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Chronic Conditions Exam 1
Diabetes
40
Other
Not Applicable
01/08/2005

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Cards

Term
What is the normal function of insulin in the liver?
Definition
Supresses release of glycogen so it the body will use carbs for energy, rather than body stores.
Term
What is the normal function of insulin in
muscle tissue?
Definition
Increases uptake and storage of glucose.
Term
What is the normal function of insulin in Adipose tissue?
Definition
Increase uptake and storage of gluces as a lipid.
Term
VOCAB: Insulin Resistance
Definition
Insulin is present in the blood stream, but the body is incapable of using it for glucose uptake.
Term
Describe the role of skeletal muscle in insulin resistance.
Definition
Contraction of skeletal muscle facilitates glucose transport into cells, increases insulin sentivity throughout the body and decreases plasma insulin levels. So those with insulin resistance can still control glucose uptake by using their muscles in exercise.
Term
Describe the pathology of insulin dependent diabetes mellitus, age of onset, and treatment.
Definition
Juvenile onset. There is destruction of pancreatic beta cells, so there is a lack of insulin production. Tx: Insulin injections, or oral insulin.
Term
Describe the pathology of non-insulin dependent diabetes mellitis.
Definition
Adult onset. Insulin is produced normally, but the body is incapable of using it.
Term
What are the risk factors for NIDDM?
Definition
Heredity, obesity, age
Term
What three major metabolic problems arise with lack of insulin?
Definition
Decreased utilization of glucose, Increased fat metabolism, Impaired protein utilization.
Term
How does lack of insulin cause decreased utilization of glucose for metabolism?
Definition
The insulin can't help cells use the plasma glucose.
Term
How does decreased utilization of glucose affect the body? (in terms of glucose in blood stream, and actions of the liver, and kidney.)
Definition
1. Glucose accumulates in the blood stream. 2. The liver increases synthesis of glucose because insulin isn't stopping it. 3. The kidney exretes excess glucose, resulting in glucose in the urine. This causes increased urine production, leading to decreased fluid volume deficit, so the person becomes thirsty and drinks large amounts of water.
Term
VOCAB: Polydypsea
What causes it?
Definition
Excessive thirst. Caused by increased excretion of fluid through the kidneys due to glucoseurea.
Term
Why does decreased insulin lead to increased fat metabolism? What problems result from this?
Definition
The body can't uptake glucose for energy, so it has to break fat down into ketones. As a result, lipid levels rise in the blood stream which leads to increased risk for atherosclerosis.
Term
What are some short-term signs and symptoms of diabetes? (6)
Definition
Polyuria, polydipsia, polyphagia, weight loss, fatigue, acetone breath.
Term
Why would a diabetic suffer from polyphagia?
Definition
Because glucose isn't absorbed into cells, the person feels hungry and is triggered to eat more.
Term
Why would diabetes lead to weight loss?
Definition
Because glucose isn't be stored, and stored fat is being broken down for energy.
Term
What are some long-term effects of diabetes? (6)
What are some secondary problems that arise from these long-term effects?
Definition
Retinopathy, Nephropathy, Vascular Problems, Neuropathy, Osteoporosis, Ulceration.
Secondary Problems:
Deformity (claw toes, flatfoot w/ valcus of midfoot, collapse of long arch b/c of motor neuropathy, charcot foot), Loss of sweat regulation --> dry, cracking skin, ulceration.
Term
VOCAB: Charcot Foot
Where do ulcerations appear?
Definition
Rigid rocker-bottom foot.
Ulcerations appear under the talus and navicular.
Term
What are some complications of insulin therapy?
Definition
Hypoglycemia, Erratic insulin action
Term
What are some symptoms of hypoglycemia?
Definition
Increased sympathetic activity (rapid HR, perspiration, piloerection - goosebumps), Weakness, irritability, lack of muscle coordination, shakiness, Inability to respond to verbal commands, confusion, difficulty concentrating, headache, double/blurred vision, hunger, shallow respiratoins, dilated pupils, convulsions, tremors, coma.
Term
What is the definition of hypoglycemia?
Definition
Blood glucose less than 70mg/Dl
Term
Signs and symptoms of hyperglycemia
Definition
Acetone breath, dehydration/thirst, weak puls, headache, fever, flushed face, polyuria, diminished reflexes, paresthesias, lethargy, confusion, coma
Term
What is the definition of hyperglycemia?
