Term
| Which population is most at risk for developing diabetes? |
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Definition
Men- Hispanic
Women- Hispanic |
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Term
| Which ethnic population is least at risk for developing diabetes? |
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Definition
Men- White Non-Hispanic
Women- White Non- Hispanic |
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Term
| Meaning of the words "Diabetes" and "Mellitus"? |
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Definition
"Diabetes" = "To go through"
"Mellitus" = "Sweet"
Sweet urine. |
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Term
Diagnosing Diabetes
(5 ways) |
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Definition
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A1C > 6.5%
fasting plasma glucose (FPG) 126mg/dL (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h
2-h plasma glucose 200 mg/dL (11.1mmol/l) during an oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 ganhydrous glucose dissolved in water;
patient with classic symptoms of hyperglycemia or hyperglycemic crisis,
random plasma glucose >200 mg/dL (11.1 mmol/l)
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Term
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Definition
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Cellular-mediated autoimmune destruction of the B-cells of the pancreas which leads to absolute insulin deficiency
- ¨ Islet cell autoantibodies
- ¨ Autoantibodies to insulin
- ¨ GAD autoantibodies
- Accounts for 5-10% of DM
- Generally diagnosed in childhood. More rapid B-cell destruction w/ younger age.
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Term
| Process of Type 1 Diabetes in the body: |
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Definition
1. The stomach changes food into glucose
2. Glucose enters the bloodstream
3. The pancreas makes little or no insulin
4. Little or no insulin enters the bloodstream
5. Glucose builds up in the bloodstream
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Term
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Definition
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Caused by insulin resistance with relative insulin deficiency to insulin secretory defect with insulin resistance
- Accounts for 90-95% of DM
- Generally goes undiagnosed for years
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Term
| Pre-disposing factors for Type 2 diabetes? |
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Definition
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Pre-disposing factors:
Obesity/overweight
Age
Lack of physical activity
Ethnic groups: AA, API, Hispanic Americans, AI
GDM- 50% rate of developing T2DM
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Term
| Symptoms of Hyperglycemia: |
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Definition
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3 Ps
Nocturia
Blurred vision
Fatigue
Recurrent infections
Wt loss
Slow healing cuts
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Term
| At risk for Pre-Diabetes if: |
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Definition
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FBS >100mg/dl
A1C- 5.7-6.4%
35% of U.S. adults aged 20 years or older had prediabetes = 79 million Americans (50% of those aged 65 years or older)
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Term
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Definition
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Healthy and balanced eating
Daily exercise
Stress reduction and management
Medication
Self Management – SBGM
Meeting diabetes guidelines for self management
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Term
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Definition
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DiaLOG (Diabetes tracking log)
VDC (Virginia Diabetes Council- is working to increase access to evidenced-based resources andpromote self-awareness and self-management of diabetes)
Diabetes A,B,C,D,E,F
A1C
BP
Cholesterol
Dilated Eye Exam
Education
Foot Care
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Term
| Goals of Medical Nutrition Therapy: |
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Definition
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Achieve and maintain BG levels in nl range and lipids to prevent vascular disease.
Normal BP (<130/80)
Prevent or slow rate of complications
Meet nutrition needs
Maintain the pleasure of eating (reduce the need to eat for meds)
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Term
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Definition
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Generally 1 unit fast acting insulin for each 15 grams CHO
This is dependent on the results of the SBGM.
With T1DM, can see varying ratios throughout the day, for example, 1:12 for breakfast, 1:15 for lunch, 1:20 for dinner |
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Term
| Insulin: Rapid Acting Information |
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Definition
Onset <15 mins
Peak 0.5- 3 hours
Duration 3-5 hours
Note: If mixing with NPH, rapid acting insulin should be drawn into the syringe first. Mixture should be given immediately to avoid effects on peak action.
