Ch 22 HUN

The most common etiology of the form of DM noted above seems to be that it is an ______________________ (1 WORD) disorder; the body mistakenly identifies the beta cells of the pancreas as foreign entities and destroys them. The result is an absolute deficiency of insulin production.

autoimmune

If an individual with diabetes experiences __________________ (1 WORD), 15-20 grams of CHO should be administered; this can be in the form of glucose gel or a beverage like juice or regular soda. Ultimately, any food with sufficient CHO can be used; once recovered, the person will need to consume additional CHO to further elevate blood glucose to an acceptable level.

hypoglycemia

It is important to understand that while most of the harm caused by DM results from hyperglycemia, the opposite, _________________________ (1 WORD), is also a point of concern that requires attention.

hypoglycemia

Decreased OR absent ___________________________ (2 WORDS) is the basis of DM.

insulin production (p. 497)

___________________________ (2 WORDS) is at the root of T2DM; the "keyholes" are not receptive to the "keys."

insulin resistance (p. 499)

Nerve damage in the vessels of our limbs results in decreased sensation and burning or tingling in hands and feet; this condition is LOGICALLY called _________________________________ (2 WORDS).

peripheral neuropathy Explanation: NEUROPATHY = nerve disease PERIPHERAL refers to our periphery, which in medical terms = the parts away from the core (namely arms AND LEGS)

A primary goal for individuals with DM is to limit intake of ____________________________ fats (3 WORDS) to decrease the risk of CVD.

saturated and trans

The ________________________ (2 WORDS) of T2DM leads to later diagnosis because the symptoms are not as obvious.

slower onset (p. 499)

COMPLETE THIS SENTENCE FROM YOUR TEXT: "The incidence of Type 2 diabetes is increasing..."

throughout the world at epidemic rates and is partially attributed to the concurrent epidemic rate of obesity.

In order to correctly diagnosis diabetes, either fasting glucose or HgbA1C must be abnormal on 2 consecutive occasions. TRUE / FALSE

true

Alcohol should be consumed in moderation and _________________ (2 WORDS) because of its potential hypoglycemic effect (due to the inhibition of gluconeogenesis by alcohol).

with food (p. 505)

Read about non-nutritive sweeteners on page 504: what did you learn?

-evidence is lacking regarding any associated long-term improvements on glycemic control or weight management -act as laxatives when consumed in large amounts -safe for people with diabetes when consumed within the recommended intake

Type ____ (#) DM is that which tends to occur early in life (age 30 or younger) and it entails the absence of insulin production by the beta cells of the pancreas, which necessitates an exogenous source of insulin. This was formerly known as both juvenile-onset DM and IDDM. It comprises 5-10% of the DM diagnoses in this country.

1

The 5 "Did you Know?" points here are good ones, so go ahead and copy them:

1. the ADA diet does not exist, but you may see this label on dietary menus in a hospital 2. sugar (sucrose) is not a forbidden food for people with diabetes 3. people with diabetes may drink alcohol within certain guidelines 4. modest weight loss can help prevent or delay the onset of type 2 diabetes 5. bariatric surgery has been shown to be very effective in controlling hyperglycemia and diabetes in patients who are obese

Formerly termed NIDDM, Type ___ (#) DM develops gradually in response to either increased cellular resistance to insulin and/or an incremental decrease in pancreatic insulin production.

2

________________________ (2 WORDS) usually become a necessary intervention in the management of T2DM and even insulin may become necessary.

oral medications

Those with Type 1 DM must inject insulin at mealtimes; the dose must simulate what the pancreas would have released based on the amount of CHO ingested, were it functioning normally. Thus, individuals with T1DM must understand the CHO content of their food so they can be sure to match the insulin dose accordingly. A typical starting point is 1 unit of insulin for every 15 grams of CHO (1:15). ½ cup pasta = 15g CHO ½ cup vegetable cooked (sauce or solid) = 5g CHO ½ cup ice cream = 20g CHO Julie is going to eat 2 cups of whole wheat pasta topped with 1 cup of tomato pasta sauce; she'll have ½ cup of steamed asparagus and also wants to have a little bit of ice cream (1/2 cup = 1 scoop for dessert). How much insulin will she need to inject to "cover" her meal? ____ (#) units

6

Read the Children & Adolescents with T1DM section and summarize the key points you learned there that you feel you should remember:

A child might snack more often because of fear of hypoglycemia. Children and adolescents with T1DM are prone to frequent highs and lows in blood glucose. A registered dietitian (preferred also CDE) formulates a meal plan. The nurse has to help emphasize the patients' responsibility.

