utilization of insulin
4
Q
(Etiology & Patho)
Insulin is made by what cells/where? and is released where?
A
Insulin is made by the BETA CELLS of the PANCREAS and is released in small amounts into the BLOOD STREAM.
5
Q
A blood sugar level of < 70 mg/dl is classified as?
A
HYPOGLYCEMIA
6
Q
Occurs when there is too much insulin in proportion to available? what is this called?
A
HYPOGLYCEMIA
Occurs when there is too much insulin in proportion to available GLUCOSE.
7
Q
counter regulatory hormones can be released when a patient is?
A
HYPOGLYCEMIC
8
Q
Does Hypoglycemia worsen rapidly or slowly? when should it be treated?
A
Hypoglycemia worsens rapidly and needs to be treated ASAP.
9
Q
What can untreated Hypoglycemia lead to?
A
Can progress to unconsciousness, seizures, coma, and death.
10
Q
what are the signs and symptoms of Hypoglycemia? 12
A
- Cold, Clammy skin
- Numbness of fingers, toes, mouth
- Tachycardia, palpitations
- Headache
- Nervousness, Tremors
- Faintness, Dizziness
- Stupor
- Slurred Speech
- Hunger
- Changes in vision
- Seizures, Coma
- Irritability
11
Q
What are the physiological consequences of hypoglycemia? 3
A
- Neurological symptoms
- Hypoglycemia Unawareness
- Autonomic Nueropathy
12
Q
Factors Affecting Hypoglycemia: (HOSPITALIZATIONS) 4
A
- Overuse of SSI (Sliding Scale Insulin)
- Lack of dosage changes when dietary intake is changed
- Overly Vigorous treatment of hyperglycemia
- Delayed meal after fast acting insulin is used
13
Q
A blood sugar level over > 200mg/dl is considered what>
A
Hyperglycemia
14
Q
When does hyperglycemia occur?
A
- Occurs when there is not enough insulin working
- Too much glucose in the blood
15
Q
Which type, Hyperglycemia or Hypoglycemia has a more gradual onset?
A
Hyperglycemia has a more gradual onset
16
Q
Untreated Hyperglycemia can lead to?
A
- Diabetic Ketoacidosis (DKA)
- or Hyperosmolar Hyperglycemia Syndrome (HHS)
- Coma
- Death
17
Q
What are some common causes of Hyperglycemia? 7
A
- Illness, Infection
- Corticosteriods
- Too much food
- Not enough Diabetic Medication ( Insulin, Oral)
- Inactivity
- Emotional, Physical stress
- Poor absorption of insulin
18
Q
Hyperglycemia signs and symptoms? 12
A
- Hot and Dry
- Increased Urination (polyuria)
- Increased Thirst (Polydipsia)
- Increased Hunger (Polyphagia)
- Weakness, Fatigue
- Blurred vision
- Headache
- Glycosuria
- Nausea, Vomiting, Abdominal cramps
- Progression to DKA, HHS
- Mood Swings
- Slow healing wounds/ infections
19
Q
Treatment for Hyperglycemia: 6
A
- Continued Diabetic medications as prescribed
- Check blood glucose frequently (Record Results)
- Check urine for Ketones (Record Results)
- Drink Fluids at least on an hourly basis
- Exercise or stay active
- Notify HCP if blood glucose levels do not decrease in a few days
20
Q
Factors affecting Hyperglycemia: HOSPITALIZATION: 4
A
- Changes in treatment regimen
- Medications
- IV Dextrose
- Overly Vigorous treatment of Hypoglycemia
21
Q
Diagnostic Studies for Diabetes: 4
A
- HA1C
- Oral Glucose Tolerance Test
- Fasting Plasma Glucose
- Random Blood Glucose
22
Q
Hemoglobin A1C : 3
A
- Also known as Glycosylated Hemoglobin A1C
- Glycosylated hemoglobin is the hemoglobin that glucose is bound to
- Reflects the average blood glucose levels over the past 2-3 months
23
Q
(Hemoglobin A1C Lab Values)
Normal:
Pre- Diabetes:
Diabetes:
American Diabetes Association recommends an A1C of ?
