Test 2

Diabetes, heart disease, wound healing

How do nitrates work?

reduce stress on the heart by improving blood flow to the heart muscle by vasodilation

What is insulin resistance?

Defect in insulin receptors, made worse by obesity

How does insulin decrease glucose?

Insulin decreases glucose by binding to insulin receptors of muscle cells and adipose tissue

What is cellular starvation?

Breakdown of fats + proteins for energy; ketones produced

Diabetes is a disorder of which organ?

the endocrine pancreas

What are common conditions that result in impaired insulin use? (2)

• pregnancy

• Corticosteroid use (long term use of Prednisone = blood sugars stay up)

What is the normal fasting plasma glucose (FPG) for people without diabetes?

4.0 - 6.0 mmol/L

What is an A1C test?

Glucose attaches to hemoglobin over span of 3 months to help evaluate how well diabetes is being managed

What are the 3 possible causes of type 2 diabetes?

• Pancreas does not produce enough insulin.

• The body does not effectively use the produced insulin.

• Body develops resistance to insulin.

What are risk factors for type 2 diabetes? (8)

• Genetics

• Age (over 40)

• Obesity

• Hypertension

• Gestational diabetes

• PCOS

• Depression

• Insulin resistance

What are the common symptoms of type 2 diabetes? (6)

• polyuria: increased urination

• polydipsia: increased thirst

• polyphagia: increased hunger

• blurred vision

• fatigue

• paresthesia: tingling/prickling sensation in lower limbs

Polyuria

Increased urination

Polydipsia

Increased thirst

Polyphagia

Increased hunger

Paresthesia

Tingling/prickling sensation in lower limbs

What is the cause of type 1 diabetes?

Insulin production absent because of autoimmune pancreatic beta-cell destruction

What is endogenous insulin supply?

Natural insulin supply

What are the signs and symptoms of type 1 diabetes? (9)

• Polyphagia

• Polydipsia

• Polyuria

• Weight loss

• Fatigue

• Blurring of vision

• Nausea / vomiting

• Fruity breath

• Rapid breathing

What is the normal IGT value?

<7.8

What is the normal IFG value?

<6.1

What is the normal A1C value?

<6.0%

What is a pre diabetic IFG value?

>6.1 but <6.9

What is the pre diabetic IGT value?

>7.8 but <11.1

What is the pre diabetic A1C level

>6.0% but <6.5%

What is the diabetic IFG level?

≥7.0

What is the diabetic IGT level?

≥ 11.1

What is the diabetic A1C level?

≥6.5%

What is IFG?

Impaired fasting glucose

An overnight fast, blood glucose is measured in the morning

What is IGT?

Impaired glucose tolerance

Measures blood glucose 2 hours after drinking glucose solution

Which foods have the greatest effect on blood glucose?

Simple carbs

Which foods have the least effect on blood glucose (3)

• fats

• Proteins

• Vegetables

What is the target fasting glucose for people with diabetes?

4 - 7 mmol/L

What is the target blood glucose 2 hours after meals for a person with diabetes?

5 - 8 mmol/L

What is the target A1C for people with diabetes?

7%

What are insulin sensitizers?

Makes cell more sensitive to let glucose in.

Ex. Biguanides - Metformin

What are insulin secretagogues?

Stimulate the beta cells to secrete more insulin.

Ex. Sulfonylureas

Where is the best site of insulin administration and why?

Abdomen - most consistent absorption and less muscle

How is insulin administered

Subcutaneously

What type of diabetes are oral hypoglycemic medications used for?

Type 2 diabetes

What is lipohypertrophy?

Hardened area of fat due to injections in same area

How long does insulin last in the fridge unopened? At room temperature?

Fridge unopened: 3 months

Room temperature: 30 days

What is the difference between Basal and Prandial insulin?

- Basal insulin works slowly throughout the day (long-acting)

- Prandial insulin is used after meals (rapid-acting)

What are 4 potential complications of diabetes?

• Hypoglycemia

• Hyperglycemia

• Macrovascular complications

• Microvascular complications

What is the blood glucose level that indicates hypoglycemia?

4 mmol/L or less

What are symptoms of hypoglycemia? (7)

• Weakness

• Shakiness

• Pale, cool skin

• Tachycardia

• Nausea

• Hunger

• Diaphoresis

How is hypoglycemia treated?

• Give 15 gm simple carbohydrate (sugar)

What are some macrovascular complications of diabetes? (4)

• Myocardial infarction

• Cerebral vascular accident

• Ischemic heart disease

• Peripheral vascular disease

Why does diabetes increase a persons risk of heart disease?

High blood glucose forms fatty deposits inside of arteries

What are some microvascular complications of diabetes? (3)

• Retinopathy

• Neuropathy

• Nephropathy

Retinopathy

Damage to blood vessels in retina from chronic high blood glucose

Neuropathy

Damage to peripheral nerves, loss of sensory ability

How will neuropathic pain be described?

Tingling, burning, numb, radiating

Nephropathy

Deterioration of kidney function, due to high glucose destroying the filtering ability of the kidneys

What is Charcot’s foot?

gradual weakening of bones, joints, and soft tissues of the foot or ankle due to neuropathy

What is the blood glucose level that indicates hyperglycemia?

over 7.8 mmol/L

What are the symptoms of hyperglycemia? (5)

• polydipsia

• polyuria

• tiredness

• blurred vision

• polyphagia

What is the most significant modifiable risk factor for cardiovascular disease?

