Term
| What is D.M. characterized by? |
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Definition
| elevated levels of glucose in the blood (hyperglycemia) |
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Term
| What are the complications of DM? |
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Definition
| amputations, blindness in working-age adults, and end-stage renal disease |
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Term
|
Definition
| Hormone produced by the pancreas (Moves glucose from blood to cells) |
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Term
|
Definition
Transports and metabolizes glucose for energy
Storage of glucose as glycogen in the liver and muscle cells
Signals liver to stop release of glucose
Enhances storage of dietary fat in adipose tissue
Facilitates transport of potassium into the cells |
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Term
| What happens if your BS drops low? |
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Definition
| pancreas secretes glucagon |
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Term
| What does glucagon stimulate? |
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Definition
| liver to release stored glucose |
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Term
| What is type 1 DM characterized by? |
|
Definition
destruction of the pancreatic beta cells
Autoimmune disease |
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Term
| What does type 1 DM result in? |
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Definition
| decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia |
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Term
| What causes glucosuria in T1 DM? |
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Definition
| If concentration of glucose in the blood exceeds a certain level (around 180 to 200 mg/dl) the kidneys can’t reabsorb all of the glucose, thus the glucose spills into the urine. As glucose is excreted in the urine, water accompanies it (osmotic diuresis). |
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Term
| What causes ketonuria in T1 DM? |
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Definition
| Fat breakdown results in ketones in the urine. |
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Term
| What is type 2 DM characterized by? |
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Definition
Main problems are insulin resistance and impaired insulin secretion
Beta cells can’t keep up with the increased demand for insulin. Usually slow progressive, glucose intolerance. |
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Term
| What are the risk factors of DM? |
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Definition
Genetic prediposition
Obesity (ie, BMI ≥25 kg/m2)
Ethnicity (eg, African Americans, Latino, Native American, Asian American, Pacific Islanders)
Age ≥45 years
Previous impaired glucose tolerance fasting glucose
Hypertension (≥140/90 mm Hg)
High HDL cholesterol level
History of gestational diabetes or delivery of babies over 9 pounds |
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Term
| What FBG level increases your risk of DM? |
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Definition
|
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Term
| What 2 hour glucose plasma level that increases your risk of DM? |
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Definition
75-g OGTT 140 mg/dL
to 199 mg/dL |
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Term
| What A1C level puts you at a risk for DM? |
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Definition
|
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Term
| What are the 3 p's of DM type 1? |
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Definition
-Polyuria
-Polydipsia
-Polyphagia |
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Term
| What are the other s/s of DM type 1? |
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Definition
-Weight loss
-Fatigue
-Increased frequency of infection
-Rapid Onset
-Insulin DEPENDENT
-Familial tendency
-Peak incidence from 10-15 years |
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Term
| What are the s/s of DM type 2? |
|
Definition
-Sedentary lifestyle
-Familial tendency
-Average age = 50
-History of high BP
-Fatigue/Decreased energy
-Obses
-Recurrent infections
-Polyuria
-Polydipsia
-Fasting blood sugar >126 mg/dl |
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Term
| What are the diagnostic tests of DM? |
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Definition
-Fasting blood glucose
-Oral glucose tolerance test
-Hemoglobin A1C |
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Term
| What is a fasting blood glucose of diabetes? |
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Definition
| Diabetes is diagnosed if it is higher than 126 mg/dL two times. |
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Term
| What is an oral glucose tolerance test of diabetes? |
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Definition
| level is higher than 200 mg/dL 2 hours after drinking a special sugar drink. |
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Term
| What is the normal a1c level? |
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Definition
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Term
| What is the pre diabetic A1C level? |
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Definition
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Term
| What is the diabetic level for A1C? |
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Definition
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Term
Which of the following risk factors for diabetes would a nurse identify as being modifiable?
The patient is of Native American ancestry.
The patient is moderately obese.
The patient’s mother and brother have type 1 diabetes.
The patient is 51 years old. |
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Definition
B. The patient is moderately obese.
Rationale: Body weight is a modifiable risk factor for diabetes; age, ethnicity, and family history are beyond the patient’s control. |
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Term
| What are the nutrition and exercise goals of DM? |
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Definition
| control of caloric intake for a healthy body weight, control of blood glucose levels, and normalization of lipids and blood pressure |
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Term
| What is the pre meal glucose level goal? |
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Definition
|
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Term
| What is the peak post eating glucose level? |
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Definition
| (1-2 hrs after beginning of meal) <180 mg/dl |
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Term
| How can ppl self monitor for DM? |
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Definition
Allows for detection and prevention of hypoglycemia and hyperglycemia
Various methods for SMBG are available and should be used frequently
Glycated hemoglobin levels reflects average blood glucose levels over a period of approximately 2 to 3 months
Urine testing for ketones and glucose may also be performed |
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Term
| Who can use Metformin preventively? |
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Definition
| those with BMI > 35, aged < 60 years, and women with prior GDM |
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Term
| What else can be done to prevent DM type 2? |
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Definition
| Screening for and treatment of modifiable risk factors for CVD is recommended (obesity, hypertension, and dyslipidemia) |
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Term
Is the following statement true or false?
