370 DIABETES

what is diabetes mellitus?

a condition when blood glucose is unable to enter the cells because the pancreas stops producing insulin or the cells develop insulin resistance

what are the two types of diabetes? explain.

type one: the pancreas stops producing insulin

type two: the cells develop insulin resistance

what is low blood sugar?

hypoglycemia

what is high blood sugar?

hyperglycemia

is diabetes characterized by hyperglycemia or hypoglycemia?

hyperglycemia

chronic elevated blood sugar can lead to what conditions

CVD

stroke (block flow of blood to brain)

nerve damage (neuropathy)

vision loss

kidney damage

decreased immune function

what is CVD and what is the most common type

cardiovascular disease

the most common type is coronary heart disease which causes destruction of the lumen leading to organ failure

insulin… where is it secreted and what is its purpose?

secreted by the pancreas (explicitly produced by islet cells)

it is essential to allow glucose into the cytoplasm to be metabolized and for the maintenance of blood glucose levels

what is insulin resistance?

the inability of the cells (the insulin receptor specifically) to respond to insulin

what is classified as prediabetes?

glucose is high, but you do not meet diagnosis criteria

your body is developing insulin resistance while also increasing insulin secretion

have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)

what are symptoms (indicators) of prediabetes?

always want food

gain weight

high blood glucose

what is type one diabetes?

B-cell destruction (islet cells) leading to a complete lack of insulin and amylin

autoimmune, sudden onset

insulin-dependent diabetes mellitus (IDDM)

no cure, only managed

what is type two diabetes?

gradual onset

B-cell dysfunction (islet cells) and insulin resistance

non-insulin dependent diabetes (NIDDM)

what is gestational diabetes?

B-cell dysfunction and insulin resistance during pregnancy

can increase complications

what are the health consequences for the baby from gestational diabetes?

* increased risk of birth complications


* caesarian section
* prenatal deaths
* very high birth weight
* birth defects
* obesity and diabetes in child
* developmental problems

what are the health risks for the mother with gestational diabetes?

* increased long term risk of type 2 diabetes (30% compared to 10% in gen pop)
* higher risk of diabetes-related complications in subsequent pregnancies
* stroke
* CVD

what are the symptoms of type 1 diabetes?

frequent and excessive urination (polyuria)

thirst (polydipsia) and sometimes hunger

dehydration

tiredness (because not utilizing sugar as well)

blurred vision (macular degeneration)

\*symptoms develop quickly

\*can progress to ketoacidosis which may lead to coma

what is ketoacidosis?

you are not able to utilize glucose which leads to an accumulation of ketone bodies

what are the symptoms of type 2 diabetes?

similar to type 1

develops gradually

some individuals have no symptoms

controlled by diet and exercise

mainly older adults diagnosed but becoming for prevalent in kids due to diet and physical activity

what percent of type 2 diabetes is related to overeating, obesity, and lack of physical activity?

60-80%

what helps increase insulin sensitivity and decrease risk for diabetes?

regular exercise

what is the normal (no diabetes) fasting plasma BG? 2-hour OGTT? A1C?

100 mg/dL

140 mg/dL

< 5.7%

what is the fasting plasma BG, 2- hour OGTT, and A1C for a prediabetic?

100-125 mg/dL

140-199 mg/dL

5\.7-6.4%

what is the fasting plasma BG, 2-hour OGTT, and A1C for a diabetic?

>(or equal to) 126 mg/dL

>(or equal to) 200 mg/dL

>(or equal to) 6.5%

which test is the biggest contributor to a diagnosis of diabetes and why?

A1C - should be lower than 5.7%

this is used because the fasting plasma and 2-hour OGTT should go down after 2 hours and the A1C is more of a 3 month period

how man people in the US have diabetes?

how many of those are diagnosed cases?

20\.8 million

14\.6 million

what percentage of people with prediabetes will develop type 2 diabetes? how long will it take to happen?

15-30%

within 5 years

what percent of patients with amputations and dialysis have diabetes?

50%

diabetes contributes to what percentage of mortality in the world?

5\.2%

what age does risk for type two diabetes increase?

45 years or older

t/f:

if you have a parent or sibling with type 2 diabetes you are more at risk.

true

what race and ethnic groups are more at risk for type 2 diabetes?

African Americans, Hispanic/Latino Americans, American Indians, pacific islanders, and Asian Americans

increased weight and obesity where in the body increases the risk for type 2 diabetes?

central obesity (fat deposits in the belly)

what type of diabetes increases the risk for type 2 diabetes?

gestational diabetes

what size of baby increases risk of type 2 diabetes?

big babies

does decreased physical activity increase risk of type 2 diabetes?

yes

what are the symptoms of type 2 diabetes?

increased thirst, increased urination, weight loss

when muscle has fat deposits, muscles is less responsive to what?

insulin

what are the ABC’s of diabetes and heart healthy?

