Term
| What should a CDE do first w/ regards to a newly dx DM |
|
Definition
| -Assess the individuals needs, interests and problems |
|
|
Term
Newly dx Type 2 DM:
Symptoms |
|
Definition
-Polyuria
-Fatigue
-Polydipsia
-Fasting BGL of 426
-Negative Ketones |
|
|
Term
Routine Lab check for a pt with hx of normal glucose, reveals a fasting glucose of 113mg/dl.
What does this indicate? |
|
Definition
|
|
Term
Skin changes a/w DM:
Shin Spots |
|
Definition
-Most Common (70%)
-Pigmented spots seen on extensor surfaces of lower extremities that lead to hyperpigmented macules
-Lesions are asymptomatic, heal over time and leave scars
-NO specific therapy |
|
|
Term
Skin changes a/w DM:
Diabetic Bullae Info |
|
Definition
-Usually seen in adults with long standing DM neuropathy
-Usually on hands, feet
-Tend to resolve in several weeks |
|
|
Term
Skin changes a/w DM:
Acanthosis Nigricans |
|
Definition
-R/t obesity and insulin resistance
-Can be thickened, velvety-brown, streaking to leathery type hyper-pigmented plaque
-Commonly around the neck, skin folds in axilla, under breast and around the belt line and groin |
|
|
Term
Skin changes a/w DM:
Thick Skin |
|
Definition
-Abnormal Collagen collection
-Thickness occurs on hands, knuckles, and fingers
-Improved glycemic control and steroids can be helpful |
|
|
Term
Skin changes a/w DM:
Xanthoma |
|
Definition
-Extracellular deposits of lipid in the form of chol/TG in dermis or SQ fat
-Usually occurs when TG >800
-Lesions mau be individual or form a cluster
-Therapy aimed at correcting elevated Lipid levels. |
|
|
Term
Skin changes a/w DM:
Vitiligo |
|
Definition
-Hypopigmentation of the skin and sometimes seen in pts w/ auto-immune dx such as DM 1
-Lesions are white and seen around orifices and over joints
-No known treatment |
|
|
Term
Alternate Testing Sites:
Location |
|
Definition
-Forearm
-Palm
-Upper arm
-Thigh |
|
|
Term
Alternate Testing Sites:
Do NOTS |
|
Definition
-Can be used before meals OR 2 hours after a meal
DO NOTS:
-<2 hr after meal
-to check for HYPOglycemia
-during peak of injected insulin
-during/after physical activity
-during illness
-before driving
-if have hypOglycemia unawareness |
|
|
Term
Pre-DM Tests and Diagnosis:
Fasting Plasma |
|
Definition
-Fasting Plasma: 100-125
(fasting = NO kcal intake for 8 hours) |
|
|
Term
Pre-DM Tests and Diagnosis:
2 hour |
|
Definition
-2 hour plasma glucose: 140-199 during 75 gm CHO intake test
-Unless increase in symptoms, must be confirmed by repeat testing |
|
|
Term
|
Definition
-Fasting Plasma >/126
(No kcal intake for 8 hours) |
|
|
Term
|
Definition
-2 hour Plasma >/200
-Unless increased symptoms of hyperglycemia, must be confirmed by repeat test |
|
|
Term
|
Definition
-Acute symptoms and Casual test >200
-Unless increased symptoms of hyperglycemia, must be confirmed by repeat test |
|
|
Term
| What is the most frequent cause of inaccurate results from BG monitoring? |
|
Definition
|
|
Term
|
Definition
-Adequate Insulin is continued to resolve acidosis
-Takes longer to reverse than does hyperglycemia therapy w/ insulin |
|
|
Term
Monitoring Effects
Related to A1c |
|
Definition
| -Each Days additional glucose measurement corresponds to a 0.2% reduction in A1c |
|
|
Term
|
Definition