A patient’s glycated hemoglobin level has been found to be significantly elevated. This indicates that the patient has been experiencing wide fluctuations in blood glucose levels. |
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Definition
False
Rationale: A patient’s glycated hemoglobin indicates the average blood glucose level over the previous several weeks, but it does not indicate the range of the levels. |
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Term
| What are the recommendations for type 1 diabetics medical treatment? |
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Definition
3-4 injections per day of basal and prandial insulin or continuous subcutaneous insulin infusion
Match prandial insulin dose to CHO intake, premeal blood glucose and anticipate activity
Use insulin analog (long-acting, rapid-acting, or premixed) to reduce hypoglycemia risk
Consider screening for other autoimmune diseases (thyroid, vitamin B12 deficiency, celiac) as appropriate
Continuous glucose monitoring system, subq, identifies high or low glucose levels along with continuous subq insulin infusion |
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Term
| How much insulin per carb? |
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Definition
| In general patients take 1 unit of insulin for every 10 to 15 gms of CHO at meals. |
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Term
| What are the rapid acting insulins? |
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Definition
-Lispro (Humalog)
-Aspart (Novolog)
-Glulisine (Apidra) |
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Term
| What is the onset of rapid acting insulin? |
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Definition
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Term
| What is the peak of rapid acting insulin? |
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Definition
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Term
| What is rapid acting insulin used for? |
|
Definition
-rapid reduction of glucose level
-treat postprandial hyperglycemia
-prevent nocturnal hypoglycemia
"mealtime insulin" |
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Term
| What are the short acting insulins? |
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Definition
| Regular (Humilin-R, Novolin-R) |
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Term
| What is the onset of the short acting insulins? |
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Definition
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Term
| What is the peak of the short acting insulins? |
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Definition
|
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Term
| What is the duration of the short acting insulin? |
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Definition
|
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Term
| What is the duration for the rapid acting insulin? |
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Definition
|
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Term
| What is short acting insulin used for? |
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Definition
| 20-30 mins before a meal, may be taken alone in with another longer-acting insulin |
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Term
| What are the intermediate acting insulins? |
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Definition
| NPH (Humulin N, Novolin N) |
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Term
| What is the onset of intermediate? |
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Definition
|
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Term
| What is the peak of intermediate? |
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Definition
|
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Term
| What is the duration of intermediate? |
|
Definition
|
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Term
| What is intermediate insulin used for? |
|
Definition
|
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Term
| What is long acting insulin? |
|
Definition
Glargine (Lantus)
Detemir (Levemir) |
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Term
| What is the onset of long acting? |
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Definition
|
|
Term
| what is the peak of long acting? |
|
Definition
|
|
Term
| What is the duration of long acting> |
|
Definition
|
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Term
| What is the use of long acting? |
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Definition
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Term
| What medications are used to treat DM type 2? |
|
Definition
Metformin, if not contraindicated, and if tolerated, is the preferred initial pharmacological agent.
In newly diagnosed and symptomatic/elevated BG levels, consider adjunct insulin therapy.
If non-insulin monotherapy at max dose does not achieve or maintain target A1C over 3-6 months, add a second oral agent, or glucagon-like peptide-1[GLP-1] receptor agonist, or basal insulin.
Due to progressive nature of type 2, insulin therapy is eventually indicated for many.