High blood pressure

What is hypertension?

Sustained elevation of blood pressure, damages arteries by making them less elastic and causing decreased flow of blood and oxygen to the heart.

What blood pressure is considered hypertension?

BP > or = 140/90

What are possible complications of hypertension? (5)

• Heart attack

• Renal failure

• Blood vessel damage

• Retinopathy

• Neurological issues (dementia)

What are objective assessment findings that indicate hypertension? (6)

• Orthostatic hypotension

• Carotid bruits

• Edema

• Decreased peripheral pulses

• Abdominal obesity

• BP > 140/90

What are symptoms of hypertension? (8)

• Dyspnea on exertion

• Palpitations

• Anginal chest pain

• Fatigue

• Intermittent claudication; muscle cramps

• Nocturia

• Dizziness, blurred vision, headache

• Erectile dysfunction

What are classes of antihypertensive medications? (5)

• Diuretics

• Angiotensin coverting enzyme inhibitors (ACE)

• Angiotensin receptor blockers (ARBs)

• Beta adrenergic blockers (Beta blockers)

• Calcium channel blockers

What is hyperlipidemia?

Increased levels of lipids (fats) in the blood, including LDL cholesterol and triglycerides

What are signs and symptoms of hyperlipidemia? (4)

• Chest pain / pressure

• High blood pressure

• Heart attack

• Stroke

What medication is used to treat hyperlipidemia, and how does it work?

Statins: inhibit synthesis of cholesterol in the liver

Coronary artery disease

Blood supply to the heart is partially or completely blocked

What is atherosclerosis?

An inflammatory response that thickens or hardens the arteries. It is caused by a buildup of plaque, and is the major cause of CAD

What are risks factors for coronary artery disease? (9)

• Age

• Genetics

• Low HDL, high LDL

• Diabetes

• Smoking

• Obesity

• High blood pressure

• Diet

• Sedentary behaviour

What are symptoms of coronary artery disease? (7)

• Chest pain / discomfort

• Weakness

• Nausea

• Dizziness

• Diaphoresis

• Pain in arm / shoulder

• SOB

What is ischemia?

A condition caused when any tissue isn’t getting an adequate blood supply

What is angina?

A type of chest pain caused when oxygen demands exceed the supply

Chronic stable angina

chronic chest pain that can be provoked by exertion, smoking, large meals, stress, etc.

What medication relieves chest pain?

Nitroglycerin

How are wounds classified? (4)

1. the underlying cause (surgical / nonsurgical)

2. the underlying pathology (vascular, pressure, etc)

3. the duration of healing (acute / chronic)

4. the depth of the tissue (superficial, partial, or full thickness)

What are the three types of wound healing?

Primary, secondary, and tertiary intention

What is wound healing by primary intention?

closed by surgical intervention (sutures, staples, glue)

What is wound healing by secondary intention?

left open to heal from inside - out

What is wound healing by tertiary intention?

left open on purpose due to infection or contamination

What are the 4 stages of wound healing?

1. Hemostasis

2. Inflammation

3. Proliferation

4. Remodeling

What happens during the hemostasis stage of wound healing?

1st phase: vasoconstriction, clotting factors released, blood clots

What happens during the inflammation stage of wound healing?

2nd phase: wbcs and enzymes enter wound site to clear bacteria and debris, preparing the wound bed for new tissue growth

What happens during the proliferation stage of wound healing?

3rd stage: filling and covering the wound with granulation tissue, wound contraction, and epithelialization to form new skin

What happens during the remodeling stage of wound healing?

4th stage: scar tissue formation, new tissue gradually becomes stronger and more flexibile due to collagen

What are local manifestations of inflammation? (4)

• Redness (from vasodilation)

• Heat (from increased metabolism at site)

• Pain (from nerve stimulation and pressure from exudate)

• Swelling (from fluid shifting to interstitial spaces)

What causes arterial wounds?

Occurs from tissue ischemia (poor circulation)

Where are arterial wounds often found?

Feet, toes, and over bony areas

What are characteristics of arterial wounds? (3)

• Painful

• High risk for infection

• Defined borders (looks like a hole punch)

What causes venous wounds?

Pooling of blood that creates increased pressure in the veins and skin breakdown

Where are venous wounds often found?

Between the knee and ankle

What are the characteristics of venous wounds? (4)

• Large, shallow, inflamed

• Dull ache throughout leg

• Weepy (serous drainage)

• Irregular borders

What causes diabetic ulcers?

Peripheral neuropathy, trauma, pressure

Where are diabetic ulcers usually found?

Feet and lower legs

Where are pressure wounds usually found?

Over bony prominences

What causes pressure wounds? (4)

• Friction

• Moisture

• Immobility

• Poor nutrition

What is incisional dehiscence

When a wound that has been closed reopens

What factors delay wound healing? (9)

• Inadequate nutrition

• Inadequate blood supply

• Smoking

• Corticosteroids

• Infection

• Age

• Obesity

• Diabetes

• Moisture

What are adhesions?

Bands of scar tissue that form between or around organs

What are contractures?

Shortening of muscle or scar tissue from excessive fibrous tissue formation

What is evisceration?

Occurs when wound edges seperate to the extent that intestines protrude through the wound