A
Normal: less than 5.7%
Pre-diabetes: 5.7%-6.5%
Diabetes: 6.5% and higher
American Diabetes Association recommends an HA1C of less than 7%
24
Q
(Fasting Plasma Glucose Lab Values )
Normal:
Pre-Diabetes:
Diabetes:
A
Normal: Less than 100mg/dl
Pre-Diabetes:100-125mg/dl
Diabetes: 126mg/dl or higher
25
What is the Oral Glucose Tolerance Test (OGTT)?
1. Two hour test that checks blood sugar before and two hours after a glucose drink is consumed
2. Test shows how well your body processes sugar
26
(OGTT Lab Values)
Normal:
Pre-Diabetes:
Diabetes:
Normal: less than 140mg/dl
Pre-Diabetes: 140-199mg/dl
Diabetes: 200mg/dl or higher
27
What is a random blood glucose test?
1. Blood can be drawn at anytime
2. Seen on a BMP or CMP
3. Diabetes: 200mg/dl or higher plus symptoms of diabetes
** 3 P's + Rapid Weight Loss
28
What are the two blood glucose monitoring processes?
1. Finger stick ( most common)
2. Continuous Glucose Monitoring (CGM)
3. Provides timely feedback to patient
4. Advised before each meal and at bedtime
29
What is the most common error for glucose monitoring tests?
Blood sample size
30
Type One Diabetes, Its characteristics: 5
1. Autoimmune Disease: antibodies against insulin
2. Results from beta cell destruction in the pancreas
3. Auto-antibodies present for months to years before clinical symptoms
4. Leads to absolute insulin deficiency
5. Insulin Dependent
31
A patient with diabetes Mellitus type one might experience what signs and symptoms? 10
1. Polyuria (^ pee)
2. Polydipsia (^ thirst)
3. Polyphagia (^ hunger)
4. Weight loss: takes proteins and fats to create energy
5. Fatigue
6. ^ Frequency of infections
7. Rapid Onset
8. Insulin Dependent
9. Familial Tendency
10. Peak incidence from 10 to 15 years
32
How would a patient get diagnosed with type one diabetes?
1. HA1C
2. Fasting Plasma Glucose (FPG)
3. Oral Glucose Tolerance Test (OGTT)
4. Random blood glucose plus symptoms of diabetes
33
What are the characteristics/causes of type 2 diabetes?
1. caused by insulin resistance or deficiency
2. more common in adults
3. progressive disease, slower onset
34
Modifiable risk factors of type 2 diabetes? (5)
1. Obese/ Fat distribution
2. Physical inactivity, sedentary lifestyle
3. Hypertension/ high cholesterol
4. poor diet
5. smoking/ alcohol consumption
35
Non-Modifiable risk factors of type 2 diabetes? (6)
1. Family History
2. Race/ Ethnic background: African American, Latino, Pacific Islander
3. Age
4. Pre-diabetic and gestational diabetes
5. PCOS (Poly-cystic ovary syndrome)
6. Chronic Glucocorticoid exposure
36
Genetic Mutations of type 2 diabetes?
Insulin resistance & familial tendency
37
A patient with type 2 diabetes can have what signs and symptoms? 8
1. Polyuria, Nocturia
2. Polydipsia
3. Polyphagia
4. Recurrent infection
5. Prolonged wound healing
6. Visual changes
7. Fatigue, low energy
8. Metabolic Syndrome
38
A patient with type 2 diabetes have what lab values? (3)
1. HA1C ^ 6.5%
2. FPG ^ 126mg/dl
3. Prediabetes FPG ^ 100-125 mg/dl
39
How do you diagnose a patient with type 2 diabetes?
1. HA1C
2. Fasting Plasma Glucose (FPG)
3 Oral Glucose Tolerance Test (OGTT)
4. Random Blood Glucose plus symptoms of diabetes
40
What are some treatment options for a patient with type 2 diabetes? (4)
1. Diabetic Medications : Insulin or Oral
2. Lifestyle Changes
3. Tight Glycemia control
4. Increased activity levels
41
What are some short term diabetic complications?