Diet, exercise, and education remain the foundation of any type 2 treatment program |
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Term
| What do sulfonylureas do? |
|
Definition
Directly stimulate pancreas to secrete insulin
Second generation include glipizide, glyburide, glimepiride
SE hypoglycemia |
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|
Term
|
Definition
Metformin, most common
Decreases hepatic production of glucose and facilitates action of insulin on receptor sites
Contraindicated in renal impairment
Extended release and combination forms with sulfonylurea available |
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Term
| What do Alpha-glucosidase inhibitors do? |
|
Definition
Acarbose and miglitol
Delay absorption of glucose in intestinal tract (GI side effects)
Must be taken immediately before meal |
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Term
| What do Nonsulfonylurea insulin secretagogues do? |
|
Definition
Stimulate insulin release from pancreas
Rapid onset, short duration, taken with meals |
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Term
| What do Thiazolidinediones do? |
|
Definition
| Enhance insulin action at receptor sites |
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Term
| Why is Metformin the first choice for DM2? |
|
Definition
| Less side effects - no weight gain |
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Term
When caring for a hospital patient who requires insulin injections, the nurse should:
Use the same injection site for all of the injections needed during that day
Store insulin vials in a warm, dry, dark place
Use a 3 mL or 5 mL syringe
Mix rapid-acting and long-acting insulin in the same syringe |
|
Definition
D. Mix rapid-acting and long-acting insulin in the same syringe
Rationale: When rapid- or short-acting insulins are given with longer-acting insulins, they usually are mixed together in the same syringe. Injections sites should be rotated, and insulin should be stored in a refrigerator. Insulin syringes range in size from 0.3 mL to 1 mL. |
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Term
|
Definition
| Blood glucose less than 50 to 60 mg/dL |
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Term
| What can cause hypoglycemia? |
|
Definition
| Can be caused by too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity |
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Term
| What are the signs of hypoglycemia? |
|
Definition
cold and clammy need a candy
inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness |
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Term
| How is hypoglycemia usually treated? |
|
Definition
Usually treated with 15 g of a fast-acting concentrated source of carbohydrate
Glucagon may be required |
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Term
|
Definition
| Diabetic Ketoacidosis (DKA) |
|
|
Term
|
Definition
| Deficit of insulin results in disorders in the metabolism of carbohydrates, proteins, and fats |
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Term
|
Definition
| Ultimately results in ketosis and metabolic acidosis |
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Term
| What are the treatment goals of DKA? |
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Definition
| DKA is directed toward correcting dehydration, electrolyte loss, and acidosis |
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|
Term
|
Definition
-Sweet breath
-Tachycardia
-Hypotension
-Acidosis
-High blood sugar (>300)
-Hyperkalemia
-Polyuria |
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Term
|
Definition
| Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) |
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Term
|
Definition
| severe hyperosmolality (≥340 mOsm/L) and profound hyperglycemia (≥600 mg/dL) with alterations in level of consciousness, absence of ketosis |
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Term
| What are the s/s of HHNS? |
|
Definition
| hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs |
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Term
| What is the onset of HHNS? |
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Definition
| Onset is over several days, usually type 2 diabetic and older adults, often preceded by illness |
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Term
|
Definition
| Fluid replacement, correction of electrolyte imbalances, and insulin administration |
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Term
| What is the nursing care related to HHNS? |
|
Definition
| close monitoring of vital signs, fluid status, and laboratory values |
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Term
| What respirations accopany DKA? Why? |
|
Definition
| Kussmaul - try to get acidosis reversed |
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|
Term
The overall approach to DKA and HHNS is similar and involves fluid replacement, correction of electrolyte imbalance and insulin administration?
True
False |
|
Definition
|
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Term
| What are the long term complications of diabetes? |
|
Definition
Blood vessel walls thicken, sclerose, and become occluded by plaque that adheres to the vessel walls
Leads to coronary artery disease, cerebrovascular disease, and peripheral vascular disease
Focus of management is aggressive modification and reduction of risk factors
Diabetic retinopathy
Diabetic nephropathy
Diabetic neuropathy:
Peripheral neuropathy
Autonomic neuropathies
Complications of the feet and legs |
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|
Term
In an effort to prevent foot and leg complications of diabetes, what measure should the nurse recommend to a patient with recently diagnosed type 1 diabetes?
Daily inspection of all surfaces of the feet
Wearing tight shoes with good arch support
Cutting the toenails daily
Avoiding walking whenever necessary |
|
Definition
A. Daily inspection of all surfaces of the feet
Rationale: To identify wounds early, patients with diabetes should be encouraged to begin the habit of thoroughly inspecting both feet on a daily basis. Tight shoes and frequent cutting of the toenails can increase the risk of foot ulcers. Exercise should not be avoided |
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Term
| What hospitalization issues must be considered for diabetics? |
|
Definition
Hospitalization creates a potential for unstable blood sugar levels:
In addition to nursing assessment for the primary problem, assessment of the patient with diabetes must focus on hypoglycemia and hyperglycemia, skin assessment, and diabetes self-care skills
Goals and interventions address improved nutritional status, maintenance of skin integrity, ability to perform basic diabetes self-care skills, and preventive care for the avoidance of chronic complications of diabetes |
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