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Final- Diabetes (Chapter 20)
Terms in this set (50)
What is the rate of diabetes in America?
It is rapidly increasing. 10.2% of American adults have it (24 million), and 25% are unaware.
What cause of death is diabetes?
6th leading cause of death
What can diabetes contribute to?
Can contribute to heart disease or kidney disease. Much damage can occur even before symptoms.
What is diabetes?
This is a metabolic disorder characterized by elevated blood glucose concentrations and disordered insulin metabolism
What are the two insulin problems that come with diabetes?
You either are unable to produce sufficient insulin or your body can not use insulin effectively... you can have both
What does having diabetes result in?
Impairments resulting in defective glucose uptake and utilization in muscle and adipose cells and unrestrained glucose production in liver. This results in hyperglycemia (elevated blood glucose).
What are 4 classic symptoms of diabetes?
Polyuria- excessive urine production
Polydipsia- excessive thirst
Glycosuria- Glucose in urine
Polyphagia- Excessive appetite or food intake
What are other symptoms of diabetes?
Blurred vision- eye tissue exposed to hyperosmolar fluid
Increased infections- weakened immune response and decreased blood circulation
Loss of weight- nutrient depletion
Constant tiredness- altered energy metabolism, dehydration, or other effects
How do you diagnose diabetes?
It is primarily based on plasma glucose levels.
When taken at random times of the day (non-fasting) if there is 200 mg/dL or higher, and classic symptoms, then diagnoses with diabetes.
If fasting glucose is greater than 126 mg/dL (after at least 8 hours of fasting) you are diagnosed.
If your plasma glucose measure after 2 hours of 75 gram glucose load is 200 mg/dL or higher you are diagnosed.
How many cases of diabetes is type 1?
5-10% of cases
What is type 1 diabetes?
This is usually caused by an autoimmune destruction of the pancreatic beta cells, which produce and secrete insulin, so insulin must be supplied by injections. (NEED INSULIN THERAPY). Inherited or environmental. And commonly occurs in children or adolescents.
What is usually the first sign of type 1 diabetes?
Ketosis- build up of acid due to ketone bodies
What is type 2 diabetes?
This is often asymptomatic. Some insulin is produced but your body resist insulin and beta cells get exhausted. Becoming increasingly prevalent in children.
What increases the risk of type 2 diabetes?
What are acute complications of diabetes?
Insulin deficiencies can cause significant disturbances in energy metabolism, and severe hyperglycemia can lead to dehydration and electrolyte imbalances. Treated diabetes, hypoglycemia is a possible complication of inappropriate disease management.
Examples are ketoacidosis, hypoglycemia, and hyperosmolar hyperglycemic state
What is ketoacidosis?
This is a sever lack of insulin. This includes Ketosis ( acetone breath- fruity breath), acidosis ( hyperventilation- trying to get rid of carbon dioxide), and hyperglycemia (polyuria -sig fluid loss lowering blood volume and blood pressure) and is often the first sign of type 1 diabetes.
What might cause ketoacidosis?
Inappropriate diabetes treatment (missing insulin), illness or infection, alcohol abuse, or other physiological stressors. This can develop quickly.
What is hypoglycemia in regards to type 1 diabetes?
This is low blood glucose. This is the most frequent complication of type 1 diabetes and may occur in type 2. This is due to inappropriate management rather than the disease itself. It is also usually caused by excessive insulin or anti diabetic drugs, prolonged exercise, skipped or delayed meals, alcohol without food.
What is hyperosmolar hyperglycemic state?
This is a condition of severe hyperglycemia and dehydration that develops in the absence of significant ketosis.
Hyperglycemia develops in poorly controlled diabetes which leads to polyuria, leading to fluid loss, electrolyte imbalance, and blood volume depletion. Unfortunately they can't notice thirst and do not replace the fluids.
The dehydration then rises the blood sugar to >600-1000 mg/dL
Develops over time
How do you treat hyperosmolar hyperglycemic state?
what are chronic complications of diabetes?
Large blood vessel damage
Small blood vessel damage
What are long term complications of large blood vessels due to diabetes?
The damage caused by diabetes accelerates the development of atherosclerosis in the arteries of the heart, brain, and limbs. CVD is leading cause of death in diabetes patients.
Also, there is also impaired circulation in limbs, causing pain when walking.
Reduced blood flow to limbs can also contribute to foot ulcers which can even lead to gangrene (tissue death)
What are long term complications of small blood vessels due to diabetes?
The primary conditions are of the eye and kidneys. Nephropathy is damage to the kidneys specialized capillaries preventing adequate blood filtration, resulting in abnormal protein loss in urine.
Retinopathy, the weakened capillaries of the retina leak fluid, lipids, or blood, causing local edema or hemorrhaging. The defective blood flow leads to damage and scaring within retinal tissue.
General neuropathy (nerve damage)
What are symptoms of neuropathy that results from diabetes?
This nerve damage depends on the severity and duration of hyperglycemia.
Symptoms vary but may include pain or burning in legs and feet,
weakness of arms and legs,
numbing and tingling,
foot ulcers go unnoticed,
disturbances in bladder and bowel function,
delayed emptying of stomach.
What is treatment for type 1 diabetes?