Read about Gestational Diabetes Mellitus (GDM) on pages 499-500; then read this webpage: https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 (Links to an external site.) What appears to be the etiology of GDM: be brief and sum it up in 1-3 sentences:

Although researchers aren't exactly sure, excess weight before pregnancy often plays a role. Additionally, hormone levels change and may not regulate blood sugar as well as before. Some of the risk factors are a lack of physical activity, previous gestational diabetes or prediabetes, polycystic ovary syndrome, diabetes in an immediate family member, previously delivering a baby weighing over 9 pounds, and race.

Now copy the first sentence under "What is Diabetes?" since it's likely not what you would have said if asked that question:

Diabetes mellitus is a chronic disease involving abnormal carbohydrate, fat, and protein metabolism characterized by hyperglycemia.

WHAT are the common symptoms of T2DM? (LIST ALL FROM PAGE 499):

Fatigue, visual blurriness, tingling and numbness in the hands and/or feet, recurrent infections in the feet and legs, nails with fungal infections, dry skin, and lesions on the feet and legs that are slow to heal.

Hypertension worsens the existing potential for damage to the microvascular system already associated with hyperglycemia; in other words, both HTN and DM damage smaller blood vessels throughout the body, which leads to a variety of systemic complications such as: (LIST ALL 3 NOTED IN BOOK):

Kidney disease, limb amputation, and vision loss. (p. 506)

Regardless of the TYPE, the progression of diabetes is a problem because it is the cause of numerous comorbidities, 5 of which are specified on page 499 (LIST THEM):

Neuropathy, blindness or increasing visual impairment, coronary artery disease, renal disease, and stroke.

THIS ONE REQUIRES UNDERSTANDING AND THOUGHT: Based on the book and lecture, explain WHY the S/S of T1DM are polydipsia, polyphagia, and polyuria.

Since our cells are not receiving glucose our body will break down fat and protein for fuel. Our body is essentially "eating itself" which can cause polyphagia or excessive eating from increased hunger/appetite. Because all of the glucose is in the bloodstream the body will try to flush out the excess which causes polyuria or the production of abnormally large volumes of urine. All of this fluid leaving our body can cause polydipsia, abnormally great thirst, in an attempt to rehydrate the body.

WHY is weight loss recommended in patients with T2DM?

So the patient can achieve a reduction in blood pressure, blood glucose, lipid levels, sleep apnea risks, and the overall complications of diabetes.

The nurse is helping a client with diabetes mellitus with meal planning. What should the nurse emphasize about carbohydrate intake? a. Low-fiber foods are needed to improve insulin sensitivity. b. There is no set amount of carbohydrates to ingest each day c. Eat a small amount of foods with high fiber content to avoid constipation. d. No fewer than 100 grams of simple carbohydrates because complex carbohydrates take much longer to metabolize.

b. There is no set amount of carbohydrates to ingest each day explanation: The American Diabetic Association does not specify a maximum amount of carbohydrates to be consumed daily, but the minimum recommendation is 130 grams/day from various fruits, vegetables, legumes, and whole grains. The addition of high-fiber foods is an important component in healthy bowels. Complex carbohydrates are recommended over simple carbohydrates which are high in calories and low in nutritional value. High-fiber foods are highly recommended as a source of complex carbohydrates and have been associated with improved insulin sensitivity.