1. Hypoglycemia
2. Hyperglycemia
3. Ketoacidosis
42
What are some long term micro-vascular diabetic complications? (3)
1. Retinopathy
2. Nephropathy
3. Neuropathy
43
What are some other long term diabetic complications? (3)
1. Foot Ulcerations
2. Amputations
3. Sexual dysfunctions
44
Home Foot Care Rules for Diabetic Patients: (14)
1. check daily for injuries or breakdown
2. wash daily with mild soap and warm water
3. moisturize with lanolin
4. Do not let lotion cake between the toes or it will cause skin breakdown
5. Annual exams by professional
6. well fitting shoes
7. no barefoot or sandals
8. break in new shoes over several days
9. clean socks daily
10. no tight elastic topped socks
11. corns or calluses to be removed by professional
12. nails cut straight then file edges
13. warm socks if feet are cold
14. pedicures are not recommended
45
What would you as a nurse do to prevent diabetic complications? (5)
1. patient education
2. assess barriers to learning
3. teach in increments
4. promote self care
5. adjust regimen to meet pt needs
46
What are some patient barriers when it comes to educating the patient on their diabetes? (8)
1. degree of life changes and complexity of management plan
2. cost of care
3. access to medical treatment
4. cultural factors
5. lack of family support
6. lack of knowledge
7. fears
8. other stressors
47
Increasing adherence to pt education by? (7)
1. encourage patient and family to take care of their health
2. simplify regimen
3. focus on the normal, not the differences
4. teach the tools
5. help the pt get supplies
6. provide safe harbor
7. provide adequate education
48
Nutrition therapy goals includes: (5)
1. maintain blood glucose levels
2. lipid profiles and bp levels
3. prevent/slow rate of chronic complications
4. nutritional,cultural, personal and economic needs
5. maintain the pleasure of eating
49
(nutrition)
type 1 guidlines include: (3)
1. meal planning (portion control, balanced w insulin and exercise)
2. day to day consistency
3. more flexible with rapid-acting insulin, multiple daily injections and insulin pump
50
(nutrition)
Type 2 guidelines include:
1. emphasis on achieving glucose, lipid and bp goals
2. weight loss
51
(Glycemic index)
Foods with a high glycemic index do what?
Foods with a high glycemic index raise glucose levels faster and higher than foods with a low glycemic index
** may provide modest additional benefit over consideration of total carbohydrates alone
52
What must you teach diabetic patients about sugar free foods?(3)
1. sugar-free does not mean carbohydrate free
2. sugar free foods often have higher saturated fat compared to the regular products
3. important to teach patients to look at food labels
53
what are sugar alcohols? (3)
1. Found on most sugar free foods
2. include: sorbitol, mannitol, xylitol, and isomalt
3. Eaten in large quantities can cause abdominal cramping, flatulence and diarrhea
54
what would you inform a diabetic patient on who drinks alcohol?
1. Limit - moderate amount
2. Inhibits glucogenesis
3. monitor blood glucose
4. Consume carbohydrates
5. high in calories
55
guidelines to alcohol consumption:
1. do not skip meals
2. risk of low blood sugar
3. may increase triglycerides
56
What are the sick day rules for a diabetic patient?
1. maintain normal diet if able
2. increase non-caloric fluids
3. continue taking anti diabetic medications
4. if normal diet is not possible, supplement with carb containing fluids while continuing medications
57
S:
I :
C:
K :
Sugar: check your blood glucose every 2 or 3 hours or as necessary
Insulin: Always take insulin, not taking it could lead to DKA
Carbs: drink lots of fluids, if sugar high= sugar free drinks
sugars are low= carb containing drinks
Ketones: check urine or blood ketones every 4 hours
take rapid acting insulin if ketones are present
** go to slide 171 for graph
58
2 groups of insulins:
Endogenous insulin: originating within the body (pancreas makes)
Exogenous insulin: originating outside the body (injection or infusion via pump)
59
What are the 4 counterregulatorey hormones?
1. Glucogon
2. Growth Hormone
3. Epinephrine
4. Cortisol
60
What do Counter-Regulatory Hormones do?