Definition
Blood glucose level greater than 300mg/dl
Term
Treatment for Hypoglycemia:
Definition
provide carbs immediately, ie:juice. If unconscious, they need immediate medical attention, don't try to feed them.
Term
Tx for hyperglycemia
Definition
Administer fluids and insulin.
Term
What do you do if you're not sure if your patient is hyper or hypoglycemic?
Definition
Give them juice. If they're hypoglycemic it will make them better immediately, but it won't really harm the patient if they're hyperglycemic. If juice doesn't make them better you know they're hyperglycemic.
Term
What are the two mechanisms for the transport of glucose into muscle?
Definition
Insulin mediated and muscle-contraction induced.
Term
How can the non-insulin dependent diabetic patient benefit from exercise? (6)
Definition
1. Improves skeletal muscle glucose transport and glucose homeostasis. 2. Incrases carb metabolism, which lowers blood glucose level. 3. Aids in maintaining optimal body weight. 4. Increases HDLs while decreasing triglycerides, BP, stress and tension. 5. Controls hyperglycemia 6. Improves short-term insulin sensitivity.
Term
How does exercise improve glycemic control in the IDDM pt?
Definition
It DOESN'T!
But it does help other systems: cardiac, etc...
Term
What is the major risk associated w/ exercise in the IDDM pt?
Definition
Hyperglycemia can be profound, and present even days after exertion. So it can result in a rise in blood glucose, ketosis, and ketoacidosis.
Term
Why do you have to time exercise and insulin injections carefully?
Definition
If exercise is done within 1hr of an insulin injection it can lead to hypoglycemia, by potentiating the effects of the injected insulin.
Term
Contraindications to exercise in DM:
Definition
1. Poor control of blood glucose levels. 2. Poorly controlled associated conditions(ie: HTN, retinopathy, nephropathy) 3. Dehydration
Term
Whare are the important key elements to discuss with the diabetic pt who wants to start an exercise program?
Definition
1. Assess glucose levels before and after exercise. If glucose is OK after exercise, that exercise is safe for them.
2. Carbohydrate and insulin requirements for the exercise. 3. Risk of injury, especially w/ walking.
Term
What is the optimal blood glucose level?
What is considered a "safe" glucose level?
Definition
Optimal = 80-120 mg/dl
Safe = between 100 and 250.
Term
To do before exercise:
Definition
1. Monitor glucose levels. 2. Monitor ketone levels in urine. Postpone exercise if these numbers are high. Wait at least 1hr after injection of insulin.
Term
A diabetic patient comes to you requesting an exercise program. Prescribe a program, taking into account risk factors and precautions. Make sure you tell her how often, how hard, and how long she should exercise.
Definition
Begin exercise gradually, 3 days a week for 30 minutes, and keep it low impact. Exercise at the same time each day you work out, and don't exercise within an hour of taking insulin. Be sure to monitor your glucose levels before exercise, and wait until it is lower than 250mg/dl before working out. Be aware of your state as you exercise, and keep hydrated. If you should begin to feel faint, dizzy, have fuzzy vision, ect... stop, and monitor your glucose levels. Have a snack every 30 minutes. You can gradually build the duration up as your body is able to tolerate it. At the conclusion of exercise, monitor your blood glucose every 15 minutes. Be sure to inspect your feet for any sores that may have begun to develop during your workout, particularly if you were walking.
Term
What effects does inactivity have on glucose transport?
Definition
Inactivity --> decr. glucose tolerance, and decr. insulin-mediated glucose disposal. Peripheral insulin resistance can be seen within 3 days of absolute bed rest. Insulin resistance progresses as duration of inactivity increases.
Term
What effect does limb immobilization have on glucose transport?
Definition
Causes skeletal muscle insulin resistance for glucose uptake and glycogen synthesis. Within 1 week of immobility, a decrease occurs in insulin mediated glucose uptake.
Term
What do glut 4 transmitters do?
Why are they so important in the diabetic pt?
Definition
Glut 4 transporters allow skeletal muscle to uptake glucose independent of insulin presence. This allows the NIDDM pt to control their glucose levels.
Term
What is important for your diabetic patients to know if they decide to stop exercising?
Definition
The exercise helped their body uptake some of the extra glucose in their bloodstream. If they stop exercising, this glucose won't be taken up, and their medication may need to be increased to counteract the higher plasma glucose levels.
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