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Chapter 34
Diabetes
29
Nutrition
Professional
08/28/2016

Additional Nutrition Flashcards

 


 

Cards

Term
What are the risks of bolus feeding the jejunum?
Definition
Dumping syndrome (and possibly bowel perf?)
Term
What are the diagnosic criteria for diabetes?
Definition

One of the following:

  • Fasting glucose >126
  • Two-hour glucose during OGTT: >200
  • HbA1c: >6.5
  • Random glucose: >200 with symptoms
Term
What are complications associated with gestational diabetes?
Definition
  • Macrosomia
  • Preeclampsia
  • C-section
  • Poor maternal-fetal outcomes
Term
What are the two prediabetic conditions?
Definition
  • Prediabetes
  • Metabolic syndrome
Term
What is the treatment for pre-diabetes?
Definition
  • Diet
  • Exercise
  • 5-10% weight loss
Term
What are the diagnostic criteria for metabolic syndrome?
Definition

3/5 of the following factors

  • Elevated waist circumference
  • Elevated fasting triglycerides
  • Elevated HDL
  • Elevated blood pressure
  • Elevated fasting glucose

 

Term
How do the diagnostic criteria for gestational diabetes differ from T2DM diagnostic criteria?
Definition
Patients with GDM have more modest glucose elevations because glucose levels are generally reduced during pregnancy
Term
When does gestational diabetes generally present and how does this differ from regular T2DM in pregnancy?
Definition

GDM generally presents between 24-28 weeks.

 

Overt diabetes can occur any time during pregnancy.

Term
What are potential complications of hyperglycemia in the hospitalized patient?
Definition
Hyperglycemia >180 is associated with depressed immune response, wound healing, and volume and electrolyte status
Term
What are glucose recommendations for critically ill patients?
Definition
  • Maintain glucose 140-180
  • Glucose <140 may be appropriate for some patients
  • Glucose <110 not recommended due to risk of hypoglycemia
Term
What are glucose goals for non-critically ill patients?
Definition
  • Premeal glucose <140
  • Random glucose <180
  • Reassess therapy for premeal glucose <100
  • Change therapy for premeal glucose <70
Term
How should hyperglycemia (>180) be managed for ICU patients?
Definition
IV insulin infusion should be initiated for BG >180 IN CRITICALLY ILL PATIENTS
Term
What is the optimal insulin therapy for non-critically ill patients?
Definition
  • Scheduled subcutaneous insulin therapy with 3 components: basal, nutritional, correctional
  • Preference for long-acting insulins
  • Prolonged use of sliding scale as sole therapy is discouraged
Term
Are oral antihyperglycemic agents recommended for hospital patients who require therapy for hyperglycemia?
Definition
No, they are not appropriate for most patients
Term
How should NPO patients with hypoglycemia be treated?
Definition
D50
Term
How much D50 should be given to hypoglycemic patients? Why?
Definition
15 g of carbohydrates' worth of D50 should be given to patients. If the whole ampule is given, overshoot hyperglycemia often occurs.
Term
How should non-NPO patients with hypoglycemia be treated?
Definition
They should receive 15 to 20 g carbohydrate as glucose tablets or an equivalent amount of other source (apple juice). They should also get a small mixed meal or snack (???)
Term
What actions should be taken with different levels of hypoglycemia?
Definition

<70: change therapy

<60: measured intervention according to hypoglycemia protocol

<40: immediate call to physician

Term
What should be done in an NPO patient in whom IV access cannot be obtained and who is hypoglycemic requiring intervention?
Definition
Glucagon can be administered intramuscularly
Term
What should be done if a hypoglycemic patient is unresponsive?
Definition
Give an entire ampule of D50 via IV and monitor blood glucose carefully
Term
How often should glucose be checked after initiating IV insulin?
Definition
Every hour until glucose has stabilized (up to 6 hours) and then every 2-3 hours thereafter
Term
What are the 3 pathophysilogical features of T2DM?
Definition
Impaired insulin secretion, elevated hepatic glucose output, and peripheral insulin resistance
Term
How frequently should blood glucose be monitored in non-critically ill patients?
Definition
4 times daily: before each meal and evening snack
Term
How should insulin be dosed and administered to non-critically ill hospitalized patients?
Definition
  • Estimated daily dose using outpatient reqs (if on insulin and well-controlled) or rule of 1500/rule of 1800
  • Administer half of total daily dose as basal dose
  • The remaining half of total daily insulin is given in divided portions before each meal
  • In addition to basal and bolus regimens, a correctional dose of rapid-acting insulin is added to scheduled premeal doses based on blood glucose level elevations
Term
Describe rule of 1500/rule of 1800
Definition

Used to determine total daily insulin dose. 

 

1500 is for long-acting insulin and 1800 is for short-acting insulin. 

 

Divide the decline in blood glucose following an injection of insulin by the units given to determine sensitivity factor (ex: 80 unit drop/5 units insulin = 16 = sensitivity factor)

 

Divide 1500 or 1800 (depending on insulin type used to induce drop) by sensitivity factor to determine total daily dose

 

Example: 80 mg BG drop after 5 units LA insulin = sensitivity factor of 16. 1500/16=94 total units insulin per day. 

Term
Is regular insulin long-acting or short-acting?
Definition
Long-acting
Term
What percentage of caloric requirements should T2DM patients iwth obesity receive?
Definition
60-70%
Term
How does hyperglycemia affect serum sodium levels? How does this affect serum sodium levels during hyperglycemia correction?
Definition
Serum sodium falls as blood glucose increases. As hyperglycemia is corrected, the serum sodium level rises as insulin drives glucose and water into the intracellular compartment
Term
When should IV insulin be discontinued relative to stopping EN or PN? Why?
Definition
IV insulin should be discontinued 30 to 60 minutes prior to stopping EN or PN due to the time that it will take the insulin to deactivate in the body
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