Chronic Complications Of Diabetes Mellitus
Diabetes Control & Complications Trial (DCCT) United Kingdom Prospective Diabetes Study (UKPDS) - intensive therapy can prevent complications and slow down the progression of already established complications - these studies lay the framework for why early intensive control is important not only for the short term, but to help with long-term prevention of complications - Action to Control Cardiovascular RIsk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease (ADVANCE), and Veteran Affairs Diabetes Trial (VADT) - these trials showed that short-term intensive glycemic control do not positively affect macrovascular risk in T2DM - RECORD study showed no increase in CV risk with rosiglitazone use - over 15 CVOTs have been initiated to evaluate occurrence of major adverse cardiovascular events (MACE) in medications used for diabetes - MACE = CV death, nonfatal MI, and nonfatal stroke - in addition to MACE, additional components may also be studied (hospitalizations for ACS, HF, or urgent revascularization procedures) - based on info regarding these trials, recommendations may be forthcoming to include GLP-1 receptor agonists and SGLT-2 inhibitors as earlier or initial choice of therapy with T2DM Increased tendency of large vessels to become atherosclerotic which then increases risk of MI, emblic strokes, and PAD Patients with DM have a 3-fold greater risk of developing CVD than the general population Leading cause of death in patients with DM = CVD Macrovascular Complications: Antiplatelet Agents When to recommend aspirin in patients with DM: - T1 or T2 at increased CV risk (10-year risk > 10%) - men or women 50+ years with one additional major risk factor (FH, HTN, smoking, dyslipidemia or albuminuria) - small amounts of microscopic protein in urine - earliest cl Continue reading >>
Chapter 57 Diabetes Mellitus
A client has just been admitted to the ER after being found disoriented at the grocery store. His medical alert bracelet indicates that he has type 1 diabetes. What clinical signs do you anticipate finding upon assessment? A client with diabetes has just finished the teaching session on mixing insulin. The nurse knows that more teaching is needed when the client: Withdraws too much NPH insulin and injects the extra back into the Lente vial What lab test offers the best information about glycemic control? A client is admitted to the hospital with DKA. The nurse can anticipate what solutions will be administered initially intravenously? What type of insulin can be administered intravenously? Diabetes is a chronic condition that requires effective long term management that will include: The corresponding hyperglycemia results from predawn release of counter regulatory hormones The Somogyi effect is when blood sugar drops too low in the morning causing rebound hyperglycemia in the morning. What is the autonomic neuropathy condition associated with diabetic complications? They lead to bowel and bladder incontinence and delayed gastric emptying an acute complication of diabetes where the blood glucose levels are less than 70mg/dL. Macrovascular complications cause changes where? Chronic complications of diabetes mellitus are: Macrovascular and microvasculare problems. Macrovascular and microvasculare problems include: The elevated blood glucose levels lead to a thickening in the capillaries and arterioles. The nurse should inform the patient that is going to have a fluorescein angiogram of what information? the steps involved in the diagnostic test the potential side effects of the procedure there could be brief discomfort associated with the camera flash What is the most fr Continue reading >>
Chapter 49 Diabetes Mellitus
the conversion of glucose to glYcogen for storage in the liver an abnormally high amount of glucose in the blood two products of lipid pyruvate metabolism, beta-hydroxybutyric acid and aminoacetic acid, from which acetone may arise spontaneously. Ketone bodies are produced from acetyl-CoA in the liver and are oxidized by the muscles. Excessive production leads to their excretion in urine, as in diabetes mellitus. Also called acetone bodies. increase in the proportion of formed elements in the blood, as a result of a decrease in its fluid content, e.g. in clinical dehydration. abnormally decreased volume of circulating blood in the body deep, rapid respiration characteristic of diabetic or other causes of acidosis the most common kind of proteinuria, characterized by presence of albumin in the urine. characterized by dilation of the retinal veins and microaneurysms which may leak blood cells and/or plasma, causing internal hemorrhaging or edema in the retina. Edema in peripheral areas of the retina goes unnoticed by the patient and may go untreated, whereas edema occurring in the central retina (macula) causes noticeably decreased vision and is the primary cause of vision loss in nonproliferative disease. (See Atlas 4, Part D.) Treatment by local laser photocoagulation is aimed at sealing shut the breaks in the blood vessels and preventing additional leakage of fluid into the area. Early diagnosis and treatment are essential In proliferative diabetic retinopathy new blood vessels form near the optic disk, break through the inner membranous lining, and grow on the vitreous chamber and elsewhere in the retina and may rupture, causing gross vitreous hemorrhage. Additionally, fibrous tissue is generated secondary to the new blood vessel formation, and both the fibrous tissu Continue reading >>
