Diabetes Mellitus Part 2 - Pathophysiology and Management PDF

Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 1. Diabetes Mellitus Chronic condition affecting glucose metabolism. 2. Acute Complica- Diabetic Ketoacidosis (DKA) tions: Hyperosmolar Hyperglycemic State (HHS) 3....

Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 1. Diabetes Mellitus Chronic condition affecting glucose metabolism. 2. Acute Complica- Diabetic Ketoacidosis (DKA) tions: Hyperosmolar Hyperglycemic State (HHS) 3. Microvascular Dermopathy (Chronic) Nephropathy Complications Retinopathy Neuropathy 4. Macrovascular Atherosclerosis (Chronic) Peripheral Vascular Complications Cardiovascular Cerebrovascular 5. Diabetic Ketoaci- Acute complication from insulin deficiency. dosis Commonly Seen in type I DM Typically, > 300 mg/dL Osmolality > 340 mOsm/L Kussmauls's respiration Confusion Develops quickly 6. Hyperosmolar Severe hyperglycemia without significant ketoacidosis. Hyperglycemic Commonly seen in type II DM State (HHS) Typically >600mg/dL Osmolarity Shallow Breaths Lethargy Develops Slow 7. Atherosclerosis causes a high incidence of coronary artery disease and vascular insufficiency of the Diabetes extremities, especially the feet 1 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 8. Dermopathy disease of the skin 9. Albuminuria albumin in the urine 10. Neuropathy any disease of the nerves 11. Long Term Ef- Diabetic Neuropathy fects of Diabetes Diabetic Retinopathy Stroke CV Disease Diabetic Peripheral Neuropathy 12. Diabetic Periph- Progressive deterioration of nerve function with the loss of sensory perception. eral Neuropathy 13. Diabetic Der- Diabetic Skin spots caused by microvascular damage, trauma, or injury. mopathy Small, round, oval patches of discolored skin 14. Nephropathy Kidney damage leading to albuminuria. Damages small blood vessels in kidney including glomeruli. Albuminuria (protein) in urine. 70% also have HTN (Hypertension) 15. Diabetic damage to the retina as a complication of uncontrolled diabetes Retinopathy Microvascular damage and occlusion of the retina. 16. Glaucoma increased intraocular pressure results in damage to the retina and optic nerve with loss of vision 17. Cataracts clouding of the lens 18. Peripheral Neu- Nerve damage causing numbness and weakness. ropathy Peripheral nerves transmit signals from CNS to the rest of the body. 2 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 19. Sensory Neu- Loss of protective sensation in lower extremities ropathy Major risk for amputation Loss of sensation, numbness, tingling 20. Motor Neuropa- Dysfunction of motor nerves leading to atrophy, weakness, and/or paralysis thy weakness, cramps 21. Autonomic Neu- damage to nerves supplying the internal body structures that regulate functions ropathy such as blood pressure, heart rate, bowel and bladder emptying, and digestion 22. Autonomic Neu- Postural hypotension ropathy Symp- Erectile dysfunction toms Gastroparesis 23. Gastroparesis a condition in which the muscles in the stomach slow down and work poorly or not at all, preventing the stomach from emptying normally 24. Peripheral Vascu- Narrowing or blocking of blood vessels in limbs. lar Disease Clotting disorders - often BLE's (Bi-lat lower extremities) 25. Peripheral Vascu- - DM lar Disease Risk - cigarette smoking Factors - HTN - hyperlipidemia - atherosclerosis - obesity - sedentary lifestyle - infection - gangrene - amputation 26. Cardiovascular Heart and blood vessel complications. Disease 3 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 27. Coronary Heart the clogging of the vessels that nourish the heart muscle; the leading cause of Disease death in many developed countries 28. Cerebrovascular disorder resulting from a change within one or more blood vessels of the brain Disease 29. Peripheral Arteri- Disease of blood vessels supplying arms and legs (diabetic foot) al Disease 30. Diabetic Foot A person who has diabetes is at increased risk for slow-healing injuries to distal extremities. It is caused by decreased vascularization; the risk of an infection that does not heal is higher. One possible intervention is limb amputation. 