CH 19- DIABETES

?, or damage to the eye producing visual impairment, is a key indicator of microvascular complications and as such of the impact of diabetes.

Retinopathy

SMBG is cruicial for both type 1 and type 2 diabetes.

Self monitoring of blood glucose levels

? diminishes pain and temperature perceptions causing lesions to go unnoticed. ? impairs blood supply needed for healing, and hyperglycemia reduces host defenses.

Sensory polyneuropathy, PAD

Glimepiride (Amaryl) and repaglinide (Prandin) stimulate insulin secretion and pioglitazone (Acta) increases sensitiveity of skeletal muscle tissues to insulin

.

If present trends continue ? in ? adult Americans could have diabetes by 2050. Prevalence is associated with ?.

1 in 3, race and ethnicity

The ADA recommends a minim of minutes of moderately intense exercise physical activity or exercise per week. For patients with type 2 diabetes, regular exercise reduces insulin resistance, promotes cardiovascular health, and prevents/improves obesity, anxiety and depression.

150

Type 1 diabetes is further classified according to pathogenesis with type ? associated with an autoimmune destruction of pancreatic beta cells and type lacking the same. A third subtype, ?of adults, refers to an autoimmune based form of diabetes that occurs in adults aged 35 years or older.

1A, 1B, latent autoimmune diabetes

Diabetes and periodontal disease have a bidirectional relationship in that diabetes increases the risk of periodonitis especially for people with type ? and periodontitis negatively affects diabetes outcomes.

2 diabetes

In 2012, 1.7 million new cases of diabetes were diagnosed in people aged 20 or older in the United States, with the majority of cases in the ? year old age range. The age-adjusted incidence of diabetes was slightly higher for ? than for ?. Incidence for African American, Hispanic, and Asian Americans is 2 to 3 times that of Caucasian Americans

45 to 64 , men for women

People with type 1 diabetes should monitor their blood glucose levels up to ? times per day including but not limited to before and after meals and exercise, before bedtime, when they suspect low blood glucose levels, and oftentimes prior to ?

6 to 10 , driving.

ITs recommended that all children engage in ? minutes of physical activity per day apply to people with type 1 diabetes.

60

The ADA recommends that people with diabetes should generally target blood pressure goals at ?mmHg: however, lower targets (ie. ? mm/hg may be appropriate for younger people.

<140/90 mmHg, <130/80 mmHg

The most common symptoms include burning pain; stabbing, prickly, or tingling sensation; or numbness and lack of protective sensation. Pain is worse at night, and symptoms are more common in lower extremities than in upper. ? reduces the risk.

Symptoms of DPN. Intensive insulin therapy and tight glycemic control

? (ie consumption of monosaturated and omega-3 fatty acids, fresh fruits and vegetables, high fiber, and vegetable protein) can reduce insulin resistance in people with 2 diabetes.

A mediterranean-style diet

? levels serve to screen for the diagnose both type 1 and type 2 diabetes published threshold levels for four types of blood glucose tests, any of which may affirm a diagnosis of diabetes or prediabetes. ADA added ?, as a diagnostic indicator for diabetes. AN HbA, level shows the average blood glucose concentration level over a 3 month period and is commonly used to screen for and diagnose diabetes in adults.

Abnormal plasma glucose, glycated hemoglobin A

Recent literature provides evidentiary support for a link between type 2 diabetes and neurodegenerative disease such as ? in that people with type 2 diabetes are at higher risk for developing ?

Alzheimer's disease (2)

Etiological factors include a strong genetic susceptibility coupled with a variety environmental factors including viral infections, infant diet, and exposure to microbial toxins. Infant diet, specifically ingestion of cow's milk; a short duration of breast-feeding; and early introduction of gluten-based cereals are thought to be inciting factors. Exposure to microbial toxins in the form of ingested nitrites and nitrates in food (processed meat products) and water may also be triggering factors.

Type 1 Diabetes

? is a condition of complete insulin deficiency and requires insulin replacement for survival. Onset of the disease is abrupt with the individual initially presenting in an acutely ill state and oftentimes with a life-threatening condition known as diabetic ketoacidosis resulting from a buildup of ketones in the bloodstream.

Type 1 diabetes

?, most frequently occurs in children and accounts for 5% to 10% of people with diabetes.

Type 1 diabetes, formerly known as insulin dependent or juvenile-onset diabetes mellitus

accounts for 90% to 95% of all cases of diabetes and typically occurs with increasing age and in people who are obese.

Type 2 diabetes

Accelerated ? is an important risk factor for cerebrovascular accident (CVA) as having diabetes doubles the risk of CVA and 1 in 8 to 9 cases of CVA is attributable to diabetes.

atherosclerosis

? leads to compromised functioning of cardiovascular gastrointestinal, genitorinary, and integumentary systems.