1. Help increase BLOOD glucose levels in periods of fasting, not eating, in between meals.
2. Stimulate glucose production (released by the liver) and decrease movement of glucose into the cells
61
What can activate these counter-regulatory hormones?
Stressful condition: pain, ill or injured (stress hormones)
62
When treating Hypoglycemia what does rule of 15 mean?
This is a form of treatment
15g of simple carbs -> check in 15 mins to see if BS went up -> if still low try 2-3 times -> if not call hcp
(fruit juice, regular sodas, glucose gels or tablets)
*1st intervention??
63
How long does it generally take for glucagon to start working?
15 minutes
64
Once someone becomes conscious after a hypoglycemic attack, what should you do?
fast acting form of sugar; juice
then long acting; crackers and cheese
65
What is the treatment for hypoglycemia?
1. Rule of 15
2. IV Dextrose (D50)
3. Glucagon IM or sub-q
66
DKA levels:
250 mg/dl
67
HHS levels:
600 mg/dl
68
In either type 1 or 2, which one is more susceptible to DKA?
Type 1
69
In either type 1 or 2, which one is more susceptible to HHS?
Type 2, 60 higher
70
What can make a HA1C level inaccurate?
anyone who has conditions that affects hemoglobin levels : pregnancy, chronic kidney disease causes rbc's to drop, liver disease, loss of blood or blood transfusion, anemia's, vitamin b12 deficiency
71
Risk factors of type 1 diabetes? 3
1. Autoimmune
2. Viral
3. Medically Induced: removal of pancreas
72
What is tight glycemic control?
BS before meals needs to be 80 - 130 mg/dl and after meals 1-2 hrs BS needs to be less than 180 mg/dl
73
Rate of Absorption Varies when it comes to insulin injection sites, what are their rates?
Abdomen: fastest
Upper Arm: slow
Thigh: slower
Buttocks: slowest
74
what is an essential part of preventing pre-diabetes or diabetes?
Exercise
75
The ADA recommends how much exercise?
ADA recommends 150 minutes per week (30 minutes, 5 days a week)
76
The ADA recommends what type of diabetic patients to perform resistance training 3x a week?
DM2
77
how is exercise good for diabetic patients?
Decreases insulin resistance and can have direct effect on lowering blood glucose levels
78
what are some increased risks for hypoglycemia?
(Exercise)
If taking diabetic medications, there is an increased risk for hypoglycemia
Hypoglycemia can occur in a sedentary patient that has an unusually active day
79
Diabetes is the leading cause of what? (3)
1. Adult Blindness
2. End stage Kidney Disease
3. Non-traumatic amputations
80
Diabetes is a major contributing factor to what? (3)
1. Heart Disease
2. Stroke
3. Hypertension
81
in regards to gestational diabetes, if you birth > 9lbs baby, you are at risk for?
35%-60% chance of developing type 2 diabetes within 10 years.
82
Continuous Glucose Monitoring: what is it? who is it advised for? (3)
1. GOOD FOR THOSE PATIENTS WITH ERRATIC AND UNPREDICTABLE DROPS
2. WARNS OF DANGEROUS LEVELS
3. PROVIDES REAL-TIME MEASUREMENTS OF BG LEVELS
83
What is insulin pump therapy defined as ?
Continuous subq insulin infusion via external device worn somewhere on the body.
84
what are the characteristics/how insulin pump therapy works?
1. Provides a continuous infusion of "basal" insulin
2. Pt will put in rapid acting insulin into pump and "boluses" for meal at time of meal
3. bolus is determined by pre-meal BS and CHO content of meal
4. never use a long or intermediate insulins
85
what is key to pump success ?
motivation
86
what does pump therapy not do? 5
1. the pump does not regulate blood glucose automatically, the pump is just the insulin giver!!!!
