Diabetes Study Guide – Flashcards
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a hormone produced by the beta cells in the islets of langerhans of the pancreas
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insulin
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normal blood sugar
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70-120 mg/dl
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Insulin promotes _______ transport from the bloodstream across the cell membrane to the cytoplasm of the ______
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glucose, cell
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Age of onset for type 1 diabetes
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most common in young people, but can occur at any age
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age of onset for type 2 diabetes
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usually age 35 or older, but can occur at any age
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type of onset for type 1 diabetes
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signs and symptoms are abrupt, but disease may be present for several years
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type of onset for type 2 diabetes
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insidious, may go undiagnosed for years
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prevalence of type 1 diabetes
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accounts for 5-10% of all types of diabetes
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prevalence of type 2 diabetes
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accounts for 90-95 of diabetes cases
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environmental factors that lead to type 1 diabetes
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virus or toxins
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presence of endogenous insulin in type 1 diabetes
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minimal or absent
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presence of endogenous insulin in type 2 diabetes
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possibly excessive, adequate but delayed secretion or utilization, secretions diminish over time
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environmental factors that lead to type 2 diabetes
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obesity, lack of exercise, genetics`
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nutritional status of individuals with type 1 diabetes
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can be thin, normal or obese
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nutritional status of individuals with type 2 diabetes
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obese or normal
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symptoms of type 1 diabetes
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thirst, polyuria, polyphagia, fatigue, weight loss
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symptoms of type 2 diabetes
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frequently none, fatigue, frequent infections, impaired wound healing
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In type 1 diabetes, the body's own T cells attack and destroy _____ cells, which are the source of ______
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beta, insulin
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When does type I diabetes manifest?
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when pancreas can no longer maintain sufficient amounts of insulin to maintain normal glucose
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What usually precedes a type 1 diabetes diagnosis?
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generally isn't discovered until individual comes to the emergency room with impending or actual ketoacidosis
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If endogenous insulin is present in the body, why does a disorder happen?
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because body is no longer responding to action of insulin, insulin receptors that are unresponsive to action of insulin or are insufficient in number
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Once the insulin receptors become unresponsive or diminish, what else happens to lead to type II diabetes?
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ability of pancreas to produce insulin decreases, and beta cells become fatigued?
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what is the role of the liver in the development of type II diabetes?
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liver responds to imbalance of insulin in body in haphazard and disorganized way that does not correspond to body's needs.
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What do the hormones and cytokines produced by adipose tissue affect?
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pathophysiology of DMII
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signs and symptoms of type 1 diabetes mellitus
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polyuria, polydipsia, polyphagia
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Why does polyphagia occur in type 1 diabetes?
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it is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose for energy
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What are the signs and symptoms of type II diabetes?
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fatigue, recurrent infections, prolonged wound healing, visual changes
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What A1C reading indicates diabetes?
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greater than 6.5%
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What does the A1C test indicate?
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the amount of glycosylated hemoglobin (amount of glucose attached to hemoglobin cells) over the life of a hemoglobin cell over the past 90-120 days
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OGTT
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oral glucose tolerance test
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what two hour glucose level generally indicates diabetes?
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a reading over 200 mg/dL
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In a patient with classic symptoms of hyperglycemia, what type of blood glucose test can be used to diagnose diabetes?
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random plasma glucose of more than 200 mg/dl
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Types of insulin
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rapid acting short acting intermediate-acting insulin long-acting insulin
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examples of rapid acting insulin
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lispro/humalog aspart/novolog glulisine/apidra
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onset, peak and duration of rapid acting insulin
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onset 15 minutes peak 60-90 min duration 3-4 hours
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examples of short acting insulin
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regular (humulin R, Novolin R, ReliON R)
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onset, peak and duration of short-acting insulin
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onset 0.5-1 hour peak 2-3 hours duration 3-6 hours
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examples of intermediate acting insulin
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NPH (Humulin N, Novolin N, ReliON N)
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onset, peak and duration of intermediate-acting insulin
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onset 2-4 hours peak 4-10 hours duration 10-16 hours
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examples of long acting insulin
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glargine (lantus) Detemir (levemir)
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onset, peak and duration of long acting insulin
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onset: 1-2 hours peak: no pronounced peak duration: 24+ hours
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examples of sulfonylureas
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glipizide (glucotrol), glyburide (micronase, Diabeta)
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action of sulfonylureas
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stimulates release of insulin from the pancreatic islets
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side effects of sulfonylureas
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weight gain, hypoglycemia
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medications that are meglitinides
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repaglinide (Prandin)
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action of meglitinides
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rapid and short lived release of insulin from pancreas
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side effects of meglitinides
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weight gain, hypoglycemia
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examples of biguanides
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metformin (Glucophage)
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action of biguanides
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decreases rate of hepatic glucose production
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side effects of biguanides
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diarrhea, lactic acidosis
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ketoacidosis
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acidosis d/t an excess of ketone bodies, occurs in individuals who do not produce enough insulin to sustain normal fat metabolism
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examples of alpha-glucosidase inhibitors
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acarbose (precose)
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action of alpha-glucosidase inhibitors
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delay absorption of glucose from GI tract
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side effects of alpha-glucosidase inhibitors
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abdominal pain
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examples of thiazolidinediones
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pioglitazone (Actos) rosiglitazone (Avandia)
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action of thiazolidinediones
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increases glucose uptake in muscles
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side effects of thiazolidinediones
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weight gain, edema, increased risk of MI/Stroke
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Nutritional goals for individuals with type 1 diabetes should be based on
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individual's food intake and balanced with insulin and exercise
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If using conventional, fixed insulin regimens, what is important?
