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Sem 1 Theory > Unit 4: Glucose Regulation > Flashcards

Unit 4: Glucose Regulation Flashcards

1
Q

What is glucose regulation?

A

The process of maintaining optimal blood glucose levels

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2
Q

What is glucose regulation achieved through?

A

A delicate balance between:
1. nutrient intake
2. hormonal signaling
3. glucose uptake by the cell

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3
Q

What happens to glucose when it enters the cell?

A

When glucose enters the cell it is oxidized through cellular respiration into adenosine triphosphate (ATP)

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4
Q

How is the efficiency of glucose metabolism reflected?

A

The efficiency of glucose metabolism is reflected in circulating blood glucose levels.

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5
Q

What is the definition of glycogen?

A

Glycogen is the major form of stored glucose, primarily in the liver and muscle cells.

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6
Q

What is the definition of glycogenolysis?

A

Glycogenolysis refers to the breakdown of glycogen to glucose.

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7
Q

What is the definition of gluconeogenesis?

A

Gluconeogenesis refers to the process of producing glucose from non-carbohydrate sources.

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8
Q

What is the scope of glucose regulation?

A

Normal/optimal regulation to impaired regulation throughout the lifespan.

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9
Q

What are the normal range of blood glucose (BG) levels?

A

Normal blood glucose levels range between:
1.) 70 and 99 mg/dL in the fasting state
2.) 100 and 140 mg/dL in the 2 hour postprandial state

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10
Q

What is euglycemia?

A

The condition of having normal concentration of glucose in the blood

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11
Q

What is impaired glucose regulation?

A

Impaired glucose regulation can be further categorized by the etiology and is reflected in abnormally high or low BG levels.

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12
Q

What is hyperglycemia?

A

Hyperglycemia is a state of elevated BG levels, generally defined as greater than 100 mg/dL in the fasting state or greater than 140 mg/dL 2 hours postprandial

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13
Q

What is hypoglycemia?

A

Hypoglycemia is a state of insufficient or low BG levels, defined as less than 70 mg/dL

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14
Q

What is the range for hypoglycemia?

A

BG <70 mg/dL
(severe <50 mg/dL)

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15
Q

What are the signs and symptoms of hypoglycemia?

A
  • Reduced cognition
  • Tremors
  • Diaphoresis
  • Weakness
  • Hunger
  • Headache
  • Irritability
  • Seizure
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16
Q

What is the range for euglycemia?

A

BG 70-140 mg/dL is the normal range
(pre- and post-prandial)

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17
Q

What is the range for hyperglycemia?

A

Post-prandial BG >140 mg/dL
(severe >180 mg/dL)

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18
Q

What are the symptoms of hyperglycemia?

A
  • Polyuria
  • Polydipsia
  • Dehydration
  • Fatigue
  • Fruity odor to breath (ketoacidosis)
  • Kussmaul breathing
  • Weight loss
  • Hunger
  • Poor wound healing
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19
Q

What is require to maintain glucose homeostasis?

A

Hormones are required to maintain glucose homeostasis

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20
Q

What is the only hormone produced that lowers elevated BG levels after carbohydrate intake?

A

Insulin

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21
Q

What are required to raise BG if levels begin to decrease or in anticipation of increased needs?

A

Several counter-regulatory hormones (hormones that oppose the action of other hormones)

E.g., glucagon, cortisol, growth hormone, norepinephrine, and epinephrine

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22
Q

How does insulin work?

A

After the consumption of food, insulin is released in response to rising glucose levels. Insulin facilitates glucose metabolism by binding to insulin receptors on the cell wall, signaling glucose transporter molecules that facilitate glucose entry into the cell. Insulin suppresses glucagon secretion and facilitates glycogen storage.

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23
Q

What is glucagon?

A

Glucagon is one of several counter-regulatory hormones released in response to cellular deficiency of glucose. Glucagon suppresses insulin and stimulates hepatic glucose production (from glycogen), resulting in elevated glucose levels.

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24
Q

What is required if blood glucose and glycogen stores are insufficient or there are stress conditions, or from use of steroid medications?

A

Gluconeogenesis

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25
Q

What are other counter-regulatory hormones released (aside from glucagon)?

A
  • Cortisol
  • Growth hormone
  • Norepinephrine
  • Epinephrine
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26
Q

What is the purpose of counter-regulatory hormones?

A

Counter-regulatory hormones also lead to utilization of glycogen stores, and these hormones are also increased with stress related conditions, both physical (pain, illness, and injury) and emotional, and are therefore often referred to as stress hormones.

27
Q

What are the main populations at risk of impaired glucose regulation?

A
  • Pregnant women
  • Infants
  • Older adults
  • American Indian/Alaskan Natives
  • African Americans
  • Hispanic/Latino
  • Asian Americans
28
Q

Why are pregnant women at risk of impaired glucose regulation?

