Diabetes Mellitus and Complications

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  1. CBG Normal values
    • 70-110=adult
    • 60-100=child
    • 30-80=newborn
    • Adult brain requires: 60-100
  2. Gluconeogenosis
    convert protein and lipid to glucose
  3. ketogenesis
    converts fats to acids
  4. glycogenolysis
    converts glycogen to glucose
  5. incretin hormones
    *from stomach*
    • released by stomach which increases insulin production from pancreas.(Beta Cells from islets of langerhans)
    • Also can inhibit glucagon secreation (alpha cells from islets of langerhans)
  6. Break slide!
    Image Upload 1
  7. IV nutrition
    • requires CBG monitoring 
    • sliding scale insulin
    • bypasses incretin hormones
  8. Which hormones increase BG
    • epinephrine
    • norepinephrine
    • growth hormone
    • cortisol
  9. High dose steroids
    increases CBG. be cognizant when administering prednisone/ steroids.
  10. Type 1
    beta cell destruction leading to absolute insulin dependence-resulting in hyperglycemia. W/O insulin glucose cannot enter cells-this can lead to S&S of hyperglycemia-polyphagia, polydipsia, polyuria, fatigue.

    • caused by autoimmune disorders due to environmental factors/ viral pathogens 
    • Coxsakier virus,measles, influenzae
    • genetic
    • idiopathic
  11. S&S of DM
    polyuria, polydipsia, polyphagia, weight loss, lethargy, weakness, enuresis, yeast infections. WBC cannot fight infection with high amounts of BG.
  12. Type 2
    • More of a metabolic disorder, disorder of carbs, fats, proteins with relative insulin deficiency. (beta cells) are slowly destroyed. 
    • beginning stages of disease-hyperinsulinemia eventually the pancreas cannot keep up with production and is unable to produce required amount.
  13. Hemoglobin A1c
    Glycoslyated hemoglobin
    • bond between RBC and hemoglobin for lifespan of RBC (120Days)
    • (normal 4-6%)
    • uncontrolled diabetic >8%
  14. Gestational DM
    Insulin doesn't pass placenta but glucose does.
  15. Glucose tolerance test
    • OGTT
    • Mainly for diagnosing gestational
    • 12 hour fast
    • FBS checked (blood sample)
    • 300ml sugary beverage
    • CBG checked intervals of 30 mins. for 2 hours.
  16. Metabolic syndrome X
    • Group of disorders which a pt. has 3 risk factors
    • central obesity 
    • HTN
    • Low HDL
    • High Triglycerides 
    • insulin resitant
  17. Hyperglycemia affects which electrolyte the most?
  18. Glucose -Postprandal
    Feasting blood test-after 2hours prior to a large carbohydrate meal.
  19. DKA-Acute hyperglycemia
    • CBG>300
    • Leads to ketogenesis-ketones on the breath (alcohol/fruity smell).
    • As acidosis develops excess K+ levels may develop due to body trying to buffer. H+ ions move into cells forcing K+ out into ECF. Also Kussmauls respirations.
  20. DKA Causes and Treatment
    missed insulin, undiagnosed type 1 diabetic, infection, high levels of stress(cortisol).

    treatments: Fluids and insulin drip.
  21. DKA presentation
    • Confusion-many DKA pts. can be mistaken for someone that is drunk. they will have a tachypnea (kussmaul), rapid heart rate, ketones on breath.
    • Blood work may show hyperkalemia, and PH less than 7.35
  22. HHS in Type 2
    • #1 cause of HHS in diabetic pt. is INFECTION. Other causes similar to DKA.
    • Higher mortality rate than DKA.
    • CBG>600 Normally higher than DKA
    • Similar to DKA, but unlikely to have ketones on breath.
  23. somogyi effect
    CBG less than 70 followed by an episode of hyperglycemia
  24. Hyperglycemia S&S
    irritable, polyphagia, polyuria, tachycardia, weakness, confusion/ altered LOC, hypotension. osmotic diuresis
  25. Dawn phenomenon
    CBG spikes in the morning due to hormones being released while they sleep.
  26. Acute hypoglycemia type 1 or 2
    • too much insulin
    • too little food
    • too much exercise
  27. what has a higher mortality? hypo or hyper glycemia
  28. Complications of Diabetes
    • retinopathy
    • peripheral neuropathy
    • gastroparesis
    • nephropathy
    • acanthosis nigricans
    • genitourinary 
    • atherosclerosis
  29. hypoglycemia unawareness
    • autonomic neuropathy
    • unable to take preventative action most common in type 1.
  30. DKA-Diabetic ketone acidosis
    • Dehydration-give fluids
    • K+ (consider potassium supplements)
    • Acidosis (prevent ketone formation give insulin consider sodium bicarb.)
Card Set:
Diabetes Mellitus and Complications
2016-01-14 19:03:21
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