Diabetes

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Author:
Michealbledsoe
ID:
212106
Filename:
Diabetes
Updated:
2013-04-08 02:46:06
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Diabetes
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Diabetes
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  1. DKA
    • untreated type 1
    • deficiency of insulin and increase in cortisol
    • BG of 300 or more
    • PH of 7.3¬† or higher from metabolic acidosis
    • bi-carb of 15 or less
    • ketones and glucose present in urine
  2. DKA symptoms
    • Fruity breath
    • confused
    • blurred vision
    • Flushed
    • dry
    • warm
    • increased thirst
    • decreased B/P
    • increased pulse
    • N/V
  3. HHS details
    • type 2
    • BG of 600 or more
    • Normal PH
    • bi-card not a factor
    • no ketones
    • increase urine glucose
  4. HHS symptoms
    • Normal Breath
    • Lethargy
    • seizures
    • extreme thirst from hyperosmolity (from possible dehydration)
    • flushed
    • dry
    • increased thirst
    • warm
    • decreased B/P
    • increased pulse
    • N/V
  5. difference in Labs for DKA and HHS
    • DKA
    • ketones
    • plasma PH 7.3
    • bi-carb 15
    • abnormal levels of sodium, potassium and chloride
    • ketones and glucose in urine

    • HHS
    • no ketones in urine
    • normal plasma PH
    • abnormal levels of sodium, potassium and chloride
  6. HHS causes
    • surgery
    • hyperailmentation
    • kidney dialysis
    • medications
    • dehydration
    • illness
    • trauma
    • surgery
  7. DKA causes
    • surgery
    • trauma
    • illness
    • omitted insulin
    • stress
  8. 4 metabolic problems with DKA
    • Hyperosmolarity
    • (thirst, warm dry skin, poor turgor, squishy eyeballs, dry mucous membranes, weakness, malaise, rapid weak pulse, hypotension)
    • metabolic acidosis
    • extracellular volume depletion (from osmotic diaresis)
    • electrolyte imbalances
  9. DKA treatment
    • Hospitalization
    • Fluid replacement
    • insulin therapy
    • correct electrolyte imbalances
    • fluid balance is big issue
  10. HHS treatment
    • ICU admission
    • establish and maintain ventilation
    • correct fluid and electrolyte imbalances
    • insulin therapy until BG is 250
  11. where is hypoglycemia most often see in
    type 1 diabetics who omit meals or engage in hyperactivity
  12. Hypoglycemia <70 treatment
    • Do not add sugar packets to juice
    • 3 glusoce tabs
    • 1/2 cup of fruit juice
    • 8oz skim milk
    • 5 life savers
    • 3 large marshmellows
    • 3 tbs honey or sugar
  13. Sever hypoglycemia treatment <50
    • 10-15 oral carbs
    • Glucose IV
    • glucagon
  14. Kimmlestiel Wilson syndrome
    • Diabetic nephropathy kidney condition from
    • long-standing diabetes. It affects the network of tiny blood vessels (the
    • microvasculature) in the glomerulus,excessive filtration of protein into the urine
    • (proteinuria), high blood pressure (hypertension), and progressively
    • impaired kidney function. When severe, leads to kidney failure, end-stage renal disease, and the need for chronic kidney
    • dialysis or a kidney transplant
  15. Insulinoma
    • tumor in pancreas that creates overproduction of insulin
    • letheragy
    • blurred vision
    • recurrent headaches
    • neuroglycopenic symptoms
    • sudden wt gain
    • may have to remove pancreas
  16. Carbuncle
    deep infection of skin and tissue underneath
  17. Eruptive xanthomatosis
    seen in young men with type1, from high levels of fat and cholesterol in blood. Firm pea like yellow enlargements of the skin, red halo, possible itching, back of feet, hands, arms, legs and buttocks
  18. call doctor for these blood sugar levels
    • more than 240 and pt cant lower
    • over 340 before a meal when taking meds
  19. how often to check sugars and keytones when sick
    q4
  20. med schedule when sick
    continue taking insulin but do not take oral hypoglycemics if nausea and vomiting presents
  21. how many carbs to eat when sick
    have 45-50 grams of carbs q4 hours