-Adequate Hydration
-Adequate Insulin to restore and maintain normal glucose metabolism
-Correct Electrolyte deficits and acidosis PRN
-Prevent complications
-Provide source of glucose PRN
-Pt/Family education and F/U |
|
|
Term
|
Definition
-Essential for type 1 DM
-Urine/Blood: Check when BGL >300
or if sick and BGL >250
-Pumpers 2 readings >250 w/ Correction Bolus and 1hr b/t readings
-Type 1 w/ Ketones call MD |
|
|
Term
Sick Day Management:
Hydration |
|
Definition
| 8 oz fluid/hr, every 3 hrs Na rich fluid |
|
|
Term
|
Definition
| every 2-4hrs while BGL high or symptoms subside |
|
|
Term
Sick Day Management:
Ketones |
|
Definition
every 4hrs until negative
(Type 2 DM individualize) |
|
|
Term
Sick Day Management:
Med Changes |
|
Definition
-Continue as able, adjust Insulin dose for increased BGL
-Hold Metformin during serious illness
-Call MD for specific instructions |
|
|
Term
Sick Day Management:
Food/Drink |
|
Definition
-Consume 150-200gm CHO daily
-Switch to liquids as tolerated |
|
|
Term
Sick Day Management:
Contact MD If |
|
Definition
-Vomiting more than once
-Diarrhea >5 times or longer than 6 hrs
-BS >300 x 2
-Moderate/large urine Ketones
-Blood Ketones >0.6 |
|
|
Term
| How often should individuals with DM have a dental checkup? |
|
Definition
| -Every 6 months and more often if there is periodontal dx |
|
|
Term
| When Evaluating a pt on a Basal/Bolus insulin regimen, what would be most helpful for basing the Basal doses? |
|
Definition
|
|
Term
| Choices for HypOglycemia Episodes |
|
Definition
-Glucose tabs/gel
-Hard Candies (3-4)
-Live-savers (8-10)
-4oz Juice/sports drink
-Anything w/ atleast 15g fast-acting CHO (1 TB Honey/Jello/Sugar, 1p Fruit, 2 TB raisins) |
|
|
Term
| Physical Activity Recommendations for Those injecting Insulin or taking Insulin Secretagogues |
|
Definition
-Monitor BGL prior/during acitivity
-Goal prior: >/110
-Snack prior to increase BGL
-Reduce Insulin w/ lower Med intake
-Good PO med to reduce = Meglitinide 2/2 Shorter duration than Sulfonylureas |
|
|
Term
| Graded Exercise Test Recommendations |
|
Definition
- > 40yo
- > 30yo with DM x 10 years OR HTN, Dyslipidemia, Retinopathy, Renal Failure, Smoker
-Any age w/ CVD, Autonomic neuropathy, renal failure |
|
|
Term
|
Definition
-Measures % Hgb with Sugar
-Normal: 4-6% |
|
|
Term
|
Definition
-Check q 6m w/ controlled BGLs
-Check q 3m w/ uncontrolled BGLs |
|
|
Term
Hgb A1c
Goals for ppl with DM |
|
Definition
|
|
Term
MicroAlbuminuria Screening:
Definition |
|
Definition
| -High levels of Albumin in Urine |
|
|
Term
MicroAlbuminuria Screening:
Indicators of early stage Nephropathy |
|
Definition
-Type 1: Annual test 5 years post DM dx
-Type 2: Annual after DM dx
-> 20mcg/min, < 200mcg/min
-30-300 mg/24 hours |
|
|
Term
MicroAlbuminuria Screening:
Overt Nephropathy (Clinical Albuminuria) |
|
Definition
->/200 mcg/min (times test)
->/300 mcg/min (24 hour collection)
->/300 mcg/g creatinine (spot test
**Must confirm with 2-3 specimens |
|
|
Term
Therapeutic Goals for BGL:
Hgb A1c |
|
Definition
|
|
Term
Therapeutic Goals for BGL:
Pre-Prandial |
|
Definition
|
|
Term
Therapeutic Goals for BGL:
Post-Prandial |
|
Definition
|
|
Term
Therapeutic Goals for BGL:
ADA Bedtime Goal |
|
Definition
|
|