2. does not decrease the need to check BS 4-5x a day
3. does not replace pancreas, does not give you free reign to eat whatever
4. not easy or inexpensive
5. not complication free (kink in line, infection at site, pump stops working)
87
Pump Therapy Indicators (who should have a pump) : 7
1. A1c of >6.5% (having diabetes)
2. shift workers (nurses, etc)
3. frequent hypoglycemic episodes
4. pediatrics
5. hectic lifestyle/ exercise
6. dawn phenomenon
7. 2DM w/ gastroparesis
88
Nursing Consideration include what? - insulin pumps
1. Pumps cannot be worn to CT or MRI
2. Ensure all members of Healthcare team are aware of pt wearing pump
3. if a problem occurs: call hcp that manages the pump
89
what is hypoglycemia unawareness?
more common in older people, body doesnt recognize cues until critically low. its related to autonomic nueropathy and lack of CRH. want to keep the BS on the higher side for older people so it doesnt drop into the critical values as quicky. remember high is better than low.
90
Etiology: T2DM
Pancreas continues to produce some endogenous insulin but?
1. Not enough insulin is produced or the body doesnt use it effectively
2. In T1DM there is an absence of endogenous insulin *key distinction
91
at the time of diagnosis of T2DM how many beta cells are no longer secreting insulin? and on average how long has an individual had DM2 without knowing?
50-80% of beta cells
roughly 6.5-8yrs without knowing
92
Leading factors to T2DM: 4
1. Insulin Resistance
2. Pre- Diabetes
3. Metabolic Syndrome
4. Gestational Diabetes
93
What are the 5 characteristics of metabolic syndrome? if you have 3 out of 5 you are considered to have metabolic syndrome.
(Increases risk of T2DM)
1. Elevated Glucose Levels
2. Abdominal Obesity
3. Elevated BP
4. High Levels of Triglycerides
5. Decreased levels of HDL (good cholesterol)
94
HDL levels:
LDL levels:
Total cholesterol levels:
Triglyceride levels:
HDL Men: higher than 40 Women: higher than 50
LDL: less than 100
Total: less than 200
Triglyceride level: 150
95
What is Metformin (Glucophage)? and what is the class of drug?
Class: Biguanides
Metformin is a commonly used drug to reduce/slow down the glucose (sugar) production of the liver. This is GOLD STAR MED, started immediately after diagnosis also prevenative --------> PCOS and Pre-diabetes
SE: GI Upset and rarely Lactic Acidosis
96
Metformin should be held when and for how long and for what?
Metformin cannot be taken before or after diagnostic studies that use dye (heart cath mri ct). you should tell pt to hold metformin 48 hrs prior and 48 hours post diagnostic study
97
why is metformin a good medication for T2DM?
Lowers blood glucose and improves glucose tolerance which enhances insulin sensitivity, improves glucose transport and may cause weight loss (big plus)
98
What is the step approach to treatment for T2DM? (4 steps in total)
Step One: Diet & Exercise
Step Two: Lifestyle changes + Metformin
Step Three: Lifestyle changes + metformin + a second drug
Step Four: Lifestyle changes + Metformin + Insulin Therapy
99
What is sulfonylureas? what does it do? and its characteristics?
Increases insulin production from pancreas
side effects: hypoglycemia and weight gain.
alcohol use can potentiate hypoglycemia effects (flushing, palpitations, and nausea)
100
Sulfonylureas
what are the second generation drugs more commonly used?
Glipizide, Glyburide, and Glimepiride
101
What drugs are used to treat hyperlipidemia? (high cholesterol)
Statin drugs
(atorvastatin, med ends in statin)
these drugs help lower cholesterol levels and triglyceride levels which will help lower risks of angina, stroke, MI, heart and blood vessels problems
102
what are some meds that help against renal insufficiency and Hypertension?
Ace Inhibitors, Calcium Channel Blockers, Angiotension II Receptor Blockers (ARB)
103
What med causes a dry hacking cough? what drug should you change to?
Ace Inhibitors cause a dry hacking cough, so change to a calcium channel blocker if necessary
104
what diuretics are used and why are they used?