Autonomic neuropathy

? results in dry, cracked, skin making it more prone to ulceration and allowing easier access for infection entry.

Autonomic neuropathy

ADA has published nutrition guidelines that recommend a healthy, balanced diet and monitoring intake of ? for people with type 1 diabetes. Long delays between meals should be avoided, as not eating in a predictable pattern consistent with one's insulin regimen may cause ?. Frequent, small snacks at the time of peak insulin action should also be taken to avoid it.

carbohydrates, hypoglycemia

People with diabetes have a higher risk for ? and is a major cause of morbidity and mortality.

cardiovascular disease (CVD)

Meal preparation must meet dietary guidelines. Tasks that require ? may be difficult due to fluctuations in blood glucose levels.

cognitive functioning (e.g. managing medication routines, financial management)

Neuropathies can impact the ability to use ?

communication devices (e.g. writing or typing) or perform home management tasks (e.g. meal preparation).

Management of mild infections involves antimicrobial therapy with surgical intervention in the form of ?. Severe infections leading to gangrene tissues require limb amputation. Risk factors for foot ulcers or amputation include being male; having diabetes > 10 years; smoking; and presence of PAD, peripheral neuropathy, nephropathy, or foot structure abnormalities.

debridement or revascularization

Finally, assessment and management of psychosocial issues (e.g. ?) are important to ensure that individuals with type 1 diabetes can responsibly and effectively manage their diabetes care.

depression, anxiety related to hypoglycemia or hyperglycemia, eating disorders, family tensions

Damage to autonomic nerves that innervate organs leads to ? that affects multiple systems in the body including the cardiovascular, gastrointestinal, and genitourinary systems. It produces a wide spectrum of symptoms and onset is gradual and progressive.

diabetic autonomic neuropathy (DAN)

Multiple sequelae of diabetes merge to make foot ulcers and infections common leading to a condition known as ?. Etiological factors leading to foot ulcers include repetitive stress on the skin with body weight and activity level increasing the pressure.

diabetic foot.

Up to 50% of people with long-standing type 1 or type 2 diabetes have damage to peripheral nerves, a condition known as ? with painful DPN affecting up to 25% of people with diabetes.

diabetic peripheral neuropathy

For people with ESRD, renal replacement therapy in the form of ? is required for survival with transplantation offering the most optimal outcomes.

dialysis or kidney transplant

People with diabetes must develop and adhere to effective routines to manage the multifaceted care demands including ?

dietary and nutritional issues, physical fitness, medication management, and reduction of health risk behaviors such as smoking cessation.

Retinopathy, neuropathy, and fluctuating blood glucose levels may make ?

driving and community mobility difficult or prohibitive.

Finally, social participation may be limited by ?

fatigue and decreased mobility.

Lower extremity neuropathies affect

functional mobility.

The ? purports that improved hygiene practices are decreasing childhood exposure to infectious agents and subsequent opportunities for immune system development leading to a rise in autoimmune diseases

hygiene hypothesis

Because of onset of type 2 diabetes is gradual, levels of ? may not be severe enough to produce noticeable symptoms.

hyperglycemia

Classic symptoms of type 1 diabetes are those caused by ? : ? (increased thirst), ? (frequent urination), ? (increased hunger), ?, and ?. Additional symptoms of type 1 may include muscle cramps, irritability, emotional lability, headaches, anxiety attacks, abdominal pain or discomfort, diarrhea or constipation, and altered school and work behaviors. The individual may also present with ?. Ketones are waste products from the body's breakdown of fat for energy, high concentrations of which leads to DKA.

hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, blurred vision, ketonuria

Risk factors for severe ? include unawareness , longer durations of insulin replacement therapy, cognitive deficits, age (e.g. early childhood or adolescence), and low socioeconomic status or health literacy. Symptoms include, but are not limited to trembling, sweating, hunger, anxiety, confusion, drowsiness, dizziness, and difficulty concentrating.

hypoglycemia

Severe ? states are dangerous as they can result in falls or automobile accidents. To treat ?, the individual needs to ingest some form of carbohydrate that contains sugar, for example, orange juice, cola, and candy. Some strategies that can prevent this are education, careful self monitoring of blood glucose levels, diet and exercise adjustments, and medication modifications.

hypoglycemic (2)

Total lack of ? is potentially lethal, and a chronic high blood glucose level has devastating effects on multiple tissues and organ systems.

insulin

For people diagnosed with diabetes, longevity and quality of life are currently better than in the past owing to improvements in ? regimens, medication treatment for ?(ie. excessive concentration of fats or lipids in the bloodstream), and ? modifications.

insulin delivery, hyperlipidemia, lifestyle

Severity of PAD increases with duration of diabetes and presence of neuropathy. Two categories of symptoms include ? and ?. PAD predisposes people with diabetes to impaired wound healing, tissue hypoxia, and decreased mobilization of white blood cells to infected tissues all of which contribute to diabetes being the leading cause of?

intermittent claudication (pain or discomfort during walking or exercise that resolves with rest), resting pain, nontraumatic lower extremity amputation.

