Ch.51 diabetes mellitus

what are the 3 functions of insulin?

1. it carries glucose into body cells as their preferred source of energy, 2. it promotes the livers storage of glucose as glycogen and 3. it inhibits the breakdown of glycogen back into glucose.

Type 1 diabetes accounts for approx what percentage of all diagnosed cases of diabetes?

5% TO 10%

Where number is diabetes ranked as cause of death in the U.S.?

7th

What should the blood sugar read with a finger testing ideally?

90 to 130 mg/dL before meals and less than 180 mg/dL 1 to 2 hours after meals.

The National Diabetes Information Clearinghouse indicates what percentage of affected people acquire the disease as adults?

90% to 95%

Insulin independence

Ability of a clients own naturally produced insulin to regulate blood glucose levels within consistently normal ranges

what can be detected on the breath in Kussmauls respirations by its characteristic fruity odor?

Acetone, which is volatile

Hyperosmolar hyperglycemic nonketotic syndrome

Acute complication of diabetes characterized by hyperglycemia without ketosis. not unusual to find the blood glucose level will over 500 mg/dL but the pH of the blood remains within the normal range of 7.35 to 7.45. Fluid and electrolyte imbalances accompany this.

In who does diabetes mellitus have a higher incidence in?

African Americans, Latinos, Native Americans, and Asian Americans (including Pacific Islanders).

Glycosylated hemoglobin

Amount of glucose stored within a hemoglobin molecule during its lifespan of 120 days.

Fasting blood glucose

Blood test performed to detect amd monitor diabetes mellitus.

Postprandial glucose

Blood test used to assess blood sugar following a meal.

Oral glucose tolerance test

Blood test used to evaluate a clients metabolism of orally ingested glucose

Lipoatrophy

Breakdown of subcutaneous fat at the site of repeated injections

Lipolysis

Breaking down of fat by the body

Lipohypertrophy

Buildup of subcutaneous fat at the site of repeated injections

Metabolic syndrome

Cluster of physiologic alterations that includes obesity (especially in the abdominal area), high blood pressure, elevated triglyceride and low-density lipoprotein, blood glucose levels, and low high-density lipoprotein level.

Insulin resistance

Decreased sensitivity to insulin at the tissue level

Hyperglycemia

Elevated blood glucose level.

Diabetes mellitus

Endocrine disorder of the pancreas that affects carbohydrate, fat, and protein metabolism.

Polyphagia

Excessive eating

Polydipsia

Excessive thirst

Polyuria

Excessive urine production

Kussmauls respirations

Fast deep breathing

Ketoacidosis

Form of metabolic acidosis resulting from an accumulation of ketones in the blood. develops quite suddenly in type 1 because the total cessation of insulin production.

Glycosuria

Glucose in the urine

What does the urine have in it in a diabetic?

Glucose or ketones may be present or both

Ketonemia

Increased ketones in the blood

Hypoglycemia

Low blood glucose level, always a potential adverse reaction when admining meds for diabetes. when blood glucose level falls below 70 mg/dL

Glycemic index

Measure of how fast a carbohydrate food is likely to raise blood sugar.

Ketones

Metabolic by-products of fat metabolism.

Does normal urine contain traces of glucose or ketones?

No

Diabetic retinopathy

Pathologic changes in the retina experienced by persons with diabetes. develops 10 or more years after onset of diabetes. the earlier it develops, the more likely it is vision will rapidly deteriorate.

Who is ketoacidosis more common in?

People with diabetes who no longer produce insulin such as those with type 1.

Diabetic nephropathy

Progressive decrease in renal function that occurs with diabetes mellitus. clients with type 1 diabetes are more likely to develop this but clients with type 2 are also affected.

Diabetic ketoacidosis

Type of metabolic acidosis that occurs when there is an acute insulin deficiency or an inability to use whatever insulin the pancreas secretes. Sometimes the event that leads to an initial dx of diabetes.

Where can a glucometer obtain blood sugar levels from on the body?

Upper arm, forearm, thigh, or calf.

What does ketonemia cause?

a decreased alkali (base) reserve, leading to acidosis.

What is Exulin?

a recombinantly produced gene known as INGAP (islet neogenesis-associated protein).

renal threshold

ability of the kidney to reabsorb glucose and return it to the bloodstream.