Hydrochloridthiazide, furosemide and they are used for fluid overload and Hypertension control
105
why are beta blockers not recommended for diabetics?
because it can mask the warning signs of hypoglycemia
106
collaborative care:
patient teaching includes? (4)
1. Drug therapy
2. Nutritional therapy
3. Exercise
4. Self- monitoring of BG
107
Long Term Affects of Hyperglycemia include: (8)
1. Major CVD: Ischemic Heart Disease, Stroke
2. Lower Extremity Amputation
3. DKA, HHS
4. Skin and Soft tissue Infections
5. Pneumonia
6. Influenza
7. Bacteremia/Sepsis
8. TB
108
Vascular Effects
Micro:
Macro:
Micro: retinopathy, nephropathy (Renal insufficiency/ Failure), Periodontal DZ
Macro: CVD/PVD, MI, Stroke
109
Effects of Diabetes on the CV system? (7)
1. Hypertension
2. MI
3. Angina (chest pain not related to blockage or MI warning signs)
4. Dyspnea
5. Peripheral Vascular Disease
6. Hyperlipidemia
7. CVA ( stroke)
110
CV Disease: 3
1. Hyperlipidemia - statin drugs
2. Smoking increases the risk
3. Microvascular disease
111
Periodontal disease: 5
1. Increased Dental Caries
2. Tooth Loss
3. Gingivitis
4. Candidiasis (yeast, Thrush )
5. Regular Dental Exams twice a year
112
Chronic Compmications Diabetic Retinopathy
Characteristics of Nonproliferative:
Partial occlusion of small blood vessels in retina which causes microanuerysms ( bleeding behind the retina)
macular degeneration
113
Characteristics of Proliferative retinopathy:
Invloves retina and vitreous humor
new blood-vessels are formed (neovascularization)
fragile and cause retinal detachment glaucoma and blindness
WORSE OF THE TWO
114
Retinopathy Treatment :
1. Laser photocoagulation: laser destroys ischemic (a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body) areas of retina
2. Vitrectomy: aspiration of blood membrane and fibers within the eye
3. Drugs to block action of vascular endothelial growth factor
115
Retinopathy increases the risk of what other disease?
1. Glaucoma
2. Cataracts
if diabetic retinopathy isn't treated then it leads to these
116
What is glaucoma?
Pressure in the eye, once you have it, you have it forever
117
What is cataracts?
cataract is a clouding of the normally clear lens of the eye.
can get cataract surgery to help
118
When diagnosed with T1dm when should you go to the eye doctor?
within 5 years of diagnosis
119
When diagnosed with T2DM when should you go to the eye doctor?
immediately upon diagnosis
120
What is nephropathy?
Damage to the small blood vessels that supply the GFR ( Glomeruli Filtration Rate)
it is the leading cause of ESRD
121
Risk factors of nephropathy:
1. HTN
2. Genetics
3. Smoking
4. Chronic hyperglycemia
122
what percent of diabetic pts have nephropathy
20-40%
123
If albuminuria is present what drugs can slow progression of nephropathy?
1. Ace Inhibitors
2. ARB (angiotensin receptor blocker)
* also need to then control htn and bg levels
124
what is the number one key of renal damage? If albumin is present, who should pt see?
Spilling albumin in urine, protien and sugar in the urine is not a good thing either. Pt should follow up with a nephrologist bc it can lead to kidney failure and dialysis
125
Labs for nephropathy:
UA clear of?
BUN/Creatinine:
GFR:
UA: clear of albumin, protein,glucose, nitrates/bacteria
BUN/Creatinine: 8-20mg/dl
0.6-1.2mg/dl
GFR: > 60 ( diff for African americans )
126
what are the cues for nephropathy?
Edema: face hands and feet
Symptoms of UTI
Symptoms of renal failure : EDEMA ( fluid overload bc not using bathroom often, place on a diuretic) , ANOREXIA, NAUSEA, FATIGUE, DIFFICULTY CONCENTRATING ( brain fog and urine toxins)
127
Sensory Neuropathy
loss of protective sensation (when diabetes causes you to lose feeling in your feet)
128
Distal Symmetric Polyneuropathy
The loss of sensation, abnormal sensations, pain, and paresthesias (pins and needles all over) very painful
129
Treatment for sensory nueropathy:
1. tight blood glucose control
2. Drug therapy
(topical creams, tricyclic antidepressants treats pain and anxiety, selective serotonin & nor epinephrine reuptake inhibitors, antiseizure meds - gabapentin & lyrica)
130
Gabapentin :
Lyrics:
it is effective for paresthesia (nerve pain) lyrica → fibromyalgia and restless pain syndrome nerve pain in the legs
131
Autonomic Nueropathy causes what 5 issues?