Long-term Complications Of Diabetes Mellitus
Sort Interventions for occlusive peripheral arterial disease Good BS control- medication compliance Protect feet from heat and cold Foot care: Wash daily in warm water, dry well, inspect feet daily (use mirror to √ bottoms) Keep skin soft; gently smooth corns & calluses Trim toenails straight- emery board to edges Wear closed toe well-fitting shoes & socks - avoid any irritation of foot No smoking (causes vasospasm) Check DP and PT pulses; examine feet daily Reduction of risk factors for Macroangiopathies Medical nutrition therapy & exercise Reduces obesity, HTN & hyperlipidemia Obesity increases insulin resistance BP control - meds and lifestyle changes Tight BS control ↓triglyceride concentrations ↓ complications No smoking Management of Retinopathy Annual eye exam Laser photocoagulation Destroys ischemic areas of the retina that produce growth factors that encourage neovascularization This prevents further visual loss - reduces the rate of progression to blindness Done as outpatient- can return to normal ADL Control BS levels Control hypertension Cessation of smoking Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes Complications in Dogs and Cats: Diabetes Ketoacidosis (DKA)
- Association of Glycemic Variability in Type 1 Diabetes With Progression of Microvascular Outcomes in the Diabetes Control and Complications Trial
Pathophysiology Module 11 Exam Review
Syndrome of inappropriate diuretic hormone (SIADH) results in excessive: Renal retention of water without sodium retention Elevated ADH secretion in SIADH stimulates increased water reabsorption in the distal and collecting tubules. Neurological symptoms of SIADH are related to: ADH secretion in SIADH causes a dilutional hyponatremia and decreased serum osmolarity. Which of the following is a serious complication of SIADH? Hyponatremia in SIADH can lead to severe, irreversible neurological damage. Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _________ diabetes insipidus (DI). When DI develops from injury to the CNS, it is called "neurogenic" DI. Classic symptoms of diabetes insipidus (DI) include all of the following except: Absence of ADH secretion in DI leads to increased urine output, volume depletion, and hypotension. When evaluating the kidney of an individual with diabetes insipidus (DI), the nurse would observe: In DI, the kidneys are unable to conserve water in the distal and collecting tubules, resulting in the production of large volumes of dilute urine. In adults, the most serious consequence of panhypopituitarism is the loss of: Loss of ACTH secretion leads to decreased cortisol production, resulting in life-threatening hypglycemia. Acromegaly is caused by increased secretion of: Acromegaly from increased growth hormone secretion results in giantism as well as other structural and physiological problems. Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women? Elevated prolactin in women causes galactorrhea, which is the discharge of milk from the breast. A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptons? Weight los Continue reading >>
Diabetes Pathophysiology
Blood glucose regulation (6) 1. When blood glucose levels rise above a set point, 2. the pancreas secretes insulin into the blood. 3. Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels. 4. When glucose levels drop below a set point, 5. the pancreas secretes glucagon into the blood. 6. Glucagon promotes the breakdown of glycogen and the release of glucose into the blood. (The pancreas signals distant cells to regulate levels in the blood = endocrine function.) Insulin and Glucagon (Regulation) (10) 1. High blood glucose 2. Beta cells 3. Insulin 4. Glucose enters cell 5. Blood glucose lowered 6. Low blood glucose 7. Alpha cells 8. Glucagon 9. Liver releases glucose from glycogen 10. Blood glucose raised What is the manifestations (symptoms) of Type 1? (10) 1. Extreme thirst 2. Frequent urination 3. Drowsiness, lethargy 4. Sugar in urine 5. Sudden vision change 6. Increased appetite 7. Sudden weight loss 8. Fruity, sweet, or wine like odor on breath 9. Heavy, laboured breathing 10. Stupor, unconsciousness DKA Processes (5) 1. sympathetic nervous system response: additional glucose converted from glycogen 2. Glycogen depleted; body burns fat & protein for energy 3. fat metabolisms produce acidic substances called ketone bodies which accumulate in blood and urine and lead to metabolic acidosis 4. protein metabolism results in loss of lean muscle mass and negative nitrogen balance 5. high osmotic pressure created by excess glucose leads to osmotic diuresis (polyuria leads to dehydration and fluid and electrolyte deficits) HHNS Warning Signs (9) 1. Plasma glucose lvl over 600mg/dl 2. Dry, parched mouth 3. Extreme thirst may gradually subside 4. Warm, dry skin (no sweat) 5. High fever 6. Sleepiness or confusion 7. Loss of vision 8. Halluci Continue reading >>
