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Clinical I > Lecture 7 > Flashcards

Lecture 7 Flashcards

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1
Q

What characterizes diabetes Mellitus?

A

Metabolic diesel characterized by hyperglycaemia

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2
Q

how many causes of DM are there?

A

30 -4 causes of diabetes but end result is the high blood sugar

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3
Q

What are the different kinds of diabetes and pre-diabetes?

A

Type 1
Type 2
Gestational Diabetes Mellitus
Maturity onset diabetes of the young (MODY)
Latent autoimmune diabets of adulthood(LADA)
Impaired glucose tolerance
Imparied Fasting glucose

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4
Q

What is type 1 diabetes?

A

Destruction of pancreatic cells
• Causes: autoimmune or idiopathic
• 10% of people with diabetes
• Age of onset ~<25 yrs but can occur at any age

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5
Q

How do you treat type 1 DM?

A

Insulin injections

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6
Q

What side condition is common with Type 1DM?

A

Diabetic ketoacidosis common

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7
Q

Why are pancreatic cells destroyed in Type 1 DM?

A
  • pancrease doesn’t produce or produces bvery little insulin

* Body attacks own pancreatic beta cells so they no longer function=autoimmune

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8
Q

What is Type 2 DM characterized by?

A

Insulin not properly utilized and/or not enough produced
▪ Ranges from predominantly insulin resistance with relative insulin
deficiency to a predominantly secretory defect with insulin resistance
• 90% of people with diabetes
• Dx in adulthood (>25yrs) but can occur in childhood
• Generally (>90%) have overweight/obesity

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9
Q

When do you start screening for type 2 DM?

A

Screen every 3 years ≥40 years of age or sooner if risk factors present

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10
Q

What is the difference between type 2 and type 1 DM?

A

• Produce enough insulin an dnot used properly and overtiime pancrease can become overworked, eventually pancrease I exhausted and becomes a secretory defect
○ Feedback with pancreas, need and amount being used
○ Cells become damaged and don’t work properly

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11
Q

What are the type 2 DM risk factors?

A
  • Age ≥40 years
  • First-degree relative with type 2 diabetes
  • Member of high-risk population (e.g. African, Arab, Asian, Hispanic, Indigenous or South Asian descent, low SES)
  • History of prediabetes (lGT, lFG or A1C 6.0%–6.4%)or GDM
  • History of GDM
  • History of delivery of a macrosomic infant
  • Use of drugs associated with diabetes: glucocorticoids, atypical antipsychotics9For mood disorders)
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12
Q

When does Gestational DM resolve?

A

Usually resolves after childbirth but mother and child at increased risk for T2DM

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13
Q

What are the goals for Gestational DM?

A

▪ N blood glucose concentration (euglycemia); meet glycemic target ranges
▪ Nutritionally adequate diet to meet pregnancy needs
▪ Preconception counseling (planning)

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14
Q

What do you screen for gestational DM?

A

Screening at 24-28weeks (or sooner If presenting with risk factors)

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15
Q

Why does insulin increase in pregnant women?

A

• Insulin increases in pregnant woman to make sure baby has enough glucose

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16
Q

What are acute complications of DM?

A

Due to hyperglycemia
Diabetic ketoacidossisss (DKA)
Hyperosmolar hyperglycaemic state (HHS)
Due to Hypoglcemia

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17
Q

What is hyperglycaemia due to?

A

Polyuria, polydipsia, unexplained wt changes, polyphagia, extreme fatigue,
blurred vision, weakness, dehydration

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18
Q

What is DKA?

A

increase ketone bodies in blood due to fat breakdown causing toxicity (glucose production by liver through gluconeogenesis)

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19
Q

What us the cause of hyperosmolar hyperglycaemic state?

A

(mainly in type 2 DM)

Hyperosmolarity and dehydration

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20
Q

What are the 2 categories of longterm complciations due to chronic hyperglycaemia?

A

Microvascular

Macrovascular

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21
Q

What is included in microvascular?

Study These Flashcards
A 
▪  Retinopathy
▪ Nephropathy
▪ Neuropathies: peripheral (foot problems) &amp; autonomic (gastroparesis, postural
hypotension)
▪ Erectile dysfunction
22
Q

What is included in macrovascular?

Study These Flashcards
A

▪ Dyslipidemia
▪ Hypertension
▪ CHD/CVD → main cause of death in people with DM
▪ Stroke

23
Q

What is the diagnosis of prediabetes?

Study These Flashcards
A

FPG (mmol/L):6.1-6.9-IFG

2h PG in a 75g OGTT (mmol/L): 7.8-11.0-IGT

A1C (%) 6.0-6.4- Prediabetes

24
Q

What si the diagnosis of diabetes ?