1. Gastroparesis (delayed gastric emptying, food just sits in stomach. the oral meds will not be absorbed, ask how much of meal can you eat? do you feel full?)
2. Cardiovascular Abnormalities: Postural hypotension, resting tachycardia, painless myocardial infarction
3. Hypoglycemic unawareness
4. Sexual function: erectile dysfunction, decreased libido
5. Nuerogenic bladder: urinary retention, emptying frequently, use crede manuever (massage bladder to push urine out), medications ( bethanechol) , self catheterization
132
what is the monofilament screening test?
tests bottom of the feet and tells if they feel it or not and if theres no feeling then they have sensory nuropathy, loss of protective sensation and unawareness of injury
133
what is PAD?
Peripheral Artery Disease
low blood flow, slow wound healing and high risk of infection
134
What are the parts of treatment for foot ulcers? 6
1. bed rest
2. Antibiotics
3. debridment: when you see blood youve reached healthy tissue
4. If pt has peripheral vascular disease ulcers may not heal ( not good o2 then wound wont heal)
5. amputation may be necessary
6. Good control of BG
135
Precipitating Factors of Diabetic Keto-Acidosis?
(events that lead to dka)
1. infection
2. inadequate insulin
3. illness
4. undiagnosed T1DM
blood sugar higher than 250-300
ketosis: breaking down of fat and muscle too quickly, body is starving
136
Pathology of DKA:
caused by a large lack of insulin
characterized by: hyperglycemia
ketosis
acidosis
dehydration
137
DKA is most common in which type of diabetes?
Type one diabetes
138
Clinical Manifestations of DKA:
1. Dehydration
2. poor skin turgor
3. dry mucus membranes
4. tachycardia
5. orthostatic hypotension: standing up or moving
6. lethargy and weakness early
7. skin will be dry and losose: eyes will be sunken
8. fruity breath
9. abdominal pain, nausea, vomiting, anorexia
10. kussmaul respirations: rapid deep breathing, medical emergencie
139
What lab results indicate DKA?
1. BG of 250mg/dl or higher
2. Blood Ph less than 7.3
3. Serum Bicarbonate level less than 16 mEq/L
4. moderate to high ketone levels in urine or serum
140
Treatment for DKA:
IV started ASAP to re-hydrate, NS is the bolus we will use
potassium will be the main electrolyte we look at, and replace them so they dont go into renal failure
as BS comes down we are going to give them D5 or D10 do not want to overtreat them
potassium replacement
141
what are the differences between DKA and HHS
DKA: mostly seen in type one, rapid onset, BG higher than 250, ph less than 7.3, Bicarb less than 15, and ketones in urine and serum
HHS: occurs more in elderly, gradual onset, BG higher than 600, Ph greater than 7.3, bicarb over 30 and negative ketones
*HHS is more deadly cause of the older population has a higher mortality rate
142
Precipitating factors of HHS:
1. UTI, Pnuemonia,Sepsis
2. Acute illness
3. newly diagnosed T2dm
4. impaired thirst senstaion or inability to replace fluids
143
HHS Pathology:
1. They have enough circulating insulin to prevent ketoacidosis
2. Fewer symptoms lead to higher glucose levels (HYPERglycemia unawreness)
3. more severe neurological manifestations- 2nd to high serum osmolality
144
signs HHS is improving?
Level of conciousness, skin tugor, and decreased urine output
145
Diabetic Dermopathy:
Shin Spots
MOST COMMON cutaneuos manifestation of diabetes
benign asymptomatic red brown macules
no treatment
146
Carbohydrate Guidlines
45-60% of coloric intake
grains fruit legumes milk
minimun 130g per day
fiber intake 25-30g perday
limit refined grains and sugars
1carb=15g
147
Protien guidlines
15-20% total calories consumed
high protien diets are not recommended
protien may reduce in pt with kidney failure
148
fat guidlines:
saturated fat 7% of total calories
minimize trans fats
limit dietary cholesterol of less than 200mg per day
fish- polyunsat fat