- Role of the Gastrointestinal Tract Microbiome in the Pathophysiology of Diabetes Mellitus
- The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
Module 9 Exam Flashcards | Quizlet
Syndrome of inappropriate diuretic hormone (SIADH) results in excessive: renal retention of water without sodium retention Neurological symptoms of SIADH are related to: Which of the following is a serious complication of SIADH? Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _____ diabetes insipidus (DI). Classic symptoms of diabetes insipidus (DI) include all of the following except: When evaluating the kidney function of an individual with diabetes insipidus (DI), the nurse would observe: In adults, the most serious consequence of panhypopituitarism is the loss of: Acromegaly is caused by increased secretion of: Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women? A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptoms? excessive production of circulating thyroid-stimulating immunoglobulin In Graves disease, accumulation of edema in the orbit can lead to: optic nerve damage, eye muscle palsies & exophthalmos. What is the cause of exophthalmos in Graves disease? Degenerative changes in the muscle and orbital edema The level of thyroid-stimulating hormone (TSH) in Graves disease is: The physiologic stress of illness or surgery can induce a severe response in individuals who have unrecognized and untreated thyrotoxicosis. The pathophysiology of thyroid storm, also known as thyrotoxic crisis, involves: fever and tachycardia leading to high-output heart failure. An endocrinologist orders a series of lab tests to assess thyroid function. Low levels of thyroid hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of: Low levels of T3 and T4 production caused by the destruction or removal of the thyroid Continue reading >>
Endocrine Flashcards | Quizlet
What are the effects of aging on the endocrine system? (Huether, 2012, p.445) D) Variable change in recepter binding and intracellular respones. E) All of the above are effects of aging on the endocrine system. E) All of the above are effects of aging on the endocrine system. What is true about the mechanisms of hormonal regulation? (Huether, 2012, p.444) A) Hormones use only negative feedback loops. B) Hormones use only positive feedback loops. C) Hormones affect only target cells with appropriate receptors and then act on these cells. E) Parathyroid hormone (PTH) inhibits bone breakdown. C) Hormones affect only target cells with appropriate receptors and then act on these cells. C) May have a role in sperm motility for men. D) Anti-diuretic effect similar to that of ADH. E) All of the above are effects of oxytocin E) All of the above are effects of oxytocin A serious complication related to a deficiency of insulin and an increase in the levels of insulin counter-regulatory hormone. ( Huether, S. & McCance, K.,Understanding Pathophysiology, 5th ed.,pg.465) A) A Jewish disease that causes brain matters to turn into mush. B) A rare condition that affects the hormones of laboring women which may lead to hemorrhaging and shock C) A rare condition that affects the hormones of laboring Jewish women, causing their brain matters to turn into mush. D) A rare condition that causes benign and slow growing pituitary adenoma E) A rare condition that causes hypertension due to high soy sauce consumption commonly occur in Asians above the age of 50. B) A rare condition that affects the hormones of laboring women which may lead to hemorrhaging and shock The adrenal cortex consists of 3 layers, determine which of the below is correct: A) Zona fasciculate = middle layer/ Zona glomerulo Continue reading >>
Diabetes
Sort 1. A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C."With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas." B."With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus. 2. The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level D. Glycosylated hemoglobin level Rationale. A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is pr Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Diabetes doctors: Which specialists treat diabetes?