EX/ Lispro, Aspart, Glulisine |
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Term
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Definition
Onset 0.5- 1 hour
Peak 2-4 hours
Duration 4-8 hours
Note: May be mixed with NPH in same syringe. Mixing order should be the clear regular drawn up first, then the cloudy NPH ("clear to cloudy")
EX/ Regular (Novolin R or Humulin R) |
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Term
| Insulin: Intermediate Acting |
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Definition
Onset 2-4 hours
Peak 4-10 hours
Duration 10-18 hours
Note: Available as pen or vial to be used with syringe. |
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Term
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Definition
Onset 4-6 hours
Peak Same action through out the day
Duration 24 hours
Note: DO NOT mix with other insulin.
Available in pen or in vial. |
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Term
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Definition
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Algorithm for rapid/fast acting
carb counting ratio plus
Correction factor (CF)
Generally 1 unit for each 30-50mg/dl above BG goal
For example: BG is 220, goal is 120, CF is 1/50
How much additional insulin would this person take to lower their BG down to goal? Answer: 2
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Term
| Nursing Considerations: Insulin |
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Definition
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Site of injection- what does it look like? Is there lipohypertrophy? How to examine this?
Rotation plan- “marching soldiers”
Insulin storage- cold insulin is more painful than room temp insulin.
Insulin life
Insulin transport- hot and cold temps
Needles: reuse – good, bad or ugly?
Users must understand insulin action times:
¨Onset, Peak, Duration
Label of vials/pens
Visual impairment
Dexterity
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Term
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Definition
Blood glucose: <70mg/dl
Signs/symptoms: Shake/extremely hungry, lightheaded/weak, cold/clammy skin, personality change, inability to waken
Causes: Too much diabetes meds, too much activity, not enough carb, alcohol, advancing age
Treatment: 15/15
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Term
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Definition
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Used to treat severe hypoglycemia
Route: IM, SQ, IV- almost always IM
Patient/family education is critical!!
Gluconeogenesis
Duration: 1-1.5 hr
Adverse effects: N, V, hyperglycemia
Must eat after administration
Glucose depletion
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Term
| Oral Agents, Insulin Secreters: |
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Definition
They help make the pancreas make more insulin. They work by stimulating the beta cells in the pancreas to release more insulin.
EX/ 1. Sulfonylureas - These drugs are generally taken 2x a day before meals
2. Meglitinides/ Nateglinide- They were similarly to Sulyonylureas except they act immediately in response to food, are very short acting and need to be taken before each meal. |
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Term
Oral agents, insulin secreters:
Common side effects |
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Definition
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Low blood sugar is the most common side effect and can be caused by taking too much of the drug, not eating enough carbs, or an unexpected increase in activity.
Other less common side effects include :
skin reactions
stomach upset
increased sensitivity to the sun
brown urine
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Term
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Definition
These drugs mainly slow the release of glucose from the liver and has a slight effect on helping the body use the insulin better. They should be taken with food for best results. Most frequently used diabetes drugs.
EX/ Metformin or Fortamet |
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Term
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Definition
Diarrhea, nausea/ vomiting, metallic taste
Side effects usually subside if dosage is increased very gradually.
Lactic acidosis is very rare though can be serious. |
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Term
| Who should not take Metformin? (3) |
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Definition
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Who should not take metformin:
people with certain kidney or liver diseases
people who drink alcohol more than 2-4 drinks a week should check with their doctor
people with serious infections or complicated heart problems
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Term
| TZDs (Thiazolidendiones) - Glitazones |
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Definition
They help insulin work better in muscle or fat, they lower insulin resistance, and have a small effect on slowing the release of sugar from the liver.
TZDs are taken once or twice daily.
EX/ Rosiglitazone, Pioglitazone |
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Term
| Side effects and considerations of TZDs: |
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Definition
SE:Headache, Muscle ache, swelling or fluid retention, liver damage
Considerations: Have been associated with liver abnormalities, may make contraceptive pills less effective |
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Term
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Definition
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The drug is controversial and is estimated to have caused 83,000 heart attacks in the United States alone.
Patients will be required to be informed of the risks associated with its use, and the drug will be required to be purchased by mail order through specified pharmacies.