There is no ? for diabetes; therefore, medical management focuses on developing individually tailored, culturally sensitive, and age and developmentally appropriate care plans. Management regimens center on insulin replacement, glycemic control, assessment of and prevention of complications, and attention to lifestyle and psychosocial issues.

known cure

Having diabetes for ?and ? further the risk of CVD for people with diabetes. Thus, CVD is becoming more common in people with type ? diabetes as these individuals are living longer. ? with diabetes have a 40% greater chance of developing CVD as compared to ?

longer duration, older age, type 1, women, men

Problems include ?, (nighttime urination), restless leg syndrome, apnea, and inadequate amount of sleep. Education, work, play, and leisure participation routines must incorporate diabetes self-management including SMBG and adhering to insulin regimens.

nocturia

One additional blood test result indicative of type 1 diabetes is the presence of ?; however, most laboratories are not equipped to measure all ? and may produce false-negative results.

pancreatic autoantibodies, autoantibodies

Functioning in specific activities of daily living (ADLs) that affect disease outcomes include ? Risk of diabetic foot complications can be reduced by ?. The link between periodontal disease and diabetes makes proper ? imperative.

personal hygiene and grooming (i.e. personal hygiene and grooming (i.e. personal hygiene, dental care) and personal device care (i.e blood glucose meters, insulin syringes). daily inspection and care of feet. dental hygiene

? is an acute and potentially life-threatening condition that may appear as the first symptom of previously undiagnosed diabetes.

DKA

Clinical signs of ? include dehydration; tachycardia (rapid heart rate); tachypnea (rapid breathing); deep, sighing respirations with fruity breath odor; nausea and vomiting; abdominal pain; and confusion or drowsiness.

DKA

? is rare in type 2 diabetes but can present concurrently with other conditions such as infections, stroke, or pancreatitis. However, symptoms related to chronic ? and subsequent systemic complications can occur, for example, nephropathy, neuropathy, and retinopathy. These symptoms may be present upon diagnosis if preceded by long periods of ?

DKA, hyperglycemia (2)

Risk factors include duration of diabetes, poor glycemic control, and cardiovascular risk factors such as abdominal obesity, hypertension, and hyperlipidemia. Cigarette smoking is also positively associated with ?.

DPN (Diabetic Peripheral Neuropathy)

Most people with ? are asymptomatic until late stages, and rate of progression can be rapid. Regular screening and early diagnosis and treatment, including intensive insulin control can slow the disease process.

DR

?is the leading cause of end-stage renal disease (ESRD), a condition of nonfunctioning kidneys.

Diabetes Twenty to forty percent of people with diabetes were diagnosed with kidney disease.

Sensory functions are affected by ? and ?. ? visual impairment can ultimately lead to blindness. ? affects sensory functioning such that people with diabetes often experience pain that may be severe along with diminished touch and pressure sensations in the upper and lower extremities.

retinopathies and neuropathies, Retinopathy, Neuropathy

For ? diabetes, non-hispanic white people have the highest while african americans and people of asian descent have the lowest prevalence.

type 1

The ? disease process is precipitated by an autoimmune response whereby antibodies are produced that destroy pancreatic insulin producing cells known as beta cells.

type 1 diabetes

Attention to lifestyle factors such as diet and physical activity levels/exercise along with psychosocial issues is important to the management of ? diabetes. People with ? diabetes should participate in nutrition therapy comprised of education related to how food impacts blood glucose, how to avoid hypoglycemia or hyperglycemia resulting from food-exercise insulin interactions, and how to adapt food-related plans to a various situations.

type 1, type 1

Non-Hispanic white youth has the highest rate of newly diagnosed cases of type ? diabetes, with type ? being extremely rare in this group under age 10. The highest rates of newly diagnosed type 2 cases occurred in American Indians/Alaskan natives, non hispanic, African americans, and hispanics. For these groups, the incidence of type 2 diabetes was greater than that of type 1.

type 1, type 2

People with ? diabetes who are insulin dependent should monitor before breakfast, dinner, and bedtime, with the goal of monitoring being to avoid hyperglycemia.

type 2

Prevalence of ? diabetes is highest among American Indians/Alaskan natives followed by non-hispanic african americans, hispanics, asian americans, and non-hispanic Caucasians.

type 2

Those with type ? diabetes commonly develop HTN associated with central obesity. HTN combined with diabetes produces significant risk for cerebrovascular disease, retinopathy, and end-stage renal disease.

type 2

?, refers to a group of metabolic conditions characterized by a malfunction in the body's ability to make insulin, to use insulin, or a combination of both.