31. Diabetes Phar- Biguanides macotherapy Thiazolidinediones Sulfonylureas Meglitinides α-Glucosidase inhibitors 32. Biguanides Metformin - preferred initial pharmacological agent. Control hepatic glucose production Decrease rate of hepatic glucose production increase glucose uptake in muscles Do not use in patients with kidney, liver, or heart failure. Hold for 48 hours after procedures using contrast dye. 33. Metformin Dia- - biguanides betes - primarily decreases glucose production in the liver, increases the uptake of glucose - may also decrease intestinal absorption of glucose - does not stimulate insulin secretion - used for type 2 diabetes, used in children >10 yrs. with type 2 - good for obesity-related diabetes 4 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n - Adverse Effects: GI complications (early on, D/N - TAKE WITH MEALS - assess for lactic acidosis (dizziness, SOB, cardiac irregularities) - contras: renal disease, acute cardiac events, sepsis - due to risk of lactic acidosis 34. What is the first Metformin line pharmaco- logic treatment for Type II DM? 35. Thiazolidine- Pioglitazone (Actos) diones Rosiglitazone (Avandia) Control hepatic glucose production 36. Sulfonylureas Oldest class of oral hypoglycemics. Stimulates pancreas to make more insulin. Take with meals. Watch for hypoglycemia glyburide (Micronase, Diabeta) glipizide (Glucotrol) glimepiride (Amaryl) 37. Glyburide Dia- - Sulfonylureas (first oral agent, increase number of insulin receptors) betes - Adjunct to diet and exercise, can be used with insulin - Type II diabetes only!!! - need beta cells - Adverse Effects: hypoglycemia, gi effects (n/v/heartburn) - do not use if pregnant 38. α-Glucosidase In- Delay carbohydrate absorption in intestines. hibitors "Starch Blockers" Best used for those with normal FBS but elevated Post Prandial Plasma Glucose (PPG). Take with 1st bite of meal. Monitor liver enzymes. 5 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n acarbose (Precose) miglitol (Glyset) 39. Dipeptidyl Pepti- Boost incretin, hormones produced by the gut in response to food intake. dase-4 Inhibitor Enhances incretin hormones to regulate glucose. (DPP-4) sitagliptin (Januvia) linagliptin (Tradjenta) alogliptin (Nesina) saxagliptin (Onglyza) 40. Incretin Mimetics Mimic incretin effects to lower blood sugar. May combine with oral agents. Do NOT use with Insulin. dulaglutide (Trulicity) exenatide (Byetta/Bydureon) liraglutide (Victoza) semaglutide (Ozempic) 41. dulaglutide Antidiabetic Agent; Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist (Trulicity) 42. Insulin Overview Injectable drugs to control: Type 1, dependent Type 2, if not controlled by other means 43. Banting and Best In 1920, they successfully isolated the hormone insulin for the first time. 44. Rapid Acting / Bo- Inject SQ 5-15 minutes before meals lus Insulin Used as prandial insulin and for correction doses (by sliding scale) Aspart, Lispro, and Glulisine - all are clear and colorless Afreeza - inhaled Onset: 10-30 minutes 6 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n Peak: 30 minutes - 1 hr Duration: 3 - 5 hours 45. Short-acting In- Regular (Humulin R, Novolin R) sulin (bolus/pran- Onset: 30 min - 1 hour dial) Peak: 2 - 4 hrs Duration: 5 - 8 hrs 46. Intermediate-act- NPH (Humulin N, Novolin N) ing Insulin Onset: 1 - 2hrs Peak: 4 - 12 hrs Duration: 12 - 18 hrs 47. Long-acting glargine (Lantus) (Basal) Insulin detemir (Levemir) Onset: 1 - 2 hours Peak: n/a Duration: 18 - 24 hrs 48. Combination In- · Short or rapid acting insulin is mixed with intermediate acting to provide both sulin (Premixed) mealtime and basal coverage. · Duration of action is 10-16 hours. 