Type 2 Diabetes Mellitus

Question 1

What % of Type 2 DM cases are r/t obesity?

Answer 1

~ 80%

Question 2

If both parents are type 2 DM, theres a 40% chance, person will be… Hint: 4

Answer 2

1) insulin resistance
2) deranged secretion of insulin
3) increased glucose production
4) beta cells become exhausted… apoptosis

Question 3

List 10 risk factors of developing type 2 DM

Answer 3

1) family Hx
2) obesity
3) ethnicity
4) age
5) gestational diabetes / delivery of babies > 9 lbs
6) HTN
7) metabolic syndrome
8) polycystic ovary syndrome (PCOS)
9) smoking & alcohol
10) corticosteroids

Question 4

What initially happens in type 2 DM?

Answer 4

Initially there is increased insulin secretion by beta cells to bring down glucose

Question 5

After initial increase of insulin in type 2 DM what happens?

Answer 5

1) insulin is NOT effective & cannot bring down glucose
2) since insulin levels are high the body increases glucose levels
3) beta cells become exhausted (lose 50% of function) by trying to compensate for insulin resistance

Question 6

Classic features of metabolic syndrome Hint: 5

Answer 6

1) increased waist circumference or belly fat
2) high triglycerides
3) elevated BP (HTN)
4) high blood sugar (hyperglycemia)
5) a low HDL (good cholesterol)

Question 7

List 7 clinical manifestations of type 2 DM

Answer 7

1) polydipsia
2) polyuria
3) polyphagia
4) fatigue
5) weakness
6) weight loss
7) visual disturbances

Question 8

What causes polydipsia in type 2 DM?

Answer 8

hyperglycemia causes ICF shifts

Question 9

What causes polyuria in type 2 DM?

Answer 9

excessive diuresis

Question 10

What causes polyphagia in type 2 DM?

Answer 10

Cell starvation from lack of glucose

Question 11

List 4 reasons obesity causes insulin resistance

Answer 11

1) causes ↑ in adipose & free fatty acids
2) induces inflammation & release of associated inflammatory mediators
3) ↑ stress on pancreatic B cells as insulin is ↑
4) results in liver ↑ glucose in the blood (impaired suppression)

Question 12

What is Acanthosis Nigricans?

Answer 12

*Sign of insulin resistance
Skin becomes darker & thicker, often seen around neck or armpits

Question 13

How do elevated blood glucose levels affect blood vessels?

Answer 13

they can damage BV leading to development of atherosclerosis, a major risk factor of CV disease

Question 14

What do insulin levels look like in patients with insulin resistance?

Answer 14

Chronically elevated insulin levels

Question 15

How does no exercise increase insulin resistance?

Answer 15

Those who do not exercise have decreased intracellular enzymes (i.e. pyruvic acid)

Question 16

How does exercise help prevent insulin resistance? Hint: 6

Answer 16

1) ↑ mitochondrial enzymes
2) ↑ insulin sensitivity
3) TG get broken into FFA to use for fuel
4) ↓ BS, ↓ insulin
5) ↑ glucagon
6) causes uptake of glucose from circulation

Question 17

What can high glycemic diet lead to…

Answer 17

Insulin resistance; several other disease processes

Question 18

What does smoking induce & lead to?

Answer 18

1) induces inflammation
2) leads to endothelial dysfunction & ↑ risk of CAD, CVA, & PAD

Question 19

Diagnosis of diabetes Hint: 4

Answer 19

1) fasting BG > 126 (2 readings)
2) a 2 hr plasma glucose during an oral glucose tolerance test (OGTT) > 200
3) Random blood glucose > 200 w/ hyperglycemic Sx
4) Hgb A1C > 6.5% (2 readings)

Question 20

What does Hgb A1C measure?

Answer 20

Reflects amount of glycated Hgb (Hgb bound to glucose) in RBCs, providing insight into long-term blood sugar levels

Question 21

What is glycated Hgb A1C used for?

Answer 21

Used to Dx or monitor diabetes

Question 22

How does glycated Hgb A1C work?

Answer 22

1) glucose does not normally go into RBC but membrane is very permeable
2) when glucose level is chronically high, it will move into RBC
3) once glucose is in RBC, it cannot leave

Question 23

Hgb A1C measures amount of glucose over _____ days

Answer 23

120

Question 24

List common cause of hypoglycemia Hint: 7

Answer 24

1) excessive exercise
2) alcohol
3) poor food intake
4) too much insulin
5) stress
6) surgery
7) medications

Question 25

How do the hypothalamus & portal vein play a role in hypoglycemia?