Diabetes mellitus, more commonly known as diabetes

? is the leading cause of blindness in adults aged 20 to 65 years. Similarly ? were more likely than ? with diabetes to report visual impairment. Risk factors include longer duration of diabetes, HTN, hyperglycemia, obesity, and puberty.

Diabetes retinopathy (DR) females, males

? results from structural and functional changes in the kidney that lead to chronic kidney disease, the progression of which can be slowed by optimal interventions of strict blood pressure and glycemic control.

Diabetic nephropathy

? glucose levels are measured following a minimum of an 8 hour period of no caloric intake.

Fasting plasma

In ? diabetes mellitus, the pancreas secretes insulin resistance is present and the amount of insulin may be insufficient, producing a chronic state of hyperglycemia.

type 2 (formerly known as non-insulin dependent or adult-onset)

? produces bladder dysfunction in the form of decreased sensation that results in decreased voiding frequency, urinary retention, and subsequent increased risk of urinary tract infections. ? is common in men with diabetes over the age of 50 with erectile dysfunction the most frequent issue. ? is typically the first sign of DAN for this age group.

Genitourinary involvement, Sexual dysfunction, Erectile dysfunction

? is a transient form of diabetes mellitus that first appears during pregnancy and typically requires no further treatment after delivery.

Gestational diabetes

Adults with ?diabetes are more prone to learning and memory deficits and a higher risk for developing Alzheimer's disease. Emotional regulation is also impacted depression and diabetes are common comorbid conditions, especially for ? diabetes over the age of 40 and youth and adults with ?

type 2 , females with type 1, type 2 diabetes.

Beta cell malfunction in ? has a clear genetic element. Nevertheless, etiological factors related to age, obesity, sedentary lifestyle and other lifestyle factors are prevalent in the literature.

type 2 diabetes

Onset of ? is gradual, and in asymptomatic cases, the disease may go undetected for years. Historically, this diagnoses were limited to adults. A marked increase in prevalence of obesity in children and adolescents both in the United States and globally has resulted in dramatic increases in this type of diabetes for these age groups.

type 2 diabetes

Along with accelerated atherosclerosis, typical cardiac risk factors (e.g. HTN, smoking, abnormal cholesterol level, obesity, and inactivity) are common in people with ?

type 2 diabetes.

Individuals with ? diabetes may initially respond to oral hypoglycemics but then not respond well after years of therapy. This could be the result of ?, progression of pancreatic failure to produce insulin, complications from comorbid medical conditions or medications, or development of tolerance to medications. ? is indicated at that point.

type 2, decreased compliance with diet and exercise programs, Insulin therapy

? are perhaps the most important IADL tasks for people with diabetes.

Health management and maintenance

is a condition of too little insulin causing abnormally high blood glucose levels. If untreated, the patient is at risk for entering into a diabetic coma. Mortality from this increases with age typically due to the presence of a comorbid condition (myocardial infarction, cerebral vascular accident, sepsis). Treatment depends on insulin to reverse metabolic abnormalities and successful treatment of the comorbid conditions.

Hyperglycemia

? has a direct toxic effect on body tissues. Few diseases have the same potential for damaging as many organ systems and producing impairments as does ?

Hyperglycemia, diabetes

? affects over two thirds of people with type 2 diabetes as well as young adults with type 1 diabetes who have an underlying disorder such as nephropathy.

Hypertension

? or insulin shock is a condition of too much insulin or oral hyoglycemic medication and not enough glucose in the bloodstream.

Hypoglycemia

Almost 16% of adults over age 60 with diabetes report needing assistance with ?.

IADLs

? is a hormone produced by the pancreas and functions to regulate glucose metabolism. It transports glucose into the body's cells where it is used for growth and energy. Without it, glucose builds up in the bloodstream producing a condition known as ?. The excess glucose is ultimately excreted in the urine. Without insulin to transport it, organs and tissues do not receive glucose causing the body to break down its own fat or lipids to produce an energy source.The by-products of this process are known as ? that are released in the bloodstream.

Insulin, hyperglycemia, ketones

? occurs at an earlier age and at a faster rate in people with diabetes with those in the age 40 to 49 year old range who have at least one other risk factor for atherosclerosis at higher risk.

PAD

?is a condition of decreased arterial blood flow to the extremities, stomach, and kidneys.

Peripheral artery disease (PAD)