Who is type 2 diabetes more common in?

aging adults and being detected in obese children

Why does glucose show up in the urine in a diabetic?

because the body fails to use glucose adequately and it excretes glucose in the urine.

Why does infection and stress invite ketosis?

because they increase the demand for insulin which the pancreas cannot accommodate in diabetes.

Why are people with type 2 diabetes more likely to develop HHNKS instead of ketoacidosis?

because with limited insulin they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level.

How can the physician assess the effectiveness of a pts treatment once a client receives a treatment regimen?

by obtaining a glycosylated hemoglobin also called a hemoglobin A1c test.

What does a glucometer measure?

capillary blood glucose from blood sampled from a finger stick.

What are ketones?

chemical intermediate products in fat metabolism, such as beta-hydroxubutyric acid, acetoacetic acid, and acetone, cause ketoacidosis when they accumulate.

What occurs if ketoacidosis is not treated?

circulatory collapse, renal shutdown, and death.

Who do physicians recommend to do self monitoring of blood glucose levels?

clients taking insulin, clients with unstable diabetes, or clients with frequent hypoglycemic episodes.

prediabetes

condition characterized by impaired fasting glucose (IFG) (level of 100 to 125 mg/dL after an overnight fast,), impaired glucose tolerance(IGT) (level of 140 to 199 mg/dL after a glucose tolerance test lasting 2 hours), or both.

What happens to a person with type 2 diabetes when they get polyphagia?

despite eating more, he or she loses weight as the body uses fat and protein to substitute for glucose.

What does the bacillus Calmette-Guerin (BCG) vaccine do for type 1 diabetes?

destroys the islet-attacking T cells using tumornecrosis factor-alpha (TNF-alpha) and stimulates the growth of new islet cells.research shows repeated lifelong administration may be needed. (this is in clinical trials and not an actual treatment yet).

What can a urinary test facilitate early detection of?

diabetes

random blood glucose

diagnostic test in which a blood specimen is obtained after 8 hours of fasting to test its glucose level.

What happens when someone has impaired glucose metabolism and hyperglycemia because of a prescription?

does not indicate that the client has diabetes mellitus and insulin may be used to manage the disorder. A normal glucose level is restored once the diabetogenic regimen is discontinued.

What are impaired glucose metabolism and hyperglycemia also associ. with?

drugs such as loop thiazide diuretics, levodopa, and oral oral contraceptives and with the administration of TPN.

What is Type 1 diabetes?

formerly called insulin-dependent diabetes mellitus (IDDM), is characterized by an absence of insulin production by the beta cells in the islets of langerhans of the pancreas.

What is Type 2 diabetes?

formerly known as non-insulin-dependent diabetes mellitus (NIDDM), characterized by insulin resistance or insufficient insulin production.

rule of 15

give 15g of rapidly absorbed carbohydrate, wait 15 mins, recheck the blood sugar, and administer another 15g of glucose if the blood sugar is not above 70 mg/dL.

what does an excessive level of glucose in the blood lead to?

glycosuria

What does MHC do?

helps the T cells identify natural cells as "self"

What are people with type 2 diabetes more common to develop instead of ketoacidosis?

hypersomolar hyperglycemic nonketotic syndrome (HHNKS)

What can high glucose levels for an extended time period in older adults with diabetes result in?

hypertension and dyslipidemia contribute to complications.

How do ketones show up in the urine of a diabetic?

if the body metabolizes fats faster than it can use them.

When is the onset of type 1 diabetes more likely?

in childhood and adolescence but can occur at any age.

What does it mean when a persons test results from their hemoglobin A1c come back and they are 8% or higher?

indicates that control of the clients blood glucose level has been inadequate during the previous 2 to 3 months.

tight glucose control

involves maintaining near-normal blood glucose levels by taking short-acting insulin throughout the day and intermediate-acting insulin at bedtime.

What has been shown in the human trial of Exulin?

it acted on stem cells, causing them to differentiate into pancreatic islet beta cells that produced insulin and normalized blood sugar levels naturally.

What does the correlation of obesity, sedentary lifestyle, and insulin resistance help explain about type 2 diabetes?

it explains how dieting, exercise and weight loss control type 2 diabetes and delay, reduce or eliminate the need for medication to treat the disease.

How does exercise help reduce blood sugar?

it increases transmembrane glucose transporter levels in skeletal muscles.