A client with diabetes has a blood glucose level of 320 mg/dL and ketones in the urine. What should the nurse explain about these findings? a. Ketones are naturally found in large numbers in the urine and are not a sign of pathology. b. Uncontrolled glucose resulting in ketoacidosis is a very serious medical problem that can lead to comma or even death. c. Ketones are a by-product of glucose metabolism and occur in varying amounts in the urine depending on the caloric intake of the client. d. Ketoacidosis results when there is an over compensation of insulin by the body in response to a large consumption of complex carbohydrates.

b. Uncontrolled glucose resulting in ketoacidosis is a very serious medical problem that can lead to comma or even death. explanation: Uncontrolled ketoacidosis is a serious medical problem that can lead to coma and/or death if not corrected. Ketones are a by-product of fat metabolism, a source of energy used by the body when glucose is not available due to insufficient amounts of insulin or starvation. Ketones are eliminated by the kidneys at a rate that is slower than they are produced and can be measured in the blood and/or urine as an indicator of fat catabolism. Ketoacidosis refers to a state in which there are metabolic alterations including altered blood pH and fluid and electrolyte imbalances.

_____________________________________ (2 WORDS) is the form of MNT taught by RD/RDNs and/or all CDEs; it involved personalized CHO recommendations and education about the CHO content of foods.

carbohydrate counting

Though most often diagnosed in adults age 40+, T2DM diagnosis is becoming more common in ______________________ (1 WORD) due to weight gain associated with poor dietary habits and too many hours spent engaged in sedentary behavior (TV, tablet, computer, video games).

children

A school-age client with type 1 diabetes mellitus wants to know why the medication is in an injection instead of a pill. Which response should the nurse make to this client? a. "The type of medication you need depends on your blood sugar levels, and yours meet the criteria for insulin." b. "Medications available in pill form can be used for type 1 diabetes if the treatment is started early enough in the disease." c. "Younger clients diagnosed with diabetes are prescribed insulin because it is long lasting and easier to keep track of than pills." d. "Medications available in pill form only work if your body makes some insulin, and in type 1 diabetes the cells that make insulin do not work."

d. "Medications available in pill form only work if your body makes some insulin, and in type 1 diabetes the cells that make insulin do not work." explanation: Medication available in pill form works with the endogenous insulin that is present in the body. People with type 1 diabetes mellitus are always treated with insulin because their bodies do not have a supply of endogenous insulin. Types of insulin with a range of rapid acting to long acting are available and can be prescribed alone or in combination according to the metabolic needs of the individual. Age at diagnosis does not affect the type of treatment used for type 1 diabetes.

A client with newly diagnosed diabetes asks when the frequent urination will stop. Which response should the nurse make to this client? a. "Once your blood sugar is less than 200 you won't be as thirsty and so won't urinate as frequently." b. "Limiting the amount of fluids in the evening may help to decrease the number of times you wake up during the night to urinate." c. "Frequent urination is a common event with diabetes and should be expected to continue regardless of how well your blood sugar is controlled." d. "Without enough insulin, glucose is not absorbed into the cells but is excreted by the kidneys along with large amounts of water causing frequent urination."

d. "Without enough insulin, glucose is not absorbed into the cells but is excreted by the kidneys along with large amounts of water causing frequent urination." eplanation: High amounts of glucose without sufficient insulin from endogenous or chemical sources result in excessive glucose circulating in the blood without being absorbed into cells which the kidneys need to eliminate along with large amounts of water resulting in frequent urination. Polyuria is a symptom of hyperglycemia and does not occur when there is a balance between glucose intake and insulin availability. Limiting the amount of fluids consumed in the evening will usually help to decrease nocturia in the absence of pathology.

A client with diabetes has been following a low-carbohydrate low-fat diet to lose weight but has been feeling dizzy and tired in the afternoons at work. What should the nurse explain to this client? a. A low-carbohydrate diet is good for diabetics and has been shown to improve glucose control b. Increased exercise is beneficial for clients with diabetes but should be increased very slowly over time c. A low-fat diet has been proven to increase the rate of metabolism in diabetic clients and help with weight control d. Diets that restrict calories from specific food groups are not recommended for diabetics and could result in hypoglycemia especially with increased exercise

d. Diets that restrict calories from specific food groups are not recommended for diabetics and could result in hypoglycemia especially with increased exercise explanation: Diets that restrict calories from specific food groups are not recommended for diabetics and could result in episodes of hypoglycemia especially with the increased energy demands during increased exercise. Low carbohydrate diets should be avoided by clients with diabetes because of the increase of LDL cholesterol that results and the increased risk for developing heart disease Increased exercise, reduction in daily calories, and developing strategies to avoid barriers to previous weight loss attempts are the recommended initial steps for a successful weight loss program.