A

Pregnancy and the associated hormonal changes (specifically hormones produced by the placenta) produce a state of insulin resistance and associated risk for hyperglycemia, especially postprandial hyperglycemia.

All pregnant women are screened for gestational diabetes during the 24-28 week gestational mark, and women with known pre-diabetes or multiple risk factors for type 2 diabetes are screened at the first prenatal visit.

29
Q

Why are infants at risk of impaired glucose regulation?

A

The large for gestational age infant is at high risk for hypoglycemia after birth and the prevalence of neonatal hypoglycemia is also higher among infants whose mothers had diabetes during pregnancy.

Hypoglycemia is generally attributed to neonatal hyperinsulinemia that occurs in response to elevated glucose levels in utero.

The small for gestational age infant and premature infants are at risk of hypoglycemic states because of increased energy needs and insufficient glycogen stores.

30
Q

Why are older adults at risk of impaired glucose regulation?

A

They are greater risk for impaired glucose metabolism and hyperglycemia because of an increase in visceral fat and associated reduction in lean muscle mass, where most glucose is metabolized. Reduction in lean muscle mass is associated with age related reduced insulin production and reduced capacity to regulate and metabolize glucose concentration.

31
Q

Why are certain racial/ethnic groups at risk of impaired glucose regulation?

A

There is a growing trend of increased diabetes prevalence seen in societies that become more modernized, affluent, and westernized and thus more sedentary. An example of this is China.

Ethnic groups, particularly those of northern European descent, have a genetic tendency for the autoimmune form of diabetes.

32
Q

What autoimmune disorders are found in increased frequency among persons with type 1 diabetes?

A
  • Celiac disease – digestion of gluten leads to damage of the small intestines.
  • Adrenal insufficiency (Addison’s Disease) – adrenal glands do not produce enough of the hormone cortisol and sometimes not enough aldosterone.
  • Pernicious anemia – a deficiency in the production of red blood cells through the lack of vitamin B12.
  • Vitiligo - long term skin disorder with people losing the pigment in their skin in patches.
  • Autoimmune thyroid disorders - immune system turns against its own tissue, sometimes turning against the thyroid gland.
33
Q

What are the genetic risk factors of impaired glucose regulation?

A

Currently there are at least 40 known genetic markers, including HLA (human leukocyte antigen) genes, associated with the risk of diabetes. Insulin resistance is the common feature associated with metabolic syndrome and type 2 diabetes. Persons with a family history of type 2 diabetes, obesity, or risk factors associated with metabolic syndrome are at increased risk of insulin resistance and type 2 diabetes.

34
Q

What are lifestyle risk factors of impaired glucose regulation?

A

One of these is poor diet with a high intake of saturated and trans-fatty acids (with the excess caloric intake leading to obesity) and a low fiber intake.

A diet high in calories, particularly with carbohydrates also adversely affects glucose metabolism.

Obesity and lack of physical activity also contributes to insulin resistance.

35
Q

What are the risk factors for impaired glucose regulation that are associated with chronic conditions?

A

Diabetes and metabolic syndrome are the most notable conditions associated with impaired glucose regulation. Good nutrition is imperative to combat these.

Malabsorption and the resulting nutrient deficiencies required for cellular metabolism of glucose, including vitamin D deficiency, contribute to insulin resistance.

Glucose regulation is also affected by physiological stress such as traumatic injury, cancer, and surgery.

36
Q

What are the risk factors associated with medications?

A

Many medications used for other health conditions can affect glucose regulation, which can put a person in hyperglycemia or hypoglycemia. Some examples are:
* Insulin
* Oral hypoglycemic agents
* Corticosteroids
* Estrogen
* ACE (angiotensin converting enzymes) inhibitors
* Beta blockers
* Potassium-depleting diuretics
* Bronchodilators
* Antipsychotics
* Many antibiotics

37
Q

What is included in the assessment history for glucose regulation?

A

The history includes:
* Personal medical history (including a list of current medications) – central obesity and diabetes
* Social history
* Family history – central obesity and diabetes
* Review of systems
In each area the nurse considers data consistent with actual or potential problems with glucose regulation.

38
Q

Compare the clinical presentation of hypoglycemia and hyperglycemia

A
39
Q

Individuals in ketoacidosis may display which three symptoms?

A
  1. Polyphagia (excess hunger) – may occur due to cells not receiving adequate glucose
  2. Polydipsia (excess thirst)
  3. Polyuria (excess urination) – due to an osmotic diuresis (when the renal glucose threshold of 180 mg/dL is exceeded, water is pulled along with it)
40
Q

What are some other symptoms to ask about in a history?

