Type 2 Diabetes Mellitus

Pathophysiology

100

The _____ organ produces the hormone insulin

What is the pancreas

200

People with diabetes mellitus type 2 cannot use insulin efficiently because their pancreas can no longer produce insulin. True or False.

False. The pancreas still produces insulin, but either the quantity is insufficient or the body becomes resistant to it (does not recognize it).

300

What is a condition in which the cells of the body do not respond to the action of insulin? A. Insulin resistance B. Stubborn cells C. Worn-out pancreas D. Insulin deficient

What is A. As a result of high blood glucose levels, the pancreas starts producing large amounts of insulin. However, insulin receptors located in body tissues such as skeletal muscle, fat, and liver cells remain unresponsive to the presence of insulin, thus impeding the passage of glucose into the cell.

500

The increase in insulin is able to keep up with excess sugars for several years, but eventually wears out causing?

What is beta-cell dysfunction. As cells become more resistant to insulin, blood glucose levels rise and the pancreas responds by secreting even more insulin. Eventually, the hypersecretion of insulin leads to beta cell exhaustion, and ultimately to beta cell death.

Risk Factors/Signs & Symptoms

100

Having a parent or sibling with type 2 diabetes is what type of risk factor?

What is non-modifiable. Other non-modifiable risk factors include: -race/ethnicity: (African, Native, Hispanic, Asian American & Pacific Islanders -age: 45 years or older -h/o gestational diabetes -delivery of a 9+lb baby

200

What are 2 modifiable risk factors for developing type 2 diabetes?

What is obesity and inactivity. 80% of people with type 2 diabetes are overweight, and the degree of obesity directly affects the degree of insulin resistance. The activity of insulin receptors can be increased by exercise, which lowers the levels of circulating insulin. In fact, adhering to a healthy diet & regular exercise has been shown to reverse insulin resistance & delay or prevent the development of type 2 diabetes.

300

An 18 year old female client, 5’4” tall, weighing 113 kg, comes to the clinic for a non-healing wound on her lower leg, which she has had for 2 weeks. Which disease process should the nurse suspect the client has developed? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Acanthosis nigricans

What is b. Type 2 diabetes is a disorder usually occurring around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary lifestyles. Non-healing wounds are a hallmark sign of type 2 diabetes. This client weights 248.6 pounds and is short.

400

What are the classic signs of diabetes? *Hint* 3 P's

What is polyuria, polydipsia, and polyphagia. As glucose levels rise in patients with diabetes, the kidneys are unable to reabsorb the large amounts so glucose is eliminated in the urine (glycosuria). Glucose molecules create increased osmotic pressure in body fluids, pulling water along with it causing polyuria, also pulling water out of tissue cells causing cellular dehydration which causes polydipsia.

500

Name signs and symptoms associated with Type 2 Diabetes besides the 3 P's

What is weight loss, blurred vision, fatigue, and recurrent infections.

Diagnosis

100

This test measures the circulating glucose level and it requires the patient to fast for at least 4-8hrs. a) Protein test b)Fasting blood glucose (FBG) c)Blood test

b)Fasting blood glucose (FBG) Glucose is a major source of energy for cells. The foods we eat (pasta, fruits) are turned in glucose. Our pancreas produces insulin which helps the cells use glucose. When we have low insulin or no insulin production, the glucose molecules are left in the blood. The FBG measures the level in the blood. Normal should not be greater than 100 mg/dl.

200

Which test is used to diagnose diabetes mellitus and requires the patient to ingest glucose and samples are drawn for testing after 30 minutes, 60 minutes and 120 minutes. a) Oral glucose tolerance test (OGTT) b) Glucose test c) Glucogon

What is a. Oral glucose tolerance test (OGTT) This test requires the patient to fast about eight hrs. before the test. The patient then drinks 75g of glucose. Samples of blood are then taken at various intervals to determine if the glucose level is decreasing as is it should in a person with normal insulin production. If it is not then it is indicative of diabetes.

300

Indicates the amount of glucose linked to hemoglobin. a) Hemoglobin test b)Glycosylated hemoglobin or Hb A1C. c)Oral glucose test

What is b. Glycosylated hemoglobin or Hb A1C. This is how much glucose is attached to the hemoglobin in the blood. The more glucose attached to the blood the higher the A1C. A1C measures the amount of glycosylated hemoglobin as a percentage of the total hemoglobin (ex. an A1c of 7% means that 7% of hemoglobin has glucose attached to it).