A client with diabetes has a blood glucose level of 480 mg/dL and is experiencing weakness and confusion. Which information would be helpful to identify the reason for the client's symptoms? a. Drank a bottle of beer last night before bed b. Skipped breakfast because of being late for work c. Takes insulin as prescribed and follows a healthy diet d. Has not taken insulin for the past four days because of a flu-like illness

d. Has not taken insulin for the past four days because of a flu-like illness explanation: Illness is the most likely cause of hyperglycemic episodes among clients with usual good glucose control. Not taking insulin as prescribed for 4 days will cause the blood glucose level to raise dangerously high. Although alcohol in excess may result in a hypoglycemia episode, one bottle of beer would not be considered excessive even for a diabetic client. Skipping meals after taking insulin could result in a hypoglycemia episode. The fact that the client always takes his insulin as prescribed and follows a healthy diet does not provide any clues for the current condition.

The nurse prepares an educational handout for overweight clients with diabetes. Which strategy should the nurse include that focuses on weight loss? a. High-fiber diet, surgery, and exercise b. Low-carbohydrate diet, increased exercise, and surgery c. Low-protein diet, coping strategies to avoid overeating, and exercise d. Increased exercise, reduction of daily calories, and ways to avoid behaviors that have been barriers in the past for weight loss

d. Increased exercise, reduction of daily calories, and ways to avoid behaviors that have been barriers in the past for weight loss explanation: Low-carbohydrate diets should be avoided in clients with diabetes to avoid increases in LDL cholesterol since they are already at risk for cardiac disease. The best initial strategy for clients with or without diabetes is increased exercise, reduction of daily calories, and developing ways to avoid behaviors that have been barriers to past attempts at weight loss. Clients wanting to lose weight should continue to eat a balanced diet that includes the recommended calories for each food group rather than restricting calories from specific food groups. High-fiber diets are recommended for clients with diabetes based on the metabolism rate for fiber, but surgical intervention should be reserved for clients who have repeatedly been unsuccessful at weight loss attempts and are morbidly obese.

Protein needs are elevated in all people with DM. TRUE / FALSE

false (p. 504)

A high ________________ (1 WORD) intake should be encouraged for individuals with diabetes to help with weight management, prevention of CVD, and to a lesser degree with blood glucose management.

fiber

Recall that the vagus nerve is that which regulates the emptying of stomach contents into the small intestine; it functions as part of the autonomic nervous system. You learned previously that a vitamin B12 deficiency can cause damage to this nerve; the other major culprit is uncontrolled DM due to the resulting nerve damage. In either case, the result is the irreversible condition of ____________________ (1 WORD), which necessitates life-long dietary modifications.

gastroparesis

Individuals with T1DM who do not administer adequate insulin are at risk for developing diabetic ______________________ (1 WORD); without insulin to allow glucose to enter cells, the cells are deprived of the fuel they need and the body resorts to breaking down fat and protein-based body components to acquire the needed fuel. The resulting chemical imbalances can be life-threatening.

ketoacidosis (p. 498)

Diabetes is the leading cause of ______________________ (2 WORDS).

kidney failure

As per the previous chapter materials, ___________________________ (2 WORDS) is a more formal term used to describe the state casually termed pre-diabetes which is when there is evidence of a cluster of metabolic abnormalities that forecast the onset of diabetes.

metabolic syndrome

Stated another way, _______________________ (kidney damage) is a common comorbidity that occurs secondary to DM.

nephropathy

Chronically elevated blood glucose (hyperglycemia) that occurs in uncontrolled DM is a concern because it damages the interior walls of the blood vessels; as the blood vessels become damaged, the nerve endings they nourish are subsequently damaged as well. The resulting nerve damage is called _______________ (1 WORD).

neuropathy (p. 507)

In its earlier stages T2DM can be treated with _______________________________ (5 WORDS) if a person is highly motivated; weight loss and improved eating habits help to improve insulin resistance and lipid abnormalities that are a part of the problem

nutrition and increased physical activity

The genetic propensity for T2DM is more likely to be expressed if one becomes ___________ (1 WORD).

obese