Term
| What are the risk factors for diabetes? |
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Definition
Central obesity
sedentary lifestyle
urbanization
certain ethnicities
pregancy
heart disease
stroke |
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Term
| What is the normal blood glucose range? |
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Definition
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Term
| What is the purpose of insulin? |
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Definition
| decrease glucose in the blood |
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Term
| What are the pancreatic hormones and what do they do? |
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Definition
1) alpha cells-glucagon(causes cells to release stored food into the blood
2)beta cells- Insulin (allows cells to take up glucose from the blood) AND Amylin: (slows glucose absorption in small intestine; suppresses glucagon secretion)
3) delta cells- Somatostatin: (decreases GI activity; suppresses glucagon and insulin secretion) |
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Term
| When does diabetic ketoacidosis occur and what can result of this? |
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Definition
| when there is no insulin, metabolic acidosis |
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Term
| What is type 1 diabetes and who is at risk? |
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Definition
| pancreas cannot produce insulin, because t cells destroy there own Beta cells. more common in younger people and children due to genetics and exposure to virus |
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Term
| What lab ranges indiciate pre diabetes and some symptoms to look out for? |
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Definition
IFG: Fasting glucose levels are 100 to 125 mg/dL
IGT: 2-Hour plasma glucose levels are between 140 and 199 mg/dL
AIC is in range of 5.7% to 6.4%.
Symptoms:
polyuria
polyphagia
polydipsia |
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Term
| What does IFG and IGT stand for? |
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Definition
impaired fasting glucose
impaired glucose tolerance |
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Term
| What are 4 common factors in people with type 2 DM? |
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Definition
people over 35 years
overweight
increases with age
genetic basis |
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Term
| What are the 4 major metabolic abnormalities with type 2 DM? |
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Definition
1) insulin resistance (results in hyperglycemia)
2) pancreas unable to produce insulin
3) inappropriate glucose production from liver
4) alteration in production of hormones |
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Term
| What is metabolic syndrome and what can it cause? |
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Definition
3 or more of the following: elevated insulin levels, elevated triglycerides, LDLs, decreased HDLs, hypertension
this is a risk factor for type 2 diabetes |
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Term
| What is gestational diabetes? |
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Definition
develops during pregnancy, 24-28 weeks
increased chances of having type 2 DM in the future |
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Term
| What do you do to treat gestational diabetes? |
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Definition
First-nutrition
Second-insulin |
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Term
| What are the clinical manifestations of type 1 diabetes? |
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Definition
| polyuria, polydipsia, polyphagia, weight loss, fatigue, weakness |
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Term
| What are the clinical manifestations of type 2 diabetes? |
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Definition
Nonspecific symptoms
May have classic symptoms of type 1
Fatigue
Recurrent infection
Recurrent vaginal yeast infection
Prolonged wound healing Visual changes |
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Term
| What are some medical conditions and drugs that can lead to secondary diabetes? |
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Definition
cushing syndrome
hyperthyroidism
pancreatitis
parenteral nutrition
cystic fibrosis
DRUGS: corticosteroids |
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Term
| What are the 4 lab values of diagnosis for DM? |
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Definition
1. AIC ≥ 6.5%
2. Fasting plasma glucose level >126 mg/dL
3. Random plasma glucose measurement ≥200 mg/dL
4. Two-hour OGTT(oral glucose tolerance test) level ≥200 mg/dL when a glucose load of 75 g is used |
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Term
| What does a normal A1C test reduce the risk of? |
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Definition
retinopathy
nephropathy
neuropathy |
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Term
| What is the hemoglobin A1C test used for? |
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Definition
| Useful in determining glycemic levels over time and Shows the amount of glucose attached to hemoglobin molecules over RBC life span, approximately 120 days |
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Term
| What can happen if an insulin injection hits the muscle? |
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Definition
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Term
| How should insulin be stored? |
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Definition
DO NOT heat/freeze or run under warm water
leave at room temp for 4 weeks max
extra insulin should be refrigerated
avoid direct exposure to sunlight
ALWAYS CHECK EXP DATE |
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Term
| What is the preferred site for insulin? |
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Definition
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Term
| What are some PROBLEMS with insulin therapy? |
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Definition
1)hypoglycemia
2)allergic reaction
3)somogyi effect (nighttime blood level drops then rebounds and hyperglycemic in the morning)
4)dawn phenomenon (growth hormone and cortisol: hyperglycemia in the morning)
5)lipodsystrophy-poking fingers too much |
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Term
| What is the effect of Thiazaolidinediones and 2 drug examples? |
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Definition
↑ glucose uptake in muscle and ↓glucose production
Ex: pioglitazone (Actos) and rosiglitazone (Avandia). |
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Term