  22. what does asprin do to blood sugar
    lowers it
  23. what do antibiotics do to blood sugar
    lower it in type 2
  24. what do decongestants do to blood sugar
    raise it
  25. when to cut toenails in relation to bathing
    Cut toenails prior to bathing
  26. what color socks should patients wear
    white
  27. when to shop for shoes
    in the afternoon or evening
  28. how much exercise is needed
    30 mins per day five days a week
  29. when to check BG in relation to exercise
    before and after exercise for type 1
  30. what does exercise do to BG
    can raise it initially then HYPOGLYCEMIA can appear 4-10 hours after exercise
  31. Most important part of diabetic diet
    Low fat/low carb
  32. Keytones (what are they and key points)
    • when body breaks down fat in attempt to raise blood sugar (glyconeogensis) keytones will form from fatty deposits.
    • seen in fasting and starvation
    • prolonged vomiting (metabolic acidosis)
    • a diet low in sugars and starches
  33. Glyconeogenesis
    formation of glucose from fats and proteins.
  34. What do Beta cells do
    secrete insulin to assist in movement of glucose across cell membranes into cells decreasing blood sugar levels also prevents break down of glycogen (glycogenolysis)
  35. what does insulin do
    allows cells to absorb glucose (from fats, carbs and proteins)
  36. what does glucose do for the cells
    cells use glucose for energy. bodys main fuel source
  37. what raises low BG
    glucagon
  38. what do alpha cells do
    produce glucagon which decreases the amount of glucose that goes into the cells to keep blood sugar levels (amount of glucose in blood stream) from going to low. activated when BG < 70
  39. what is glycogenolysis
    breakdown of liver glucose (glycogen)(stored glucose) happens when body has not received enough glucose from diet.
  40. where does body store extra glucose
    fat and muscle
  41. ketoacidosis
    when body does not have enough glucose from diet, body will begin to get glucose from stored fat and protein (glyconeogensis) and fatty acids break off and get into blood stream causing ketoacidosis
  42. how soon do blood sugar levels rise after eating
    within minutes and peaks in 3-5 mins baseline 2-3 hours
  43. where is insulin made and how does it enter circulation
    made in pancreas enters circulation thru liver
  44. what is amylin
    glucose regulating hormone released by beta cells
  45. what do delta cells do
    produce somastatin which inhibits both glucagon and insulin production by slowing G.I. motility
  46. two hormones produced by small intestine after we eat
    GLP1 and GDIP
  47. what is the incrintine effect
    insulin release from small intestine to lower blood glucose
  48. 3 early manisfestations of type 2
    • polydipsia
    • polyphasiga
    • polyuria
    • blurred vision
  49. early manisfestations of type 1
    • polydipsia
    • polyphasia
    • polyuria
    • fatigue
    • wt loss
    • glycosuria
  50. type 1 DM
    • juvenile¬†
    • rapid onset
    • insulin dependant
    • patient may have lost all beta cells so body can't produce insulin
    • wt does not matter
  51. type 2 DM
    • adult onset
    • gradual onset
    • insulin resistant (the more food you eat the more insulin your body produces, too much insulin is toxic to cells, to prevent cellular intoxication from insulin cells will down regulate insulin receptors to protect themselves therefore becoming resistant to insulin. the resistance means glucose cant move into cells so stays floating in blood stream)
    • or liver can be producing more glucose than normal
  52. history of mumps or rubella increases risk for type 1 or type 2
    type 1
  53. norm BG
    70-99
  54. prediabetic range
    100-125 fasting
  55. when is gestational diabetes detected
    24-28 weeks
  56. blood test for DM and range
    HA1C norm 4-6
  57. non fasting BG ranges
    • <140 norm
    • 140-200 prediabetic
    • over 200 diabetic
  58. what kind of insulin must you have for type one
    exogenous insulin

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