400

Enzymatic method used to estimate the amount of glucose in urine. a)Enzyme test b)Glucose studies c)Urine Studies

What is c. Urine studies Normally there is very little or no glucose in urine. When the blood sugar level is very high, as in uncontrolled diabetes, the sugar spills over into the urine. This test measure the amount of glucose in the urine by a dipstick and checking for changes in color.

500

What is the purpose of measuring the amount of acetone excreted in urine as result of incomplete fat metabolism a)The purpose of measuring Ketones b)The purpose of measuring Red blood cells c)The purpose of measuring the amount of fat

What is a. The purpose of measuring Ketones. If your body cannot use glucose properly, as in type 2 diabetes, fat is broken down for energy and the body makes substances called ketones. These are passed in the urine. Large amounts of ketones in the urine may mean a very serious condition, diabetic ketoacidosis.

Complications

100

Acute condition with symptoms of polyuria, polydipsia, nausea, vomiting, and severe fatigue, progressing to stupor and eventual coma.

What is DKA (Diabetic ketoacidosis)? hyperglycemia, metabolic acidosis, osmotic diuresis results from DKA patient may have abdominal pain or tenderness and fruity breath smell from ketoacids. tachycardia and hypotension result from dehydration.

200

A patient comes in with a glucose level of 650 mg/dL and appears lethargic and confused. The patient is sweating profusely and states that he has been urinating frequently. Pulse is increased and blood pressure decreased. This patient is presenting with what complication?

What is HHS (Hyperosmolar Hyperglycemic State)? hyperglycemia and hyperosmolarity with dehydration occur. There is also CNS dysfunction which can result in seizures, aphagia and visual disturbances. tachycardia and hypotension result from fluid depletion.

300

A patient comes into the hospital with symptoms of confusion and a hard time focusing along with complaints of a headache. He states that he uses insulin to control his glucose levels. When vitals were taken he was tachycardic. What complication is this patient presenting with.

What is hypoglycemia? Abnormally low glucose level that can be caused by errors in insulin dosage, failure to eat regularly, increased exercise, medication adjustments, or changes in injection sites. the brain relies on continuous glucose supply so the sympathetic nervous is activated to increase glucose level.

400

The occurrence when the retinal capillary structure undergoes alterations in blood flow, leading to retinal ischemia and breakdown in the blood-retinal barrier.

What is diabetic retinopathy? Retinal capillary structure is altered by blood flow which leads to blood retinal barrier breakdown. Leading cause of blindness between ages 20 and 74. Increased risk for developing cataracts.

500

Disease of the kidneys characterized by the presence of albumin in the urine, hypertension, edema, and progressive renal insufficiency.

What is diabetic nephropathy? Thickening of glomeruli of basement membrane which can lead to impaired renal function. Glucose accumulates in the glomeruli and forms glycoproteins which leads to glomerulosclerosis. The large molecules such as proteins leak into urine.

Mixed

100

Possible result of non-healing sores, arteriosclerosis in lower extremities, and decreased sensation and perception of pain.

What is an amputation Angiopathy, neuropathy, and infections are causes for amputation. People with diabetes have increased healing time.

200

70-100 mg/dL

What Are Normal Glucose Levels?

300

Tests done to monitor DM management

What is fasting blood glucose, oral glucose tolerance test, and glycosylated hemoglobin (A1C) Fasting blood glucose is obtained following a fast of 8 hours. if FPG results are abnormal (100mg/dL) a OGTT is obtained, where a dose of 75 g of glucose ingested and glucose level obtained 2 hours later. Hemoglobin A1C (HbA1C) glucose remain at normal levels, only 4% to 6% of circulating hemoglobin will have glucose bound to it.

400

three eye manifestations

What are diabetic retinopathy, cataracts, and glaucoma retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye cataracts is the clouding of the normally clear lens of the eye glaucoma is a group of eye conditions that can cause blindness

500

Nutritional components that should be monitored by people with type 2 diabetes.

What are carbs, fiber, protein, fats, sodium, sweeteners, and alcohol