A - A1C is less than 6.5%

B - blood pressure is lower than 140/90 or 130/80

C - cholesterol (LDL) is less than 70 to 100

what are 4 major risk factors for diabetes complications?

blood sugar

blood pressure

cholesterol

smoking

when A B and C are abnormal this can lead to what?

stroke, heart attack, diabetes

what is the target blood sugar level when fasting and before meals?

between 80-100

what is the target blood sugar level two hours after starting a meal?

less than 180

what is the recommended A1c?

below 6.5%

what is the best type of diet and why?

the Mediterranean diet

why is the vegetarian diet bad?

can lead to amino acid deficiency

diabetes junior

why is intermittent fasting bad?

reduced metabolism, change in hormone sensitivity

throws off your circadian rhythm → reduces body weight → stop diet → gain weight back

what should you educate patients about reguarding diabetes?

non-starchy vegetables

minimize the addition sugars and refined grains in the diet

select whole grains over processed foods

lifestyle changes/interventions

what are the reccomendations for individuals with type 2 diabetes?

at least 5% weight loss (safe way)

optimal weight loss: 15% in safe way

how much weight should someone with prediabetes lose?

7-10%

when someone is underweight, but has diabetes or is considered overweight should they lose weight?

no

what can help with weight loss?

moderate portion sizes

combination of limiting caloric intake with physical activity

lifestyle interventions

when 5-10% of body weight is lost, remission in patients is what percentage?

60%

what are the blood glucose guidelines?

normal: less than or greater to 100 mg/dL

prediabetes: 101-125 mg/dL

diabetes: greater than 126 mg/dL

blood glucose should be tested how?

on two separate days

what are the consequences of high blood glucose levels?

increased risk of infection in postoperative pts

fluid losses resulting in dehydration

delayed wound healing

increased platelet aggregation = thrombosis (clots)

changes in drug metabolism

gastroparesis

what are some more long term effects of diabetes?

death (due to hypoglycemia from diabetes)

blindness (retinopathy)

renal failure

neuropathy

erectile dysfuncation

foot problems

macrovascular

reduced life expectancy (average 20 years in type 1 and up to 10 years in type 2)

which long term effect is the biggest cause of death?

macrovascular disease (75%)

what is the increase in risk for stroke and heart disease in those with diabetes?

2x risk of death from heart disease

1\.5-4x risk of stroke

what are the microvascular complications?

neuropathy → 60-70% (tingling or burning, pain, foot ulcers, limb amputation, decreased sensation)

retinopathy → blindness (damage to small blood vessels in retina)

kidney disease → 30% of people w/diabetes (dialysis)

how does high blood glucose affect the reproductive systems?

females: vaginal dryness, yeast infections, liver infections

males: sexual dysfunction

how much weight should be lost per week?

1-2 pounds

how much should cals be decreased?

300-500

when losing weight and participation in lifestyle changes, what is the percent reduction of type 2 diabetes?

58%

what should portions on the plate look like?

1/4 grains or starchy foods

1/4 protein

1/2 non starchy veggies (give fiber)

add 1 glass of milk or small piece of fruit

what does fiber do?

limits high caloric food absorbtion

for a diabetic person, it is better to have meals more or less often?

better to have higher frequency but smaller portions

what are some benefits of physical activity?

increases insulin sensitiviry

decreases weight

decreases BP and cholesterol

decreases stress

decreases risk of type 2 diabetes

recommendation for physical acitivity?

30 mins/day 5 to 7 days a week (can be in 10 min increments 3x)

there is an inverse association between type 2 diabetes and what?

yogurt intake

yogurt consumption is associated with what?

healthy weight, decreased weight circumference, healthy levels of glucose, decreased BP

recommended of moderate activity per week to reduce incidence of diabetes in people at risk for diabetes?

120-200 min/week

what is included in a healthy lifestyle?

eating healthy

physical activity

stress management

no smoking

what is considered low blood sugar? what are symptoms?

70 mg/dL or less

sweating or cold, clammy skin,

dizziness, shakiness, fast HR, headache, confusionw

what should you do when blood sugar is less than 70 mg/dL?

eat/drink 15 g of carbs (1/2 can diet soda, 8 oz skim milk, 15 jelly beans, 4 oz apple juice)

recheck in 15 mins

if still low repeat