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day to day consistency
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What kind of insulin allows type 1 diabetics to make adjustment in dosage before the meal based on current blood glucose levels and carbohydrate content of meals?
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rapid acting insulin
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rapid acting insulin allows patients to make adjustment in dosage before the meal based on
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current blood glucose levels and carbohydrate content of meal
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Why should individuals with type II diabetes look to achieve moderate weight loss?
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because even a loss of 5-7% increases glycemic control
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How many carbohydrates should be included in a diabetic diet?
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130 g/day minimum
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What sources of carbohydrates should be emphasized?
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fruits, vegetables, legumes, whole grains and low fat milk
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How should carbohydrate intake be monitored?
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counting, exchanges, or experience based estimation
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What types of sweeteners are recommended for diabetics?
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artificial sweeteners
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Your diabetic client heard that his friends are having a lot of weight loss on the Atkins diet, and wants to try it because he wants to reduce his body weight. Should you recommend this diet?
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no
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How much fiber is recommended in a diabetic diet?
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14 g/1000 kCal same as standard diet
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How much fat should individuals on a diabetic diet consume?
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7% of daily intake from saturated fat, transfat should be minimized
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how much cholesterol should an individual on a diabetic diet consume?
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less than 200 mg/day, 2 servings of fish per week
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how much protein should be included in a diabetic diet?
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15-20% of total calories
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causes of diabetes
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1. genetic 2. autoimmune 3. environmental
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examples of environmental causes of diabetes
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obesity, viral component
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why is insulin minimal or absent in type I diabetes?
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because of the destruction of beta cells by the body's own T cells
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Type 1 diabetes is considered an _________ disorder
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autoimmune
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What is the basal rate of insulin?
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the small amount of insulin released at a constant rate
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What is a bolus?
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an increased amount of insulin released after food is ingested
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Type 1 diabetes is considered an _________ mediated disease
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immune
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Explain the pathophysiology of type 1 diabetes?
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Body's own T cells attack and destroy beta cells (pancreatic beta cells)
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What is the source of insulin?
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pancreatic beta cells, some insulin produced by liver
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The onset of type 1 diabetes is generally associated with a
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long clinical period, possibly months to years
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In contrast to the onset of the disease of type 1 diabetes, the onset of symptoms of type 1 diabetes is
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rapid
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What precedes an onset of symptoms of type 1 diabetes?
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the depletion of beta cells
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What is the etiology (cause) of type II diabetes?
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obesity, genetics
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If a type II diabetic's pancreas continues to supply insulin, why is medical intervention needed?
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because the supply of insulin is insufficient, poorly utilized, or both
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How is the onset of type II diabetes characterized?
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a gradual process, sometimes not noticed by patient until routine labwork reveals abnormality
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What are the advantages of using a pen for insulin administration versus a syringe?
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the pen has audible clicks that visually impaired patients can use to self-manage medication, more convenient to carry, less overwhelming to patient
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How does a pump help individuals manage their diabetes?
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it provides a continuous, subcutaneously administered basal rate of insulin that can be adjusted for higher demand d/t activity, illness or stress, can also deliver bolus at mealtimes
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What is the role of oral medications in diabetes management?
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instead of replacing insulin, they help individuals who produce some insulin improve mechanisms that may not be producing enough or not using the produced insulin appropriately
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What is the overall nutritional goal for individuals with diabetes mellitus?
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achieve a stable glucose that is as much as possible within a normal range
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How is nutrition for type 1 diabetics determined?
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based on person's usual food intake and balanced with insulin food patterns
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What are important questions to ask about various insulin medications?
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When will the insulin kick in? How long will the effects last?
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What are the nutritional goals for an individuals with type 2 diabetes?
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the emphasis is on achieving glucose, lipid and BP goals
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How does weight loss affect medication for type 2 diabetics?
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it can reduce need for medications
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What is one serving of carbohydrates?
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15g
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How much exercise is recommended for individuals with diabetes?
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at least 2.5 hrs/week
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How does exercise benefit individuals with diabetes?
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it decreases insulin resistance, and effects can last up to 48 hours after activity
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What kind of exercise is especially recommended for individuals with type II diabetes?
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resistance training
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When administering more than one kind of insulin, what is important to know?
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Which insulin will kick in first, when each insulin will kick in, whether insulin can be mixed, which insulin needs to be drawn up first
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When drawing up more than one kind of insulin, what should you remember?
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"clear then cloudy" so that you don't contaminate regular insulin with intermediate insulin
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What kind of insulin should NEVER be mixed?
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long acting insulins such as Lantus
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How soon after taking a short acting insulin should a patient eat?
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30 minutes
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If a blood sugar reading is between 0-149 mg/dl, how many units of sliding scale glucose should be administered?
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0 units
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If a blood sugar reading is between 150-200 mg/dl, how many units of sliding scale glucose should be administered?
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5 units
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if a blood sugar reading is between 201-250 mg/dl, how many units of sliding scale glucose should be administered?
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10 units
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if a blood sugar reading is over 250 mg/dl, what should you do?
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call the doctor