| What can Thiazide/loop diuretics results in? |
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Definition
| can potentiate hyperglycemia by inducing potassium |
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Term
| What is a good diet for a diabetic? |
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Definition
Carbohydrates
Sugars, starches, and fiber minimum of 130 g/day; whole grains, along with fruits, vegetables, and low-fat milk)
Fats (Less than 200 mg/day of cholesterol and trans fats)
Protein |
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Term
| What are the effects of alcohol on diabetes? |
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Definition
| inhibits gluconeogenesis by the liver and leads to hypoglycemia |
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Term
| What exercise regimen should be made for a diabetic patient? |
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Definition
| 150 min/week of moderate intensity aerobic physical activing, resistant training 3 times a week, monitor glucose before during and after, best done after meals, small carb snacks every 30 min to avoid hypoglycemia |
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Term
| What is some objective and subjective date is important to assess with a possible diabetic patient? |
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Definition
past health history
obesity
weight loss
thirst
hunger
poor healing
kussmaul respirations |
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Term
| What are some Nursing Diagnosis for a diabetic patient? |
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Definition
ineffective self health management
risk for injury
risk for infection
powerlessness
imbalanced nutrition |
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Term
| What are common manifestations of hypoglycemia? |
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Definition
Confusion
Irritability
Diaphoresis
Tremors
Hunger
Weakness
Visual disturbances |
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Term
| What can happen if hypoglycemia is left untreated? |
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Definition
| loss of consciousness, seizures, coma, death |
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Term
| What are goals of diabetes managment? |
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Definition
Decrease symptoms
Promote well being
Prevent acute complications
Delay onset and progression of long term complications Patient teaching
Self-monitoring of blood glucose
Nutritional therapy
Drug therapy
Exercise |
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Term
| What does infection have to do with diabetes? |
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Definition
diabetics are more susceptible to infection because of a defect in mobilization of inflammatory cells and impairment of phagocytosis by neutrophils and monocytes
therefor…loss of sensation may delay detection |
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Term
| What is diabetic neuropathy and signs and symptoms? |
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Definition
damage to nerves due to high blood sugar levels which can lead to amputations (usually hands or feet).
loss of sensation/abnormal sensations
pain (burning, cramping, crushing, tearing)
usually worse at night
foot injury and ulcerations can occur without pain
can cause atrophy of small muscles of hands and feet |
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Term
| What is a complication of diabetic neuropathy? |
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Definition
gastroparesis (delayed gastric emptying)
cardiovascular abnormalities |
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Term
| What is diabetic nephropathy? |
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Definition
damage to small blood vessels that supply the glomerurli of the kidney
LEADING cause of end stage renal disease |
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Term
| What are factors in order to prevent diabetic nephropathy? |
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Definition
tight glucose control
BP management
yearly screening (microalbuminuria and serum creatinine) |
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Term
| Why is albumin important? |
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Definition
protein, helps with preventing edema
no albumin=pitting edema |
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Term
| How does diabetic retinopathy occur? |
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Definition
| occlusions in small blood vessels in retina, cause microanerurysms, capillary fluid leaks out, hardens or hemorrhages |
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Term
| What syndrome can result from type 2 diabetes? |
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Definition
| HHS- hyperosmolar hyperglycemic syndrome |
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Term
| What is diabetic angiopathy and an example? |
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Definition
1) Macrovascular
Diseases of large and medium-sized blood vessels
one of the leading causes of diabetes-related deaths
2) Microvascular
Result from thickening of vessel membranes in capillaries and arterioles
In response to chronic hyperglycemia
Is specific to diabetes, unlike macro vascular
EX: diabetic retinopathy
nephropathy
dermopathy |
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Term
| When do clinical manifestations usually appear with diabetic angiopathy? |
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Definition
| 10-20 years of having diabetes |
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Term
| If patient is alert enough to swallow, what would you implement for treatment of hypoglycemia? |
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Definition
if <70 begin treatment
if >70 investigate signs and symptoms (if monitoring equipment not available, begin treatment)
give 15 to 20 g of a simple card such as (4-6 oz fruit juice or regular soft drink)
avoid foods with fat, glucose gel tablets can also be used
recheck blood sugar every 15 min after treatment until >70 and give patient regular snack to prevent rebound hypoglycemia
check blood sugar again 45 after treatment |
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Term
| What should be avoided when initiating treatment for hypoglycemia in a patient that is alert enough to swallow? |
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Definition
| avoid large quantities of quick acting cards so that fluctuation to hyperglycemia does not occur |
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Term
If patient is NOT alert enough to swallow, what would you implement for treatment of hypoglycemia?