49. Drawing UpTwo 1. Draw air into syringe. Different Insulins 2. Inject air into NPH insulin. 3. Inject air into Short-Acting Insulin. 4. Draw Short-Acting Insulin 5. Draw NPH Insulin 50. Insulin Pump Device delivering continuous insulin infusion. Delivers Insulin via an infusion set. through a thin tube that goes under the skin. Mimics a healthy pancreas. 7 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n Basal dose Bolus dose 51. Phases of Insulin Onset, peak, and duration of insulin effects. Action 52. Insulin Onset when the effect of Insulin first begins 53. Insulin Peak when the Insulin is working at its "optimal" level 54. Insulin Duration how long the Insulin persists in the system 55. Non Pharmaco- Exercise logic Therapies Diet for Diabetes Medications Blood Pressure & Cholesterol Management Using Risk Reduction Approach 56. Dietary Recom- Non-starchy Veggies mendations in Di- spinach, carrots, broccoli abetes Protein chicken, salmon, eggs Carbohydrates whole grain foods, pasta, potatoes Water is the best beverage choice Add: serving of fruit & dairy. Choose healthy fats 57. Role of Fiber in Improves blood sugar control. DM Digestive health Weight management Heart health 58. 8 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n Physical Activi- Aerobic Exercise ties Recommen- Anaerobic Exercise dations Mixed Exercise 59. Aerobic Exercise Lower intensity; longer duration Diabetes Expect a drop in blood glucose 60. Anaerobic Exer- Higher intensity; shorter duration cise Diabetes Expect spikes in glucose levels 61. Mixed Exercise Combination of aerobic and anaerobic activity Diabetes Expect glucose level to fluctuate, can spike or drop 62. Sick Days Man- Special considerations for illness in diabetes. agement 63. Foot Care Essential practices to prevent diabetic foot complications. Wash Daily Dry well especially between toes Feel for bumps or temp changes Look between toes, check each toenail file toenails straight across Check for dry, cracked skin Examine bottom of feet Track your findings 64. Tips for Healthy Check your feet everyday Feet NEVER go barefoot Wear well-fitting shoes Trim your toenails straight across Do NOT try to remove corns or calluses by your self Get your feet checked at EVERY healthcare visit 9 / 11  Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n 65. Vision Care Complete a dilated eye exam every year Contact doctor immediately with complications 66. Vision Complica- Blurred or double vision tions to CONTACT Narrowed field of vision PROVIDER IMME- Seeing dark spots DIATELY Feeling pressure in the eyes Unusual difficulty seeing in dim light 67. Skin Care Dia- Bathe daily with mild soap and lukewarm water betes Avoid scratches or bruises Gardener gloves Sunscreen Avoid long exposure to very cold weather Treat skin injuries quickly 68. Diabetic Sick Sugar Days (S.I.C.K) Insulin Carbs Ketones 69. Patient Education Take your meds as prescribed (T.R.A.C.K) Reach and maintain a healthy weight Add more physical activity to daily routine Control your ABC's; A1C, BP, and Cholesterol Kick the smoking habit 70. Generate Demonstrates blood glucose test on self. Solutions: Verbalize proper foot care. Patient/Caregiv- Verbalizes exercise guidelines. er will: State when to contact physician. Verbalizes importance of outpatient DM education after discharge. Verbalizes target glucose ranges and A1C levels. 10 / 11 Diabetes Mellitus Part 2: Pathophysiology and Management Study online at https://quizlet.com/_gngr5n Demonstrate SQ injection. States appropriate time schedule for insulin. States drug/drug and drug/nutrient interactions. States symptoms, treatment of hypoglycemia. States symptoms, treatment of hyperglycemia. Verbalizes sick day guidelines. States one day meal plan. 11 / 11