A
  • Retinopathy – reduced vision
  • Peripheral neuropathy – reduced sensation or pins-and-needles sensation in the lower extremities.
  • Wounds that do not heal or generalized pain may be suggestive of poor peripheral perfusion.
  • Insulin-resistant individuals and those with type 2 diabetes may experience sleep apnea, which can result in worsening glucose control and chronic fatigue.
  • It is established that people with diabetes are at higher risk of developing depression and are thus screened for depressive symptoms which include:
    ➢ Lack of interest
    ➢ Feelings of sadness or worthlessness
    ➢ Difficulty with sleep
    ➢ Appetite or weight changes
    ➢ Suicidal thoughts
    ➢ Difficulty concentrating
41
Q

Why should the examination always include vital signs and anthropometric measurements such as height and weight?

A

To determine body mass index and waist/hip measurements (to determine waist-to-hip ratio). These measurements assess for hypertension and determine overweight or obesity as well as central obesity which are both associated with insulin resistant states.

42
Q

What are some common physical findings among individuals with long standing states of impaired glucose
metabolism?

A
  • Acanthosis nigricans – a velvety darkening of the skin that is sometimes seen on the posterior neck, axillae, and skin folds of the groin, is a cutaneous
    marker of insulin resistance and a “red flag” for diabetes risk.
  • Skin tags – often seen with insulin resistance, commonly seen on the neck and axillae.
  • Peripheral vascular disease – poor perfusion and chronic wounds. A foot exam includes inspection of skin for blisters, ulcers, skin lesions, nail abnormalities, and excessive callusing. Sensation and motor strength should be assessed to evaluate neuropathy.
  • Retinopathy – assessing visual acuity and inspection of intraocular structures may provide important information associated with retinopathy, although a dilated eye exam provides a more detailed retinal exam.
43
Q

What is blood glucose testing? How are the results interpreted?

What results are indicative of pre-diabetes, indicative of diabetes, or conclusive of diabetes?

A

Measurement of blood glucose is used widely for screening and monitoring glucose metabolism.

A fasting glucose level greater than 100 and less than 126 mg/dL is indicative of pre-diabetes or impaired fasting glucose.

A level of 126 mg/dL or greater on two separate occasions is indicative of diabetes.

A random blood glucose measurement of greater than 200 mg/dL with signs and symptoms of diabetes is conclusive.

44
Q

What is the glucose tolerance test (GTT)?

A

Most sensitive measure of glucose metabolism and can often detect early diabetes.

45
Q

What is glycosylated hemoglobin (also known as HgbA1C)?

A

Laboratory measurement reflecting the average blood glucose reading and estimates glucose control for the prior 3 months. Used for diagnostic screening and monitoring disease management. A reading of 6.5 or higher is indicative of diabetes.

46
Q

What is antibody testing?

A

Assessment of antibodies is used to confirm type 1 diabetes.

The most common test is the glutamic acid decarboxylase antibody test.

A C-peptide test (an indirect measure of
insulin levels) and fasting insulin level may also be measured to help determine the quantity of residual insulin production.

47
Q

What is lipid analysis?

A

The most common lipid assessment includes measurements of:
* Total cholesterol
* High density lipoprotein (HDL) cholesterol
* Triglycerides

From these the low density lipoprotein (LDL) cholesterol is calculated. When glucose levels are high, triglycerides will
also be high. Low HDL cholesterol is seen frequently in insulin-resistant individuals.

48
Q

What are the renal function tests?

A

An early indication of renal disease associated with diabetes is microscopic protein loss in the urine, which is measured by the amount of albumin (microalbuminuria).

Significant loss of albumin into the urine (>300 micrograms/dL) is associated with renal damage and the risk for development of end-stage renal disease.

Two other tests to assess renal function are:
* Blood urea nitrogen
* Creatinine

49
Q

What is the C-Reactive Protein?

A

C-reactive protein (CRP) is made by the body during times of stress or infection. It is often elevated in those with diabetes and it is associated with the inflammatory process of insulin resistance and cardiovascular disease risk. Can also be elevated in those with inflammatory processes such as rheumatoid arthritis.

50
Q

What is the primary prevention for glucose regulation?

A

Emphasizes healthy lifestyle behaviors. General measures include:

  • Maintaining optimal body weight - obesity is directly linked to insulin resistance and the development of diabetes. The increase in diabetes prevalence in recent years directly correlates with the increase in obesity and the decline in regular physical activity.
  • Regular physical activity – exercise dramatically improves insulin resistance and cellular metabolism. The American Diabetes Association recommends moderate-intensity aerobic exercise for at least 150 minutes per week and additional moderate resistive training 2 or 3 days per week for those with diabetes or for diabetes prevention.
  • Eating a balanced diet – avoiding excess caloric intake, sweet drinks, and striving for a healthy weight. ChooseMyPlate.gov is a great resource and these foods contribute to optimal cellular metabolism through provision of vitamin, minerals, fiber and appropriate amounts of macronutrients and kilocalories needed for health. Low sodium guidelines can help lower blood pressure and reduce the risk of cardiovascular disease.
51
Q

What is secondary prevention for glucose regulation?

