Diabetes

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Author:
rwilliams144
ID:
185802
Filename:
Diabetes
Updated:
2012-11-27 23:14:20
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Diabetes
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Description:
Med Surg
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  1. what is diabetes?
    • disturbance in metabolism of 
    •  glucose
    •  protein
    •  fat
    • leads to vascular complications and neurological
    •  arthrosclerosis
    •  kidney disease
    •  blindness
    •  
  2. what is insulin?
    • hormone that decreases blood glucose
    •  acts on:
    •   CHO-- glucose
    •    stimulates the active transport of glucose into the cells
    •    regulates glucose metabolism
    •     high levels of insulin inhibit conversion of glycogen to glucose
    •     low levels of insulin stimulate conversion of glycogen to glucose-- increasing blood glucose levels 
  3. fats
    • promotes fatty acid synthesis and the conversion of fatty acids into fat
    • inhibits the breakdown of fat
    • low levels of insulin cause fat to break down
    •  fatty acids are stored in the live
    •  increases production of lipoproteins
    •  increases rish of CVD
  4. Proteins
    • inhibit conversion of protein to glucose
    • enchances protein synthesis 
    • low levels of insulin allows large amts of amino acids to circlulate in the blood
    •   increases risk of gout
  5. Counter hormomes
    • hormones that increase blood glucose 
    •  glucagon
    •  glucocorticoids
    •  growth hormone
  6. TYPE 1- auto immune
    • Insulin dependent
    •  no production of insulin
    •   honeymoon period- shortly after diagnosis and last until complete destruction of beta cells ability to produce insulin is gone. 
    •  INJECTION OF EXOGENOUS INSULIN NEEDED
    • Age of onset
    •  early
    •  juvenile
    • maybe occur middle and older age
    • Cause- etiology
    •  auto immine disease-- cell mediated destruction of beta cells of pancreas
    •  onset- sudden and severe
    • risk factors
    •  genetic predispostion
    •  
  7. TYPE 2- all other forms
    • Insulin production
    •  insulin resistant
    •  hyperinsuleineamia/ decreased prod of insulin
    • Age of onset
    •  after 40s 
    •  children
    •  adolescents
    • EXOGENOUS INSULIN maybe
    • Risk factors
    •  central obesity
    •  lack of activity
    •  family genes
    •  over 40
    •  hist of gest dia
    •  african americans
    •  native americans 
    •  having baby over 10lbs
    • presence of 
    •   acanthosis nigricans 
    •    thickening of the skin and skin folds- darkening
    •   cutaneous papillomas- skin tags
  8. Metabolic syndrome- insulin resistance syndrome
    • the body cells resits the action of insulin, the usual consequence is an increased prod of insulin to override the resistance at the cell level
    • Hyperinsulineamia
    •  excess insulin in body- large role in health issues
  9. Metabolic Syndrome
    • obesity BMI > 25
    • Central obesity
    •  waist >40 inches men >35 women
    •  waist to hip >1.0 men > .8 women
    • impaired glucose tolerance
    • high serum insulin
    • low HDL
    • high LDL
    • low grade inflammation of endothelial tissue
    • hypertension- 130/85
    • atherosclerosis- heart disease
    • gout
    • polycystic ovary disease
  10. who does diabetes affect?
    • 23.6 million- 7.8%
    •  6 million undiagnosed
    • 57 million people have pre diabetes
    • 90% type 2
    • More women
    •  AA, hispanic, NA
  11. Screening 
    • >40 
    • obesity
    • family history
    • high risk ethnic group
    • hist of Gest diabetes
    • baby weighning over 10lbs when delivered
    • HDLS- <35mg/dl
    • triglyceride level- >250 mg/dl
  12. Diabetes diag tests-- 2 separate occasions
    • Fasting blood glucose- FBG
    •  126 mg/dl or diagnostic
    •  normal- 70-100 mg/dl
    •  no caloric intake for 8 hrs
    • Random glucose level >200 mg/dl with symptoms
    •  polydipsia- thirst
    •  polyphagia- urination
    •  wt loss- excessive wt loss, no energy, melting away
  13. Oral glucose tolerance test-- OGTT
    • diet of 150-300 gm of CHO xz 3days
    • fast p MN
    • 75 grams CHO load- glucola
    • Monitor BG levels
    •  30 min, 1 hr, 2hr(most common), 3 hr, 4hr, 5hr(reactive hypoglycemia)
    • can't smoke, eat, drink during test
    • must rest
    • 2 hr- > 200mg/dl
  14. Glycosylated hemoglobin
    HbA1c
    • measures BG over a period of time
    •  RBC lifespan- 120 days
    •  glucose attaches to hemoglobin
    •  result shows average blood glucose level over 3-4mths.
    • montior adherence to treatment
    • motivator
  15. Fructosamine levels
    • glycated serum protein- glycated albumin
    •  reflects glucose levels over several weeks
    •  if pt fruc is increased, then the pt average glucose over the last 2-3 weeks has been eleveated. 
    •  the higher the fruct concentration the higher avg BGL
  16. Impaired Fasting Glucose
    IGT- Impaired Glucose Tolerance
    Bordeline diabetes- Prediabetes
    • IFG- 100-125
    • IGT
    •  2 hr OGTT bt 140-199
    • associated with increased risk of macrovascular disease
    • treatment
    •  wt loss
    •  increase physical act
    •  same as type2
  17. Diabetes symptoms- classic
    • Polydipsia
    • Polyuria
    • Polyphagia- famine in state of plenty
    • unexplaned wt loss
  18. type 2 complications
    complication of the disease may be first symption
  19. Diabetes symptoms
    • infection
    • delayed wound healing
    • vascular changes
    •  retinal damage
    •  HPT
    •  PVD- per vas disease
    •  MI
    •  Kidney damage
    •  
  20. Diabetes management ind
    • Diabetes control and complications trial
    •  tight control
    •   <7.2% HgbA1c or BG <155 mg/dl avg
    •  self monitoring blood glucose SMBG
    •   normal- always <140(even after meals)
    •   acceptable- max 180 to prevent exceding renal threshold and dehydration
    • Prevent complications up to 75%
    •  eyes
    •  kidneys
    •  Nerv Sys
  21. ADA
    • <7% HgBa1c
    • BP <130/80
    • total CHO- <200 mg/dl
    • LDL- <100
    • HDL- >50
    • Tri- <150 
  22. Diabetes Management
    • diet
    • exercise
    • medication
    •  insulin
    •  oral hypoglycemics
  23. TYPE 1 treatment/management
    • insulin
    • diet 
    • exercise

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