What is the consensus about type 2 diabetes?

its an inherited disease and that obesity, especially intra-abdominal obesity is likely a co-factor that triggers its onset.

What are alternate sites regarded as and why?

lagging test sites because they actually provide a measurement of blood glucose as it was 20 to 35 mins. prior to test. these are only used for people who have relatively stable and are not on tight glucose control.

What is the normal level of hemoglobin A1c?

less than 7% which id equivalent to an average blood glucose level of 150 mg/dL.

What are some symptoms of hyperglycemia in older adults?

may include depression, cognitive changes, lethargy, unexplained weight loss, urinary incontinence, falls, or nonketotic hyperosmolar syndrome.

what do the scientific studies show about obesity and type 2 diabetes?

obesity causes low-grade inflammation that then causes changes in liver function accompanied by hyperglycemia and insulin resistance.

What are the 3 classic symptoms of both types of diabetes mellitus?

polyuria, polydipsia, and polyphagia

What happens when the overstimulated beta cells become exhausted?

results in a decline in insulin production and the client with type 2 diabetes may also become insulin deficient like those with type 1 diabetes.

What does the formulation of a diabetic diet consist of?

sex, age, height and weight, activity level, occupation, state of health, former dietary habits, and cultural background.

What are some of the S/S in type 2 diabetes with the gradual onset?

some develop skin, urinary tract, and vaginal infections, possibly because the elevated level of blood glucose supports bacterial growth.May be changes in visual acuity manifested by blurred vision because the hypertonicity of the body fluid affects the cells in the lens and retina.

What has Faustman and colleagues shown about type 1 diabetes?

that a genetic mutation causes killer (CD8) T-cell lymphocytes to attack and destroy the insulin-producing islet cells.

What is the result of MHC?

the T cells misidentify islets cells as unnatural and subsequently destroy them.

What happens when type 2 diabetes is manifested?

the beta cells of the islet of Langerhans secrete increased levels of insulin into the bloodstream to offset hyperglycemia, but the blood glucose level remains higher than normal because there is a deficiency of transmembrane glucose transporters on the surface cells.

what system tries to neutralize the ketones in a person with type 2 diabetes?

the bicarbonate buffer system.

what happens in the body without insulin production?

the blood glucose level rises beyond its normal range, sometimes 300 to 1000 mg/dL and the body breaks down fat and protein as alternative sources of cellular energy.

What is an example if a physician prescribed a client diabetes may have only 1500 cals/day.

the calories are then distributed according to the percentage of carbohydrates, fats, and proteins that equal the total prescribed caloric amount.

What happens when dietary allowances are prescribed?

the client is given a diet prescription and a list of substitutes and exchanges to vary the diet.

what is polyuria a result of?

the hypertonicity from concentrated amounts of glucose in the blood and pulls fluid into the vascular system

what happens in type 1 diabetes?

the islets cells, or endocrine portion of the pancreas, cease to produce insulin. considered and autoimmune disorder.

at the point of glycosuria what do the kidneys reach?

their renal threshold

What do transmembrane glucose transporters do?

they form channels that facilitate diffusion of glucose into cells, and they may function only at 20% efficiency in people with type 2 diabetes and? this contributes to hyperglycemia.

How do the S/S come on in type 2 diabetes?

they have a gradual onset

How do the S/S come on in type 1 diabetes?

they have an abrupt onset.

What is the hypothesis about people with type 1 diabetes?

they lack a protein marker known as major histocompatibility complex or MHC.

What do the results of a hemoglobin A1c (glycosolated hemoglobin) show?

they reflect the amount of glucose that is stored in the hemoglobin molecule during its life span of 120 days.

True of false. Type 2 diabetes runs in families?

true,even though a specific gene for diabetes has not been isolated.

What can prediabetes lead to?

type 2 diabetes, heart disease, and stroke.

What are people with diabetes mellitus at an increased risk for?

vascular disorders such as artherosclerosis, CVA, MI, peripheral vascular disease with decreased ability to heal, renal failure, blindness, and neuropathy. Women: prone to complications in pregnancy; Men, prone to erectile dysfunction.

What are additional symptoms of diabetes mellitus?

weight loss, weakness, thirst, fatigue, and dehydration.

when does glycosuria appear?

when the blood glucose level rises above 180 mg/dL

How can people with prediabetes delay or avoid type 2 diabetes?

with weight loss and increased physical activity.