Students will be referring to a �Diabetes� section on my class by 5Bm5eqr

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									Students will be referring to a “Diabetes” section on my class web page to
  guide them through the majority of the unit. On the following pages,
     I have provided you with the links they will be using to find the
     information required to complete the Clinical Diagnosis Packet.



          PART I: DIAGNOSING & MANAGING DIABETES

                      DIAGNOSING DIABETES
                    Lab Tests Online: Glucose Tests
 http://www.labtestsonline.org/understanding/analytes/glucose/test.html

                SELF-MONITORING BLOOD GLUCOSE
                  Diabetes Handbook: Ch. 5- Monitoring
        http://www.umassmed.edu/diabeteshandbook/chap05.htm

                  Diabetes Handbook: Ch. 8- Insulin
        http://www.umassmed.edu/diabeteshandbook/chap08.htm

                     URINE GLUCOSE TESTING
                 Diabetes Handbook: Ch. 5- Monitoring
        http://www.umassmed.edu/diabeteshandbook/chap05.htm

                               INSULIN
                    Lab Tests Online: Glucose Tests
 http://www.labtestsonline.org/understanding/analytes/glucose/test.html

                  Diabetes Handbook: Ch. 8- Insulin
        http://www.umassmed.edu/diabeteshandbook/chap08.htm

                TESTING THE URINE FOR KETONES
                 Diabetes Handbook: Ch. 5- Monitoring
        http://www.umassmed.edu/diabeteshandbook/chap05.htm

                    HEMOGLOBIN (A1C) TEST:
                        Lab Tests Online: A1C
   http://www.labtestsonline.org/understanding/analytes/a1c/test.html

        Clinical Diabetes: The Expanded ABC’s of Diabetes Care
       http://clinical.diabetesjournals.org/cgi/content/full/21/3/128
DIAGNOSING & TREATING DISEASES ASSOCIATED WITH DIABETES

                    CARDIOVASCULAR DISEASES
                 Diabetes Handbook: Ch.12- Complications
         http://www.umassmed.edu/diabeteshandbook/chap12.htm

                            ABC’s of Diabetes Care
        http://clinical.diabetesjournals.org/cgi/content/full/21/3/128

                            KIDNEY DISEASE
                  DiabetoValens.com- The Diabetes Guide
            http://my.diabetovalens.com/infocus/feafeb0404.asp

                            ABC’s of Diabetes Care
        http://clinical.diabetesjournals.org/cgi/content/full/21/3/128

         Physicians Reference Laboratory: Kidney Function Panel
                    http://www.prlnet.com/Kidney.htm

             Diabetes Handbook: Ch.12- Complications 57, 58
         http://www.umassmed.edu/diabeteshandbook/chap12.htm

                              NEUROPATHY
                Diabetics Foot Disease: An Interactive Guide
            http://www.diabetes.usyd.edu.au/foot/Neurop1.html

                 Diabetes Handbook: Ch. 12- Complications
         http://www.umassmed.edu/diabeteshandbook/chap12.htm

                            ABC’s of Diabetes Care
        http://clinical.diabetesjournals.org/cgi/content/full/21/3/128

                            RETINOPATHY:
              New England Eye Center: Diabetic Retinopathy
   http://www.neec.com/Vitreoretinal_Disease_Diabetic_Retinopathy.html

                              PERIODONTITIS
               Diabetics Handbook to Complications with Teeth
    http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.htm

               Periodontal Disease: Diagnosis and Treatment
                  http://www.stevedds.com/periodon.htm

                                 INFECTION
                            ABC’s of Diabetes Care
        http://clinical.diabetesjournals.org/cgi/content/full/21/3/128
   Clinical Diagnosis Packet                Name_____________________________

                 PART I: DIAGNOSING & MANAGING DIABETES

   DIAGNOSING DIABETES

   1. Name five symptoms of diabetes/hyperglycemia.



   2. In order to diagnosis diabetes, when is the blood drawn to determine the fasting
      blood glucose level?

   3. If the symptoms of diabetes are present, but the blood glucose level from the
      above test is not very high, the oral glucose tolerance test may be required. What
      is involved in this test?



   4. Complete the charts below.

   FASTING BLOOD GLUCOSE:
Lab Result                                   Meaning
From _____ to _____ mg/dL                    Normal glucose tolerance
(_____ to ______ mmol/L)
From _____ to _____ mg/ dL                   Impaired fasting glucose (pre-diabetes)
(_____ to ______ mmol/L)
_____ mg/dL ( _____ mmol/L and above)        Probable diabetes


   ORAL GLUCOSE TOLERANCE TEST (2 hours after a 75-gram glucose drink)
Lab Result                          Meaning
Less than _____ mg/dL (_____mmol/L) Normal glucose tolerance

From _____ to _____ mg/ dL                   Impaired fasting glucose (pre-diabetes)
(_____ to ______ mmol/L)
Over 200mg/dL (_____ mmol/L)                 Probable diabetes



   5. What is meant by “pre-diabetic” levels?
       6. What are some reasons, other than pre-diabetes or diabetes, that a person may
          have elevated blood glucose levels?




       SELF-MONITORING BLOOD GLUCOSE

       7. How many times a day (range) are diabetics advised to test their own blood
          glucose levels (Self Monitoring Blood Glucose- SMBG), and what are typical
          times of day recommended for testing?