What would you administer for acute settings? |
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Definition
Administer 1 mg of glucagon IM or subcutaneously.
Side effect: Rebound hypoglycemia
Have patient ingest a complex carbohydrate after recovery.
In acute care settings
20 to 50 mL of 50% dextrose IV push |
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Term
What is hyperosmolar hyperglycemic syndrome (HHS)?
Who is it common in?
Is it life threatening? |
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Definition
this occurs when patient has little but enough circulation insulin that ketoacidosis does not occur, neurological manifestations occur because of increased serum osmolarity
common in patients 60 years and older with type 2
life threatening but less dangerous that DKA |
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Term
| What is the usually history of HHS and its lab values? |
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Definition
Inadequate fluid intake
increasing mental depression
polyuria
blood glucose >400 mg/dL
increase in serum osmolarity
absent/min ketones |
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Term
| What do you do when a patient is experiencing DKA or HHS? |
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Definition
ADMINISTER:
iv fluids (more for HHS)
insulin therapy
electrolytes
ASSESS:
renal status
cardiopulmonary status
LOC
sign of K+ imbalance
cardiac monitoring
vital signs |
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Term
| What is diabetic ketoacidosis (DKA) and its signs and symptoms? |
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Definition
SUPPLY OF INSULIN IS INSUFFICIENT
signs:
Lethargy/weakness: early symptoms
Dehydration
Poor skin turgor
Dry mucous membranes
Tachycardia
Orthostatic hypotension
Abdominal pain
Anorexia, vomiting
Kussmaul respirations
Rapid deep breathing
Attempt to reverse metabolic acidosis
Sweet fruity odor
Serious condition
Must be treated promptly |
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Term
What do you when a patient is experiecing DKA?
be specific |
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Definition
1) manage airway (give O2)
2) correct fluid/electrolyte balance
IV infusion 0.45% or 0.9% NaCl
restore urine output
raise BP
…When blood glucose reaches 250
give 5% dextrose added to regimen to prevent hypoglycemia, replace K+, sodium bicarb
3) Insulin therapy
HOLD until fluid resuscitation has begun
give bolus followed by insulin drip |
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Term
What are the 3 RAPID acting insulin?
give there:
ONSET, PEAK, DURATION |
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Definition
1) lispro (Humalog)
2) aspart (Novoog)
3) glulisine (Apidra)
ONSET: 10-30 min
PEAK: 30 min-3 hr
DUR: 3-5 hr |
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Term
What is the short acting insulin?
give its:
ONSET, PEAK, DURATION |
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Definition
1) regular (Humulin R, Novolin R)
ONSET: 30 min-1 hr
PEAK: 2-5 hr
DUR: 5-8 hr |
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Term
What is the intermediate acting insulin?
give its:
ONSET, PEAK, DURATION |
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Definition
1) NPH ( Humulin N, Novolin R)
ONSET: 1.5-4 hr
PEAK: 4-12 hr
DUR: 12-18 hr |
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Term
What are the 2 long acting insulin?
give there:
ONSET, PEAK, DURATION |
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Definition
1) glargine ( Lantus)
2) detemir (Levemir)
ONSET:0.8-4 hr
PEAK: no pronounced
DUR: 24 hr + |
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