A

Blood glucose screenings among adults with risk factors for diabetes and among all pregnant women after 24 weeks of gestation is widely recommended. There are no specific recommendations for population-based screening for hypoglycemia.

There are several regular screening measures for early detection of complications:
* HgbA1C at least twice per year
* Annual renal function tests
* Annual dental, foot, and dilated eye examinations
* Thyroid function monitored for type 1 diabetes

52
Q

What are specific collaborative interventions for glucose regulation?

A
  • Patient education for self-management
  • Glucose monitoring
  • Nutrition therapy
  • Pharmacologic agents
53
Q

What is patient education for self-management?

A

Diabetes education is aimed at promoting self-care behaviors for those with diabetes. The diabetic patient can get insight from professionals but ultimately is in charge of their own disease management. The components of self-care behaviors include:
* Diet
* Exercise
* Weight control
* Medication management
* Getting adequate rest
* Maintaining awareness of complications

54
Q

Describe monitoring and managing blood glucose.

A

Involves regular monitoring of BG levels and using this data to determine medication or dietary actions (if needed) to correct the imbalance. There are two approaches:

  • Self-monitoring of blood glucose – done with a standard BG meter or a continuous glucose monitor that can reveal BG concentration changes that occur every 5 minutes.
  • HgbA1C – determines the progression of diabetes. The goal is less than 7.0 for patients with diabetes.
55
Q

How do we correct hypoglycemia?

A

The 15/15 rule is recommended for correcting hypoglycemia:
* 15 g of quick acting carbohydrate – can raise blood glucose levels by approximately 50 mg/dL (see examples in Box 15-1).
* Checked after 15 minutes to determine effectiveness if the patient is severely hypoglycemic, they give 30 g of
quick acting carbohydrate and if the person is unconscious they give either intravenous dextrose or glucagon. Patients may also rebound to very high blood sugar after being hypoglycemic.

56
Q

What is nutrition therapy?

A

Cornerstone of diabetic management. Individualized dietary strategies should be developed in conjunction with
the patient in accordance with his or her needs, readiness, and ability to alter lifestyle.

Education should include
strategies to facilitate weight loss for patients with type 2 diabetes.

Nutrition education for those with type 1 diabetes is focused on knowledge of various nutrient components of each meal (carbs, proteins, fats) to optimize nutrition as related to insulin therapy.

57
Q

American Diabetes Association and the American Association of Clinical Endocrinologists emphasize….

A

an individualized approach to medication therapy for those with diabetes

58
Q

What factors should be considered when creating medication management plans?

A
  • Life expectancy
  • Support system
  • Comorbidities
  • Patient engagement and understanding of the disease
    process
  • Risk for hypoglycemia
  • Disease duration
  • Vascular complications
59
Q

What are oral hypoglycemic agents?

A

Are used in the treatment of type 2 diabetes and help to manage glycemic control by reducing insulin resistance and enhancing insulin secretion.

60
Q

What is insulin replacement?

A

Patients who require insulin replacement need both basal (or long acting) insulin and mealtime (or short-/fast-acting) insulin to achieve euglycemia.

See Table 15-2 Characteristics of various insulin preparations.

61
Q

What are statin agents?

A

Used for the primary prevention of cardiovascular disease (CVD) in all individuals with diabetes ages 40-75 years and an LDL cholesterol of 70-189 mg/dL without any evidence of CVD.

Evidence suggests that statin agents reduce the rate of myocardial infarction, stroke, and death in those with
diabetes.

62
Q

What is now the recommended approach for glucose control?

A

Pattern management based on carbohydrate counting can be effective in stabilizing BG levels with reducing frequency of hypo-and hyperglycemia.

63
Q

What is the typical ratio of insulin?

A
  • Type 1 diabetes requires 1 unit per every 15 g of carbohydrate (1 carb serving).
  • A very active adult or a young child may need as little as 1 unit for every 30 g of carbohydrate
  • An obese, insulin resistant individual with type 2 diabetes may need as much as 1 unit for every 2 or 3g of carbohydrate intake.
64
Q

What are the interrelated concepts for glucose regulation?

A
  • Nutrition
  • Mobility
  • Adherence
  • Culture
  • Family dynamics
  • Perfusion
  • Immunity
  • Sensory perception
  • Tissue integrity
  • Elimination
  • Patient education
  • Hormonal regulation

Sem 1 Theory (12 decks)

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