Precautions: MI, Heart failure, CVA, bone fractures, macular changes, hepatatoxicity
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Term
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Definition
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There may be an increased chance of having bladder cancer when taking pioglitazone;
Do not take pioglitazone if receiving treatment for bladder cancer;
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Term
| Alpha-Glucose Inhibitors: |
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Definition
Starch blockers.
Slows or blocks the breakdown of starches and certain sugars in the intestines. Actions slow the rise in blood sugar levels following a meal. Should be taken with first bite of meal. EX/ Acarbose, Miglitol
SE: Intestinal gas, diarrhea, abdominal pain
Considerations: Those with any type of bowel disease or significant kidney disease shouldn't take this. |
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Term
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Definition
While taking a combination drug may be easier, you should remember if you combine two drugs into one- you are still at risk for the side effects of both medications.
EX/ Glucovance, Metaglip, Avandamet |
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Term
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Definition
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Small intestine hormones that responds to a meal. No hypoglycemia!
Ex/ GLP-1 (glucagon-like peptide), DPP-4 (dipeptidyl peptidase 4)
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Term
GLP-1 (glucagon-like peptide)
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Definition
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¨Extenatide (Byetta) and liraglutide
¨↑ insulin
¨↓ glucagon
¨Delay gastric emptying
¨↑ satiety
¨SQ administration
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Term
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DPP-4 (dipeptidyl peptidase 4)
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Definition
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¨Linagliptin (Tradjenta), Saxagliptin (Onglyza), sitagliptin (Januvia)
¨Work by preventing the breakdown of incretins, allowing higher hormone levels
¨Oral administration
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Term
| Exercise’s affect on Blood Sugar |
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Definition
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lower blood sugar levels
improve insulin sensitivity and
strengthen the heart
Precautions:
¨Type 1: dilated eye examine
Avoid if BG >250 or ketonuria
¨T2DM or adult w/ T1DM>5yr – cardiac w/u
¨Frequent monitoring for hypoglycemia –
Take precautions!
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Term
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Definition
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7% of all pregnancies
Increased incidence in overwt, AA, AA, HA, NA
75 g OGTT: FBS, 1, 2 h BG at 24-28 wks
DX w/
¨FBS > 92 mg/dl
¨1 h: > 180 mg/dl
¨2 hr:> 153 mg/dl
BG goal: ,90 pre-meals, ,140 I hr post meal, ,120 2 hr post meal
Treat with MNT, exercise, SBGM >4x/d,
¨if needed BG not at goal - insulin.
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Term
| Other types of DM (non-T1orT2) |
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Definition
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Genetic defects of the B-cell
Genetic defects in insulin action
Diseases of the exocrine pancreas
¨(pancreatitis, trauma, infection, ca)
Endocrinopathies (acromegaly, Cushing’s syndrome, glucaogonoma, pheochromocytomoa)
Drug or chemical-induced diabetes-insulin resistance prior to med
¨Glucocorticoids, nicotinic acid
Infections
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Term
| Diabetic Ketoacidosis - DKA |
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Definition
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S/S: severe dehydration, 3 Ps, fatigue, N,V, breath w/ fruity (alcohol) smell as the body attempts to remove ketoacids, as acidosis worsens, may lead to Kussmaul respirations w/ increase rate and rhythm, tachycardia and hypotension, may lead to stupor and death.
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Term
| Hyperosmolar Hyperglycemic State- HHS |
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Definition
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Mortality rate of 20-40%. Seen in elderly, obese, w/ co-morbid conditions. Gradual onset and may be viewed as a CVA due to neuro involvement (confusion / lethargy). Treat w/ fluid replacement while avoiding cerebral or pulmonary edema.
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Term
| Nursing Considerations for DKA and HHS |
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Definition
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Hydration!
K+ supplementation
Insulin administration- IV, IM, SQ
Monitor acidosis
I&O, VS, Wt, neuro status
Educate: cause, treatment, prevention
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