Diabetes Mellitus And Metabolic Syndrome
the beta cells of the pancreas release the hormone insulin. Insulin helps move glucose from the blood and into body cells, thus lowering blood glucose levels. Low blood glucose levels; In this case, to restore balance, the pancreas releases the hormone glucagon. Glucagon stimulates the liver to release glucose into the blood. What additional hormones help elevate blood glucose levels? epinephrine, cortisol, and growth hormone What are the types types of diabetes and what are both characterized by? characterized by high levels of blood glucose, which we now know is called hyperglycemia. In type 1 diabetes, there is a lack of insulin. Most commonly, this is caused by autoimmune destruction of the beta cells of the pancreas. Remember, insulin moves glucose out of the blood and into the cells. In type 2 diabetes, the pancreas can produce insulin, but the cells have become resistant to accepting it. The body responds by producing even more insulin, but the insulin remains unable to carry out its work. Blood glucose levels stay elevated. obesity and lack of physical activity. Fat cells are particularly resistant to insulin. Remember: it is a disease of hyperglycemia, so diagnosis is based on blood glucose testing. There are three common methods: fasting blood glucose level, oral glucose tolerance test, and glycated hemoglobin test, also called the HbA1c test. The HbA1c test can assess blood glucose control over the preceding three months. Diabetes has serious potential complications Managing blood glucose levels is key in treatment. With type 1 diabetes, insulin is always needed. Medical management of type 2 diabetes often requires a stepwise approach. The first step is lifestyle modifications, followed by monotherapy of an oral antidiabetic agent. If these are not effective Continue reading >>
- Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
- Ultraviolet Radiation Suppresses Obesity and Symptoms of Metabolic Syndrome Independently of Vitamin D in Mice Fed a High-Fat Diet
- Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations
Long Term Complications Of Diabetes
Sort how do microvascular complications occur? how long do they take to develop, when do they normally present? Most cells are able to reduce glucose transport in response to extracellular hyperglycaemia Retinal endothelial cells Mesangial cells of glomerulus Schwann cells and peripheral nerve cells many years to develop Rare before 5 years of type 1DM May be detected at presentation of type 2 what are the 3 clinical stages of retinopathy? -Non-proliferative Background Pre-proliferative -Proliferative -Macular Oedema Sight threatening Non sight threatening give some associated symptoms of autonomic neuropathy? 5 Gastroparesis (disease of the muscles of the stomach or the nerves controlling the muscles that causes the muscles to stop working. Gastroparesis results in inadequate grinding of food by the stomach, and poor emptying of food from the stomach into the intestine.) Postural hypotension Erectile dysfunction Gustatory sweating (Symptoms of profuse head and neck diaphoresis with eating ) Diarrhoea disecribe the link between diabetes and foot problems? Diabetes is the commonest cause of non-traumatic lower limb amputation PVD Neuropathy Imapaired leucocyte function claw-foot, callus (soft tissues necrose and liquefy), neuropathic ulcer (risk of bone infection) charcot foot (swollen foot due to high blood flow, loss and destruction of joint s in foot, mid part of foot begins to prolapse down, fracture to bones in foot) Continue reading >>
Pathophysiology Of Diabetes Mellitus
Sort Hyperosmolar Hyperglycemic Syndrome (HHS) Life threatening. Pt produces enough insulin to prevent DKA but not enough to prevent SEVERE HYPERGLYCEMIA, osmotic diuresis and extracellular fluid depletion (extreme dehydration!). Increased glucose leads to increase osmolality which leads to increase in sx. Key diagnostics: >600 glucose, increased serum osmolality (>310, increases with dehydration), NO KETONES. Manifestations: Coma, seizures, polyuria (unable to sense thirst to replenish fluid loss) Continue reading >>
- Role of the Gastrointestinal Tract Microbiome in the Pathophysiology of Diabetes Mellitus
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations
Unit 3: Acute And Chronic Complications Of Diabetes Mellitus And Adrenal Gland Disorders