Answer 25

Hypothalamus & portal vein sense a decreased glucose & in response sends signal to adrenal gland, pancreas, & liver

Question 26

What is responsible for most of the S&S of hypoglycemia?

Answer 26

Release of epinephrine & glucagon that causes activation of the SNS

Question 27

What happens as hypoglycemia continues...

Answer 27

epinephrine & glucagon promote glycogenolysis & gluconeogenesis in the liver

Question 28

Blood glucose level considered MILD hypoglycemia

Answer 28

100-55 mg/dL

Question 29

List 8 Sx of MILD hypoglycemia

Answer 29

1) fatigue 2) sweating 3) hunger 4) dizziness 5) rapid HR 6) anxiety 7) irritability 8) shakiness

Question 30

Blood glucose level considered SEVERE hypoglycemia

Answer 30

< 55 mg/dL

Question 31

List 7 Sx of SEVERE hypoglycemia

Answer 31

1) blurred vision 2) impaired thinking 3) confusion 4) palpitations 5) loss of consciousness 6) seizures 7) coma

Question 32

What is a nrusing intervention for an awake patient experiencing hypoglycemia?

Answer 32

Give them juice & something to eat

Question 33

What is a nursing intervention for a patient experiencing hypoglycemia that is not awake?

Answer 33

Give IV D50, sublingual glucose tablet

Question 34

How should you Tx potential hypoglycemic episode in emergency situations? Why?

Answer 34

**Better to treat with sugar** Blood sugar level may be unknown so giving sugar can help hypoglycemia w/o significantly harming those w/ elevated glucose

Question 35

Give 2 examples of high-fat foods that should NOT be used to Tx hypoglycemia

Answer 35

1) peanut butter 2) milk

Question 36

List 2 types of diabetic neuropathy

Answer 36

1) somatic neuropathy 2) autonomic neuropathy

Question 37

Somatic neuropathy

Answer 37

-Diminished perception: vibration, pain, temperature -Hypersensitivity: light touch; occasionally severe "burning" pain

Question 38

Autonomic neuropathy

Answer 38

1) defects in vasomotor & cardiac responses 2) urinary retention 3) impaired motility of the GI tract 4) sexual dysfunction

Question 39

What causes neuropathy?

Answer 39

high glucose levels can damage peripheral nerve endings

Question 40

List 3 things neuropathy can lead to

Answer 40

1) decreased sensation in extremities (i.e. hands/ feet) 2) increased risk of injury & infection (pt may not feel cuts/ injuries) 3) balance issues due to loss of sensation & proprioception

Question 41

Hyperosmolar hyperglycemic syndrome (HHS) is only seen in ____ DM

Answer 41

Type 2 DM

Question 42

HHS is characterized by...

Answer 42

severe hyperglycemia (>600), hyperosmolality, & dehydration caused by insulin resistance **Cells are not absorbing glucose**

Question 43

How does HHS compare/ differ from DKA?

Answer 43

1) ECF increases & there is intracellular dehydration 2) B/c there is some insulin there is NO ketone formation in HHS unlike DKA

Question 44

How does HHS develop?

Answer 44

Over several days to weeks

Question 45

List 5 causes of HHS

Answer 45

1) infection 2) non-compliance with diet or meds 3) undiagnosed 4) substance abuse 5) alcohol

Question 46

List 10 Sx of HHS

Answer 46

1) extreme glucose levels 2) rapid/ thread pulse 3) hypotension 4) profound dehydration 5) polydipsia 6) polyuria 7) confusion 8) disorientation 9) possible seizure 10) coma

Question 47

List 3 Tx options for HHS

Answer 47

1) hydration (given first) 2) IV insulin 3) electrolyte replacement

Question 48

Guidelines for hydrating as Tx in HHS

Answer 48

1) Give normal saline to correct dehydration & restore electrolyte balance 2) rehydration helps move glucose back into cells & corrects K+ imbalances

Question 49

How does insulin help in treating HHS?

Answer 49

helps regulate glucose & prevent further complications, but hydration must come first to stabilize patient

Question 50

What electrolytes are replaced in Tx of HHS?

Answer 50

1) potassium 2) magnesium

Question 51

Why is it important to monitor potassium levels in HHS?

Answer 51

Rehydration & insulin therapy can lead to K+ shifts back into the cells, potentially causing hypokalemia

Question 52

What is the importance of monitoring magnesium levels during Tx of HHS?

Answer 52

Magnesium levels can drop during rehydration

Question 53

Question: Why is it necessary for a person to maintain blood glucose no lower than 70? **Hint: 4**

Answer 53

1) To improve insulin secretion 2) allow beta cells to have periods of rest 3) maintain a continuous supply of glucose for energy 4) to avoid too much glucagon from being broken down in the liver