Insulin therapy, life long treatment
What is treatment for type 2 diabetes?
Oral medications or insulin
Life long therapy
What are over all treatment goals of diabetes?
You want to lower and maintain blood glucose levels within desired range
Other goals include maintaining healthy blood lipid concentrations, controlling blood pressure, and weight management.
How can you evaluate your diabetes treatment?
Treatment is largely evaluated by monitoring glucose levels using home monitoring device. Ideally, patients with type 1 diabetes should test at least 3 times a day
Healthcare providers periodically evaluate long term glycemic control by measuring HbA1c levels. This reflects glycemic control over two or three months.
Also, routine blood pressure checks, lipid screening, urinary protein screening, and ketone testing.
What are body weight concerns for someone with type 1 diabetes?
These people are usually thin when newly diagnosed but gain weight due to insulin therapy
What ar body weight concerns for someone with type 2 diabetes?
Usually overweight when newly diagnosed which worsens insulin resistance so weight loss is beneficial.
What are nutrient recommendations of someone with diabetes?
Carbs- the more grams of carbs, the higher the glycemic response. You want high fiber/ whole grain diet.
Fiber- same as general population (says high because usually doesn't get enough)
Do NOT want excess sugar
Protein- 15-20% of daily calories
Fat- saturated fat is less than 7% of total calories
cholesterol is <200 mg/day
2 or more servings of fish per day
Lower alcohol consumption
Micronutrients same as general population
What are meal planning strategies for someone with diabetes?
Carb counting because this is simpler and more flexible than other methods. A person is given a daily carb allowance and divides it into meals and snacks.
What is an alternative meal planning strategy other than carb counting for a diabetic?
Exchange list- This is more complex and difficult to learn. It sorts foods according to their carbs, fats, and proteins, and each food in groups have similar macronutrients and energy content.
Who uses insulin therapy?
This is for those who can not produce enough insulin such as those with type 1 diabetes. Sometimes people with type 2 take insulin but not always.
How is insulin delivered?
Sub-q injections with syringe
What is the insulin regimen for someone with type 1 diabetes?
Diabetes is best managed by intensive insulin therapy. They have multiple daily injections of several types of insulin or use an insulin pump.
What is the insulin regimen for someone with type 2 diabetes?
30% of these cases need insulin. As the disease progresses, pancreatic function worsens, and many individuals require insulin. Some people might treat with insulin alone and some with oral medications as well.
What is the most common complication of insulin therapy?
Hypoglycemia. It most often results from intensive insulin therapy because the attempt to attain near normal blood glucose levels increase risk of over treatment.
How is hypoglycemia corrected after over treatment with insulin?
Can be corrected with the immediate intake of glucose or a carb containing food. Usually 15-20 grams of carbs can relieve this in about 15 minutes.
What are examples of 15 grams of carbs?
2-3 glucose tablets
4 tsp table sugar
1 tbs honey
15 small jelly beans
.5 cup unsweetened grade juice
.5 cup canned orange juice
How can anti diabetic drugs help treat diabetes?
Treatment of type 2 diabetes often requires the use of oral medication. The modes of actions include:
Improves insulin secretion
Suppresses glucagon secretion
Decreases insulin resistance
Delay carb digestion and absorption
How does physical activity help manage diabetes?
Regular physical activity can improve glycemic control considerably and is therefore a central feature of diabetes management, for type 2. It can also improve insulin sensitivity, improve lipid levels, lower blood pressure, and promote weight loss. But for type 2 a medical evaluation is needed before starting exercise.
What should people taking insulin do when working out?
Do not take insulin immediately before exercise, might need to reduce it, and check blood sugar before and after activity
What does pregnancy do to diabetes?
Due to hormonal changes, pregnancy increases insulin resistance and the body's need for insulin so glycemic control is more difficult.
What percent of pregnant people get gestational diabetes?
What can uncontrolled gestational diabetes lead to?
Birth defects, miscarriages, and fetal deaths. Newborns can suffer from metabolic problems and respiratory problems. These babies are also larger and require a C section.
What do women with diabetes need to do when they expect to get pregnant?
A person with diabetes needs to maintain glycemic control at conception and during the first trimester to reduce risks of birth defects, during the 2nd and 3rd trimester it reduces the risk of large babies and infant mortality.
They may need to restrict carbs to 40-45% total calories
Space carbs out through day
May need insulin
What women are more at risk for gestational diabetes?
Those with family history of diabetes
Those who are obese
Certain ethnic groups such as blacks, asians, hispanics, native americans, and pacific islanders
Or those who have previously delivered babies over 9 pounds
What is metabolic syndrome?
This is a cluster of metabolic abnormalities that are associated with increased risk of developing CVD and type 2 diabetes. Insulin resistance is a central feature. It is diagnoses when you have three of the following:
Hypertriglyceridemia, reduced HDLs, and hypertension
Risk increases with age and high prevalence of obesity and central abdominal fat.
How do you treat metabolic syndrome?
Correct abnormalities that increase CVD and diabetes risk. Weight loss and physical activity can help improve insulin resistance, blood pressure, and blood lipid levels. (dietary and lifestyle changes). Also by reducing sugar and refined grains. If these are not successful then medications are used.