beta-cell destruction, usually leading to absolute insulin deficiency ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance -random glucose levels in an individual with symptoms the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a RBC the most common pediatric chronic disease and affects .17% of US children and the incidence is increasing -occurs secondary to other diseases like pancreatitis or to a more fulminant disorder called idopathic (type 1B) diabetes type 1B diabetes occurs mostly in people of -and affected individuals varying degrees of insulin deficiency a slowly progressive autoimmune T cell-mediated disease that destroys beta cells of the pancreas related to genetic susceptibility and environmental factors the strongest genetic association is with histocomplatibility leukocyte antigen class 2 environmental factors that affect beta cell destruction are exposure to result in the formation of autoantigens that are exposed on the surface of the pancreatic beta cells and circulate in the bloodstream and lymphatics these two type of immunity are stimulated as a result of gene-environmental interactions -cellular immunity (T cytotoxic cells and macrophages the stimulation of cellular and humoral immunity cause over time with cellular and humoral stimulation insulin synthesis for insulin synthesis to decline enough such that hyperglycemia occurs ___ to ____ % of the insulin-secreting beta cells of the islets of langerhans must be destroyed a hormone produced by the alpha cells of islets, acts in the liver to increase BG level by stimulating glycogenolysis and gluconegenesis suppresses glucagon relea Continue reading >>
Module 09: Alterations Of Hormonal Regulatione
Syndrome of inappropriate diuretic hormone (SIADH) results in excessive renal retention of water without sodium retention Neurological symptoms of SIADH are related to Which of the following is a serious complication of SIADH Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _____ diabetes insipidus (DI) Classic symptoms of diabetes insipidus (DI) include all of the following except In adults, the most serious consequence of panhypopituitarism is the loss of Acromegaly is caused by increased secretion of Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women A clinician would suspect thyrotoxicosis if a patient presented with which symptoms excessive production of circulating thyroid-stimulating immunoglobulin In Graves disease, accumulation of edema in the orbit can lead to AOTB :optic nerve damage, eye muscle palsies,exophthalmos When evaluating the kidney function of an individual with diabetes insipidus (DI), the nurse would observe? What is the cause of exophthalmos in Graves disease Degenerative changes in the muscle and orbital edema The level of thyroid-stimulating hormone (TSH) in Graves disease is The physiologic stress of illness or surgery can induce a severe response in individuals who have unrecognized and untreated thyrotoxicosisThe pathophysiology of thyroid storm, also known as thyrotoxic crisis, involves fever and tachycardia leading to high-output heart failure An endocrinologist orders a series of lab tests to assess thyroid functionLow levels of thyroid hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of If left untreated, congenital hypothyroidism results in Signs and symptoms of hypothyroidism include all of the followin Continue reading >>
Pathophysiology Chapter 25 Long-term Complications Of Diabetes
Place the following sequence of events in the proper order. Decreased T cell activity and increased microorganism growth causes infection of the wound. Hyperglycemia causes demyelination of peripheral nerves. Development of infection in wound prolongs healing of the wound, resulting in further damage. Decreased pain sensation results in blister being formed on foot without person being aware. Blister forms into a wound, as blood supply to wounded area is compromised. George has been managing his diabetes for 20 years. His recent check-up revealed the following: He has had bouts of alternating constipation and diarrhea. He complains of being too hot when he goes outdoors in the summer and admits he is sweating less. He has been treated for urinary tract infections twice in the past year. Drag and drop the complication related to George's symptoms and illnesses. Hyperglycemia can injure the capillaries of the glomeruli of the kidneys. One of the initial signs of this damage is the presence of albumin in the urine. Eventually, so much damage occurs to the glomeruli that proteins may also begin to appear in the urine. The damage and resulting changes to the glomerulus lead to renal dysfunction. Renal dysfunction is a source of hypertension, which further damages the glomeruli. This damage then continues in a cyclical manner. Chronic hyperglycemia may cause ____________________. Select all that apply. both microvascular and macrovascular angiopathy damage to peripheral, but not autonomic nervous system damage to both peripheral and autonomic nervous systems both microvascular and macrovascular angiopathy damage to both peripheral and autonomic nervous systems Which conditions may be caused by chronic hyperglycemia? Select all that apply. Continue reading >>
