50 terms

Diabetezzz

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Diabetes
a disorder of carbohydrate, protein and fat metabolism
Majority of cases are which type of diabetes?
Type 1 and Type 2
Type 1
deficiency of insulin
younger people
ketones in urine
common signs of type 1
polydipsia, polyphagia, and polyuria
Type 2
older people
overweight/obese
may be asymptomatic
gradual symptoms; may have complications upon diagnosis (eye, kidney, heart problems)
Prediabetes
precursor for Type 2 and at risk for cardiovascular disease
Treatment for prediabetes
metformin or lifestyle changes
Gestational Diabetes
abnormal values between 2nd and 3rd trimester
complications during pregnancy
birth defects for the baby
can affect mother or baby
Disease related diabetes
Cushing's syndrome, cystic fibrosis, and after organ transplant
Medication related diabetes
corticosteroids, atypical antipsychotics, thiazide diuretics
Without major changes, as many as ___ in ____ US adults could have diabetes by _____
1 in 3
2050
Increase the blood glucose
carbohydrate intake
increased hepatic glucose production
decreased insulin secretion
and decreased peripheral glucose intake
Criteria for testing for diabetes or prediabetes in asymptomatic adults
BMI greater then or equal to 25 with one or more of these risk factors:
-first degree relative with diabetes
-high-risk race or ethnicity
-history of CVD
-hypertension (greater than 140/90 mmHg or on
-therapy for hypertension)
-HDL cholesterol level less than 35 mg/dL and or a triglyceride level more than 250 mg/dL
-women with polycystic ovary syndrome
-physical inactivity
-other clinical conditions associated with insulin resistance
Patients with prediabetes should be tested how often?
yearly
Women who were diagnosed with GDM should have lifelong testing how often?
at least every 3 years
For all other "non-special" patients, testing should begin at what age?
45
If diabetes results are normal testing should be repeated how often?
a minimum of 3 year intervals
Symptoms of diabetes
lethargy
stupor
weight loss
vomiting
smell of acetone in breath
Kussmaul breathing (hyperventilation)
Nausea
abdominal pain
blurred vision
glycosuria
3 P's
Microvascular complications
Retinopathy
Neuropathy (tingling of hands and feet)
Nephropathy (urine/blood test; early detection of kidney disease)
Macrovascular complications
atherosclerosis
peripheral vascular disease
cardiovascular disease (diabetics 2-4 times more likely)
cerebrovascular disease
Fasting Plasma Glucose
no caloric intake for at lease 8 hours
more than or equal to 126 mg/dL
commonly chosen
Oral glucose tolerance test
Given 75g of oral glucose solution, and then tested over 2 hour period
more than or equal 200 mg/dL
Random plasma glucose
classic symptoms of hyperglycemia (3 P's or unexplained weight loss)
more than or equal to 200 mg/dL
A1C
looks at glucose over a long period of time
more than or equal to 6.5%
FPG (pre diabetes)
100-125 mg/dL
OGTT (pre diabetes)
140-199 mg/dL (indicates glucose tolerance)
A1C (pre diabetes)
5.7-6.4% (indicates glucose tolerance)
Treatment goals for non-pregnant adults with diabetes
Hemoglobin A1C less than 7%
FPG 80-130 mg/dL
postprandial less than 80 mg/dL BMI less than 25
BP less than 140/90 mmHg
immunizations (influenza, pneumococcal HepB)
Exclusions of Self Treatment
-uncontrolled diabetes
-concurrent conditions or medications that may alter glucose levels
-no visit to a primary care in the last year
-history of severe hypo/hyperglycemia
-nonadherence to provider-recommended medications
-pregnancy
-perception that prescription medications are ineffective
-unknown status of other comorbid conditions
-use of dietary supplements without provider's knowledge or without achieving set goals
Goals of treatment
-glycemic control
-managing comorbid conditions
-prevent the development and progression of long-term complications
-devise individualized diabetes care plan
Diabetes Care Plan
1. assessment of patient's knowledge
2. healthy eating
3. physical activity
4. self-monitoring
5. safe and effective use of medication drug therapy
6. patient self-management education
7. assessment of adherence
8. Follow-up
Medication Nutrition Therapy
-macronutrients: patient preference
-non-caloric sweeteners/sugar-free products
-alcohol consumption can enhance the effects of insulin that lead to diabetes
--1 drink a day for women
--2 drinks a day for men
-physical activity
-smoking cessation (nicotine can worsen cardiovascular complications
Nonpharmacologic therapy for diabetes
medical nutrition therapy and monitoring of glycemic control
Diabetic readers
calibrate, digital display, windows and memory recall
Advantages of self monitoring blood glucose
immediate feedback for the patient
recognize glucose patterns
prevent or detect hypoglycemia
evaluate glycemic response to foods, exercise, or medications
aid practitioners to make changes to diabetes care plan
Type 1 self monitoring
receive insulin and has to check blood glucose at least 3 times a day
Type 2 self-monitoring
sometimes receives insulin; no required amount of times but checking blood glucose 2 times a day is recommended
Testing for ketones
Type 1
glucose levels elevate, fat and protein begins to be used, producing ketones
Ketostix reagent strips and ketocare Ketone teststrips
estimated average glucose formula
28.7*A1C-46.7
OTC A1C Kits
A1C Now and AccuBase A1C Test Kit
OTC Insulin
Humulin N, Humulin R, Humulin 730, Novolin and Reliol
Insulin
-stimulates glucose uptake and storage as glycogen in muscles and the liver and fatty acid, and triglyceride synthesis
-decreases hepatic glucose output, lipolysis, and ketone production
-enhances amino acid incorporation into proteins
Side Effects of Insulin Therapy
hypoglycemia
weight gain
lipodystrophy
lipoatrophy (loss of fatty tissue)
Lipohypertrophy (fat accumulation)
Symptoms of low sugar levels
autonomic nervous system response
trembling, shakiness, sweating, anxiety, irritability, pallor, heart palpitations, tingling lips
Treat with 15g of carbs
Level 1 Hypoglycemia
Glucose alert value
less than 70 mg/dL (3.9 mmol/L)
sufficiently low for treatment with fast-acting carbohydrate and dose adjustment of glucose-lowering therapy
Level 2 Hypoglycemia
Clinically significant hypoglycemia
less than 54 mg/dL (3 mmol/L)
sufficiently low to indicate serious, clinically important hypoglycemia
Level 3 Hypoglycemia
severe hypoglycemia
no specific glucose threshold
hypoglycemia associated with severe cognitive impairment requiring external assistance for recovery
Hypoglycemia treatment
3 glucose tablets (5g/tablet)
Retest the glucose level in 15 min.
Repeat as needed
Subcutaneous Insulin Injection sites
in order of decreasing absorption
abdomen
upper arm
lateral thighs
superior of buttocks
Whatever spot picked, have to stick with that spot.
Do not inject near the navel.
Insulin subcutaneous self-injection technique
pinch the skin
insert needle at 90 degree angle (45 degree if small)
leave needle in skin, release skin, and leave for at least 5-10 sec to make sure insulin is completely delivered