T3 New Flashcards
(168 cards)
cell destruction leading to absolute insulin deficiency • Autoimmune • Idiopathic
Type 1 Diabetes (T1DM)
• Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance
The body does not respond correctly to insulin,
blood sugar can not get into its cells To be stored later for energy,
so a high level of sugar builds up in the blood
Type 2 diabetes
Conditions resulting in hyperglycemia
Infection Cancer Beta cell defects Virus Pancreatitis Trauma
Genetic defects of beta-cell function
• Genetic defects in insulin action • Pancreatic diseases (pancreatitis, trauma, cancer, cystic fibrosis, hemochromatosis)
• Endocrine problems (acromegaly, Cushing’s disease, hyperthyroidism, aldosteronism)
• Drug- or chemical-induced hyperglycemia
• Infections: congenital rubella, cytomegalovirus, human immune deficiency virus
• Genetic syndromes associated with diabetes: Down syndrome, Klinefelter syndrome, Turner syndrome, Huntington disease, and others
Glucose intolerance with onset or first recognition during pregnancy. (All pregnant women should be screened.)
Gestational Diabetes Mellitus (GDM) •
Differentiation of Type 1
and Type 2 Diabetes Features
Type 1 Genetic DKA May occur- ketones Insulin dependent Young with dx Auto immune disease 3 ps Weight loss Pancreases doesn’t release insulin as needed so BS increases (pancreatic beta cell destruction)
Juvenile-onset diabetes- Ketosis-prone diabetes - Insulin-dependent diabetes mellitus (IDDM) Usually younger than 30 yr Abrupt onset, thirst, hunger, increased urine output, weight loss Viral infection, autoimmunity Antibodies Present at diagnosis Non-obese Dependant on insulin Inheritance is complex Pancreatic beta-cell destruction
Type 2 Any age- adults common Sedentary lifestyle Obese Can reduce insulin with exercise and diet Insulin resistance- body doesn’t react to insulin properly to sugar stays in blood and increases BS Dehydrated HHS - common no ketones C-peptide
Adult-onset diabetes Ketosis-resistant diabetes Non–insulin-dependent diabetes mellitus (NIDDM) May occur at any age in adults Frequently none s/s; thirst, fatigue, blurred vision, vascular or neural complications Insulin resistance Dysfunctional pancreatic beta cell Most obese c-peptide present
is the simultaneous presence of metabolic factors known to:
increase risk for developing type 2 DM and cardiovascular disease
Big belly
Increased fasting BS over 100
Increases BP - 130/85
Increased cholesterol over 150
Features of the syndrome include:
• Abdominal obesity: waist circumference of 40 inches (100 cm) or more for men and 35 inches (88 cm) or more for women
• Hyperglycemia: fasting blood glucose level of 100 mg/dL or more or on drug treatment for elevated blood glucose levels
• Hypertension: systolic BP of 130 mm Hg or more or diastolic blood pressure of 85 mg Hg or more or on drug treatment for hypertension
• Hyperlipidemia: triglyceride level of 150 mg/dL or more or on drug treatment for elevated triglycerides; high-density lipoprotein (HDL) cholesterol less than 40 mg/dL for men or less than 50 mg/dL for women
Metabolic syndrome
Risk for type 1 DM is determined by
inheritance of genes
is a low blood glucose level that induces specific symptoms and resolves when blood glucose concentration is raised. Once plasma glucose levels fall below 70 mg/dL (3.88 mmol/L), a sequence of events begins with release of counterregulatory hormones, stimulation of the autonomic nervous system, and production of neurogenic and neuroglycopenic symptoms.
Hypoglycemia
Peripheral autonomic symptoms,.
including sweating, irritability, tremors, anxiety, tachycardia, and hunger, serve as an early warning system and occur before the symptoms of confusion, paralysis, seizure, and coma occur from brain glucose deprivation
Neuroglycopenic symptoms occur when?
S/s
brain glucose gradually declines to a low level:
• Weakness • Fatigue • Difficulty thinking • Confusion • Behavior changes • Emotional instability • Seizures • Loss of consciousness • Brain damage • Death
Neurologic symptoms result from
autonomic nervous activity triggered by a rapid decline in blood glucose:
• Adrenergic: • Shaky/tremulous • Heart pounding • Nervous/anxious • Cholinergic: • Sweaty • Hungry • Tingling
▪ Signs and symptoms
Hypoglycemia s/s:
Skin: Cool, clammy
Dehydration: absent
Resp: no change
Mental status: anxious, nervous, irritable, mental confusion, seizures, coma
Symptoms: weakness, double vision, hunger, high pulse, palpitations
Glucose: less than 70
Urine or blood ketones: negative
▪ Treatment
For mild hypoglycemia:
(hungry, irritable, shaky, weak, headache, fully conscious; blood glucose usually less than 60 mg/dL [3.4 mmol/L]):
• Treat the symptoms of hypoglycemia with 10 to 15 g of carbohydrate. You may use one of these:
• Glucose tablets or glucose gel (dosage is printed on the package)
• cup (120 mL) of fruit juice • cup (120 mL) of regular (nondiet) soft drink
• 8 ounces (240 mL) of skim milk
• 6 to 10 hard candies
• 4 cubes of sugar
• 4 teaspoons of sugar
• 6 saltines
• 3 graham crackers
• 1 tablespoon (15 mL) of honey or syrup
• Retest blood glucose in 15 minutes.
