61 terms

Therapeutics: Hart

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Type I diabetes
absolute insulin deficiency
Type II diabetes
-difficulty at periphery
-impairment at insulin secretion
diabetes
a group of metabolic disorders that's characterized by hyperglycemia
hyperglycemia results when
central component in diabetes
-impairment in insulin secretion
-impairment in insulin action
-impairment of both
impairment at the periphery
-receptor sites may be defected
-available insulin is not able to move glucose from the blood to cells
classic signs of diabetes type I
-polydipsia (excessive thirst)
-polyphasia (excessive hunger)
-polyurea (excessive urination)
type I patient signs
-younger
-may present with ketones
-may present with classical signs
type II patients signs
-older
-overweight/obese
-may be asymptomatic
type I diabetes
mellitus (TIDM)
pre-diabetic patients
-have abnormal values but aren't high enough to be classified as diabetic
-at risk for developing Type II diabetes and cardiovascular disease
there is still some insulin in which type of diabetes
type II, symptoms are gradual
gestational diabetes
diabetes within the 2nd and 3rd trimester
-often time complications during pregnancy
-may be birth defects of baby
at risk diabetes patients (disease related)
-cushion syndrome
-cystic fibrosis
-patients that undergo organ transplants
medications that can cause glucose levels to increase putting patients at risk for diabetes
-corticosteroids
-atypical antipsychotics
-thiazide diuretics
most patients living with diabetes have what type
type II
over 30 million americans
living with diabetes
84 million americans
living with pre-diabetes
diabetes is _____ the leading cause of death in 2015
7th
1 in 3 US adults could have diabetes by
2050
normal pathology of non-diabetics
ingest macromolecules--> insulin breaks glucose down--> glucose moves from the blood to different cells--> energy
diabetes mellitus pathology
-decrease of glucose being taken up at the periphery
-insulin not being secreted
-overproduction of glucose at the liver
criteria for testing for diabetes
1. look at patient's weight (if BMI is greater than 25, greater than 23 for Asian americans)
2. patients who have been diagnosed with pre-diabetes should be tested yearly
3. women with gestational diabetes should have testing every 3 years
4. all other patients need to be tested at age 45 and up (if results are normal, test patients every 3 years)
test bmi and one other thing from the list of criteria
if just bmi, don't test
symptoms are gradual for
type II diabetes
microvascular
-retinopathy
-neuropathy
-nephropathy
neuropathy
tingling in hand or feet
nephropathy
test is done to see if patient is spilling proteins--> early detection of kidney disease
macrovascular
-atherosclerosis
-peripheral vascular disease
-cardiovascular disease
-cerebrovascular disease
diabetics are 2-4 times at risk of developing
stroke or heart attack
fasting plasma glucose test (preferred test)
-greater than or equal to 126, can be considered diabetic
-no caloric intake for at least 8 hours
oral glucose tolerance test (OGTT)
-patient is given 75 g oral glucose solution
-blood is tested over 2 hour period
-if value is greater than or equal to 200, can be considered diabetic
all tests should be
repeated
A1c test
greater than or equal to 6.5, can be diabetic
pre-diabetes tests
-FPG impaired fasting glucose (IFG) (100-125mg/dL)
-OGTT impaired glucose tolerance (IGT) (140-199mg/dL)
-A1c (5.7-6.4%)
ADA goals for non-pregnant with diabetes (age, co-morbidities, hyperglycemic conditions, living situations, life expectancy, other barriers need to be considered)
these values decrease complication with diabetes
-A1c less than 7%
-pre-prandial 80-130mg/dL
-post-prandial less than 180mg/dL
-bmi less than 25
-blood pressure less than 140/90
-immunizations (influenza, pneumococcal, hep B series)
goals of treatment
-glycemic control
-manage co-morbid (hypertension, obesity, hyperlipidemia
-prevent development of longterm complications
-monitor
-non-medication recommendations
MNT medical nutrition therapy
patient lifestyle change
alcohol (fat) can effect insulin leading to hypoglycemia
-men- two 12 oz beers a day
-women- one 5oz a day
alcohol can lead to
hypoglycemia by enhancing the effects of insulin
nicotine can worsen
microvascular complications
diabetic readers have in common
-all are calibrated
-all have digital display window
-all have memory recall
patients monitor insulin at least
twice a day
goals for pre-prandial values
80-130
ketone testing
-test to check for diabetes
average glucose formula
-gives us estimated average glucose value
-eAG = 28.7 x A1C - 46.7
lipaastrophy
loss of fatty tissue
lipohypertraphy
associated with fat accumulation
atrophy
loss of fat
15 g of carbs is needed to treat (then check glucose level after 15 minutes)
glucose alert
glucose alert examples
-milk
-sodas
-fruit juices
-glucose tablets
-glucose gels
injection sites (patient should do the shot around the same place each day)
-abdomen (best place)
-upper(posterior) arm
-thigh (lateral)
-superior part of button
how to self inject
-have patient pinch the area
-go in at 90 degree angle (for thin patients- 45 degree angle)
-once needle is in skin, release pinch
-inject insulin
-wait 5-10 seconds for complete delivery
-remove the needle
largest organ
skin
helps to protect body from harmful agents
skin and appendages
when there's a disruption in the patients skin 4 problem can occur
-injury
-dehydration
-inflammation
-infection
primary function of epidermis
-helps regulate water content
-helps control drug transport
dermis
structural support
-usefull in wound healing
atopic dermatitis (AD)
-chronic
-puritic
-inflammatory skin disorder
AD mostly affects
-infancy
-early childhood
AD known as
the itch that rashes
cause for intense itching
dry skin