NR 566_Chapter 33_completed Study Guide_ LATEST UPDATED,100% CORRECT
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NR 566
NR 566_Chapter 33_completed Study Guide_ LATEST UPDATED
CHAPTER 33: DIABETES MELLITUS
Clinical S/Sx
o T1DM- abrupt, although insulin secretion decline begins long before the symptoms develop.
▪ Classic manifestations (new onset):
• Polydipsia
• Polyuria
• Wt loss
• Hyperglycemi...
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NR 566_Chapter 33_completed Study Guide_ LATEST UPDATED
CHAPTER 33: DIABETES MELLITUS
➢ Clinical S/Sx
o T1DM- abrupt, although insulin secretion decline begins long
before the symptoms develop.
▪ Classic manifestations (new onset):
• Polydipsia
• Polyuria
• Wt loss
• Hyperglycemia
• Ketonemia or ketonuria
▪ DKA = classic s/sx + fruity-smelling breath + drowsiness/lethargy +
vomiting
▪ Silent (asymptomatic) incidental discovery
o T2DM
▪ Polydipsia
▪ Polyuria
▪ Hyperglycemia
➢ Risk Fx and Associated complications
o T1DM
▪ Genetic
• abnormalities at six genetic loci
• mutation of the hepatic transcription factor
(HNFP-1 alpha) on chromosome 12
• defective glucokinase molecule on chromosome 7p
▪ Autoimmune- destruction of islet cells -> beta cells destruction
▪ Environmental- toxins, food antigen, viral infection
▪ Race- idiopathic T1DM is common among African American or
Asian American.
o T2DM
▪ Obesity
▪ Race- native americans, Asian americans, latinos, pacific
islanders, african americans
▪ Sedentary lifestyle
▪ Hypertension
▪ Dyslipidemia
▪ Family hx- 15% if both parents have T2DM
▪ Gestational hx
▪ Age
▪ Genetics- have strong influence- chromosome arm 7q – insulin
resistance
o COMPLICATIONS (all types):
▪ Microvascular
,• Eyes, heart, kidneys, nervous system
• Retinopathy with potential loss of vision
• Nephropathy leading to renal failure
, • Peripheral neuropathy with risk of:
o Foot ulcers
o Amputation
o Charcot’s joint
• Autonomic neuropathy with:
o GI, GU, CV s/sx
o sexual dysfunction may occur.
▪ Macrovascular
• Atherosclerotic conditions which increases the risk of
HTN, abnormalities in lipid metabolism, abnormalities
of platelet function, and periodontal disease:
o Cardiovascular
o Peripheral vascular
o Cerebrovascular
➢ Diagnostic Criteria
o Pre-diabetes
▪ BG too high to be considered normal BUT does not meet criteria
for DM
• Impaired glucose tolerance (IGT) or Impaired fasting glucose
(IFG)
• IFG 100-125 mg/dL
• IGT 140-199 mg/dL
• HbA1c 5.7% - 6.4%
▪ At risk for diabetes and CVDs and may have insulin-resistance
syndrome
o T1DM and T2DM
▪ 4 tests used:
• Acute symptoms of DM + casual plasma glucose ≥ 200mg/dL
• Fasting plasma glucose (FPG) >126 mg/dL- most reliable
• 2-h post-load plasma glucose in an oral glucose
tolerance test ≥ 200mg/dL
• HbA1c ≥ 6.5%
▪ Tests should be:
• confirmed on a subsequent day, unless (+) overt clinical s/sx
• preferrable to confirm with the same test OR one
that is considered more predictive
• If a repeated test is below the diagnostic criteria ->
REPEAT TEST in 3- 6months.
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