• Repeat this treatment if glucose remains less than 60 mg/dL (3 mmol/L). Symptoms may persist after blood glucose has normalized.
• Eat a small snack of carbohydrate and protein if your next meal is more than an hour away.
Tx For moderate hypoglycemia:
(cold, clammy skin; pale; rapid pulse; rapid, shallow respirations; marked change in mood; drowsiness; blood glucose usually less than 40 mg/dL [2.2 mmol/L]):
• Treat the symptoms of hypoglycemia with 15 to 30 g of rapidly absorbed carbohydrate.
• Retest glucose in 15 minutes. • Repeat treatment if glucose is less than 60 mg/dL (3 mmol/L). • Eat additional food, such as low-fat milk or cheese, after 10 to 15 minutes.
For severe hypoglycemia
(unable to swallow; unconsciousness or convulsions; blood glucose usually less than 20 mg/dL [1.0 mmol/L]):
• Treatment administered by family members: • Give 1 mg of glucagon as intramuscular or subcutaneous injection. • Give a second dose in 10 minutes if the person remains unconscious. • Notify the primary health care provider immediately and follow instructions. • If still unconscious, transport the person to the emergency department. • Give a small meal when the person wakes up and is no longer nauseated.
The most common causes of hypoglycemia are:
- Too much insulin compared with food intake and physical activity
- Insulin injected at the wrong time relative to food intake and physical activity • The wrong type of insulin injected at the wrong time
- Decreased food intake resulting from missed or delayed meals
- Delayed gastric emptying from gastroparesis
- Decreased liver glucose production after alcohol ingestion
- Increased insulin sensitivity as a result of regular exercise and weight loss
- Decreased insulin clearance from progressive kidney failure
o hyperglycemia
▪ signs and symptoms
most people have no symptoms. However, some patients experience headaches, facial flushing (redness), dizziness, or fainting as a result of the elevated blood pressure. Obtain blood pressure readings in both arms. Two or more readings may be taken at each visit (Fig. 36-1). Some patients have high blood pressure due to anxiety associated with visiting a health care provider.
Tests for hyperglycemia
A1c
Fasting blood glucose
Two hour bg
Random bg concentration
Tests that indicate high bs :
1. >6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.
- greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.
- equal to or greater than 200 mg/dL (11.1 mmol/L) during oral glucose tolerance test. The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
- In a patient with classic manifestations of hyperglycemia or hyperglycemic crisis, a what????? greater than 200 mg/dL (11.1 mmol/L). Casual is defined as any time of the day without regard to time since last meal.
The classic symptoms of diabetes include??
NOTE: In the absence of unequivocal hyperglycemia, the first three criteria should be confirmed by repeat testing.
A1c
Fasting blood glucose
Two hour bg
Random bg concentration
polyuria, polydipsia, and unexplained weight loss.
Tx for diabetes mellitus
The patient is expected to manage DM and prevent disease progression by maintaining blood glucose levels in his or her target range. Indicators are that the patient consistently demonstrates these behaviors:
- Performs treatment regimen as prescribed
- Follows recommended diet
- Monitors blood glucose using correct testing procedures
- Seeks health care if blood glucose levels fluctuate outside of recommended parameters
- Meets recommended activity levels
- Follows prescribed drug regimen
- Reaches and maintains optimum body weight
- Problem solves about barriers to self-management
When a patient who has had reasonably controlled blood glucose levels in the hospital develops an unexpected rise in blood glucose values, check for ??
wound infection.
Hyperglycemia often occurs before a ?.
Fever
S/s for hyperglycemia
Skin: warm, moist
Dehydration: present
Resp: rapid deep kussmaul type; acetone (fruity breath)
Mental status: varies from alert to stuporous, obtunded, or frank coma
s/s: none specific to DKA, acidosis, hypercapnia, abd cramps, nausea and vomiting. Dehydration, decreased neck vein filling, orthostatic hypotension, tachycardia, and poor skin turgor.
Glucose: 250 or above
Urine blood or ketones: positive (present)
What ? leads to osmotic diuresis with dehydration and electrolyte loss.-DKA
Hyperglycemia