       8. Complete the following chart regarding blood glucose level guidelines for SMBG:

   TIME:            EXCELLENT                GOOD                  FAIR                   POOR
Before a meal
 (or fasting)
After a meal


       9. What are the 3 causes of fluctuations in blood sugar level?


       10. What are some common reasons for blood sugar fluctuations?
URINE GLUCOSE TESTING

11. Why isn’t simple urine testing used to determine glucose levels? (Give 3 reasons)




12. Considering the drawbacks of urine testing, why would a doctor decide that this is
    the best option for some patients?




13. What percentage range indicates a positive urine test?


14. A negative urine test indicates that the blood glucose level is probably below
    _______.



INSULIN

15. What do the insulin test and the C-Peptide test monitor?

16. What are signs of an allergic reaction to insulin (mild/generalized)?

17. Insulin edema may develop when insulin therapy is started, subsiding in a few
    weeks. What are the signs?



18. What is lipohypertrophy?
19. What is lipoatrophy, and why is the condition now rare?



20. What happens to the blood glucose level when one has an insulin reaction?



21. What are common triggers of an insulin reaction (hypoglycemia)?



22. What are the symptoms of a mild hypoglycemia, and what should be done?




23. What are the symptoms of moderate hypoglycemia, and what should be done?




24. What are the symptoms of severe hypoglycemia, and what can family member do
    to help?




TESTING THE URINE FOR KETONES

25. At what blood glucose level would a doctor recommend the patient to test the
    urine for ketones, and in general, what do ketones in the urine signify?
HEMOGLOBIN (A1C) TEST

26. What is the glycosylated hemoglobin/ hemoglobin A1C test and why is it tested?




27. A normal level on the glycosylated hemoglobin (A1C) test can result from what
    two situations?




28. What is a good test result for the A1C test if you are a diabetic?



29. Each 1% decrease in A1C translates into a __________% decrease in the
    frequency of microvascular complaints.


DIAGNOSING & TREATING DISEASES ASSOCIATED WITH DIABETES

CARDIOVASCULAR DISEASES

30. To what does macrovascular disease refer? Briefly describe
    arterio/atherosclerosis.




31. What blood pressure level is indicative of hypertension?


32. Hypertension increases the risk of what related health problems for diabetics?
33. Epidemiological analyses show that blood pressures > _______ mmHg are
    associated with increased cardiovascular event rates and mortality in people with
    diabetes.


34. What are the target lipid levels for diabetics?


35. Why is lipid management so important?


36. Explain, in your own words, why aspirin is used for the prevention of
    cardiovascular events.


37. What dosage does the ADA recommend for aspirin therapy for all adult patients
    with diabetes and macrovascular disease?


38. What is the name of the medication that can be used as adjunctive therapy for
    very-high-risk patients or as alternative therapy in aspirin-intolerant patients?



39. What is peripheral vascular disease, and what symptoms result if blood flow is
    only partially interrupted versus completely interrupted?




40. How is peripheral vascular disease treated?


41. What is coronary artery disease, and what medical conditions result if blood flow
    is decreased versus completely blocked?




42. What are the symptoms of partial/complete blockage of coronary arteries?
43. What are treatments of coronary artery disease?


44. What is cerebral vascular disease?




45. What is the medical phrase given to describe a reduction in blood flow due to a
    partial blockage in an artery of the brain?


46. What causes complete loss of blood supply to an area of the brain, and what is the
    result?




47. What are symptoms of a partial/complete blockage of cerebral arteries?




KIDNEY DISEASE

48. What is microalbuminuria, and why is it a sign of diabetic nephropathy?




49. Of what, other than nephropathy, is microalbuminuria a well-established marker?


50. What are normal levels of urine microalbumin?


51. What level is indicative of macroalbuminuria?


52. What is creatinine and blood urea nitrogen (BUN), and why are blood tests for
    these administered to measure kidney function?
53. What is the reference range for BUN?


54. What is the reference range for creatinine?


55. What are the signs and symptoms of kidney disease?




56. Name 3 treatments for kidney failure.



57. What causes diabetic bladder dysfunction, and what further organ complications
    can result from this dysfunction?




NEUROPATHY


58. Describe the various stages of treatment required for neuropathic ulcer.




59. What body parts are involved in peripheral neuropathy?
60. What body parts are involved in autonomic neuropathy?




61. With what is autonomic neuropathy most often associated?



62. What are the symptoms of autonomic neuropathy?




63. What are some treatment options for the above symptoms?




64. What should be included in the annual comprehensive foot examination for
    diabetics?
65. What are the foot-related risk conditions that are associated with an increased risk
    of amputation?




RETINOPATHY

66. Comprehensive eye examinations are important for diabetics. What is the name
    of the therapy that can prevent the loss of vision for those with diabetic
    retinopathy and why is it effective?




67. What surgery is used to treat hemorrhage (into the vitreous chamber)/retinal
    detachment?




68. What surgery is used for the treatment of cataracts?




PERIODONTITIS

69. Why do individuals with diabetes have an increased risk for gum disease
    (periodontitis)?



70. What are the signs/symptoms of gum disease?
71. What is the difference between gingivitis and periodontitis?



72. The clinician checks for the amount of tartar (calculus), checks the mobility of all
    teeth, and evaluates the bite. Why are x-rays needed?




73. Treatment of periodontitis involves “scaling and root planning.” What is this?




74. What is the goal of treatment?




75. Why are laser treatments sometimes used?




INFECTION

76. Why are immunizations so important for diabetics?


77. What immunizations are recommended, and what are the indications for repeat
    vaccination?

								
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