Study These Flashcards
A

FPG ≥7.0 mmol/L

A1C ≥6.5% (in adults)

2hPG in a 75 g OGTT (oral glucose tolerance test) ≥11.1 mmol/L

Random PG (plasma glucose)≥11.1 mmol/L

25
What are the ABCDES3 of diabetes care?
A • A1C – optimal glycemic control (usually ≤7%) B • BP – optimal blood pressure control (<130/80) C • Cholesterol – LDL <2.0 mmol/L or >50% reduction D • Drugs to protect the heart E • Exercise / Healthy Eating S • Screening for complications S • Smoking cessation S • Self-management, stress and other barriers
26
For type 2 DM how do you manage wt?
Diet, exercise, lifestyle change, wt loss ▪ In prediabetes and recently diagnosed type 2 diabetes, weight loss is the most important and effective dietary strategy if overweight or obese ▪ Weight loss of 5% to 10% body weight may help normalize BG levels
27
What is the main medication for type 2 DM?
Oral anti-hyperglycemic agents ▪ Metformin (Glucophage ®): 1st line of defense ▪ Injectable medications ▪ E.g. Insulin, liraglutide ▪ Combination therapies
28
What are other medications used in the treatment of type 2 diabetes?
Glucagon-like peptide 1 (GLP-1) receptor agonists DPP-4 Inhibitors Insulin secretagogues Sodium-glucose co-transporter 2 inhibitor (SGLT-2 inhibitor) Alpha-glucosidase inhibitors Combination pills
29
What do Glucagon-like peptide 1 (GLP-1) receptor agonists do?
stimulate glucose-dependent insulin release from pancreas
30
What do DPP-4 inhibitors do?
Enhances glucose-dependent insulin secretion
31
What do insulin secretagogues do?
Targets pancreas to increase insulin production/secretion * Independent of glucose * Pancrease will produce insluin regardless of if you eat or no * Noot top choice in drugee * Also v inexpensive
32
What do sodium-glucose co-transporter 2 inhibitors do?
Blocks reabsorption of glucose by increasing excretion in urine Common side effect: UTI
33
What do alpha-glucosidase inhibitors do?
• Inhibits breacdown of sucrose in the gut so it is not absorbed Problem: if you have hypoglycemia it wonot be broken down to the degree that would help them
34
what are the different kinds of insulin?
Bolus : one time short acting Basal: intermediate acting Premixed: short and long acting
35
If you are taking premixed what should you be following?
Longer acting mixed with short cting so only have to take it a few times per day -Need to follow a set meal plan, if have a snack not on the plan then they could have low insulin
36
What is basal insulin mimic?
• Background insulin | ○ Helps mimick pancrease insulin release througout the day
37
What are the causes of hypoglycaemia?
– Too much insulin or insulin secretagogues (meds) – Delayed or decrease usual food intake – Extra activity/exercise – Alcohol consumption (insulin and insulin secretagogues)
38
If you have DM what should you keep your levels at when you're driving?
–Should not drive whenBG<4.0mmol/L and should wait at least 40 minutes after treatment of hypoglycemia has increased their BG level to at least 5.0 mmol/L
39
What are the neurogenic(autonomic) symptoms of hypoglycaemia?
* Trembling * Palpitations * Sweating * Anxiety * Hunger * Nausea * Tingling
40
What are the neruoglycemic (brain) symptoms of hypoglycaemia?
* Poor concentration * Confusion * Weakness * Drowsiness * Visual changes * Speech impaired * Headache * Dizziness
41
What is hypoglycaemia unawareness?
No symptoms of hypoglycaemia
42
What classifies as mild, moderate and severe hypoglycaemia?
Mild: autonomic-mediated symptoms • Person can self-treat • BG < 4.0 mmol/L Moderate autonomic and neuroglycopenic symptoms • Person can self-treat Severe: Person may be unconscious or require assistance • BG<2.8mmol/L • Glucagon injection
43
When do you use the 15/15 rule?
Treatment of mild moderate hypoglycaemia in conscious adults
44
What is the 15/15 rule?
1. Give 15g of fast-absorbed CHO equivalent 2. Retest blood glucose 15 min. later 3. Repeat if needed 4. If next meal is ≥ 1 hour away have a snack containing PRO and CHO 5. Avoid overtreating
45
What lab values can we use to get a comprehensive nutrition assessment ?
▪Dx blood glucose test values (e.g. OGTT, FPG) ▪ Capillary blood glucose values - self blood glucose monitoring (SBMG) ▪ A1C (Blood glycosylated hemoglobin concentration) ▪ Blood lipid concentrations
46
What do you measure at home?
Capillary blood glucose values | - self blood glucose monitoring (SBMG)
47
What is self monitoring blood glucose?
• the testing that the patient performs • all who are able - fingertip (most common) or alternative site • must be used by the patient to be useful -consider cost • look for patterns of response to different foods, meals, activities, stressors
48
What is A1C?
▪ Blood glycosylated hemoglobin concentration -Shows us how much sugar attaches to HgB molecule ▪ Reflects average blood glucose control over 2-4 mos. - with recent past having most influence ▪ Correlates with SBMG values ▪ Take a look at SBMG values for interpretation! ▪ Target = or less than 7.0% in most people
49
What do we need to watch alongside A1C?
• Also nee to look at individual testing that the individual is doing because it could be really highg and really low at certain points but on average looks normal
50
Where should peoples A1C if they have type 1 or 2?
Equal to or less than 7.0

Clinical I (17 decks)

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