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Undeleted > 3 glucose dysregulation > Flashcards

3 glucose dysregulation Flashcards

1
Q

Diabetes Mellitus

A

chronic, body is unable to use glucose as it should to produce energy

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2
Q

Type 1

A

unable to produce insulin

  • irreversible disorder of pancreatic beta islet cells (severe insulin deficiency)
  • altered macronutrient metabolism
  • dependent on exogenous insulin
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3
Q

Type 2

A

unable to use insulin

  • pancreas doesn’t produce enough (deficiency)
  • cells don’t use insulin properly (resistance) majority
  • dysfunction of liver: excess glucose released
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4
Q

insulin role

A
  • promotes uptake and storage of glucose from blood
  • promotes uptake and storage of glucose by other cells

minor

  • promotes fat deposition, amino acid transport
  • inhibits protein degradation
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5
Q

hyperglycemia pathophysiology

A

osmotic gradient shift - fluid from ICM -> ECM -> glomerular filtrate
glucose > 180 mg/dl -> glucosuria, polyuria

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6
Q

diabetes clinical manifestations

A
  • frequent urination
  • increased thirst, appetite
  • decreased energy
  • vision disturbances
  • abdominal pain
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7
Q

alpha cells

A

glucagon: acts on liver to release glycogen, increases blood sugar

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8
Q

beta cells

A

insulin: decreases blood sugar

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9
Q

delta cells

A

somatostatin: stops glucagon and GH, decreases blood sugar

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10
Q

type 1 etiology

A

Human Leukocyte Antigen (HLA) system
- identifies cells to immune system as self or non. Certain patterns indiate a susceptibility to Type 1 DM

autoimmune process
- islet cell antibodies, insulin antibodies

environmental factors
-viruses

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11
Q

diabetic ketoacidosis

A

BIGGEST ISSUE.

  • often presenting symptom in children
  • moderate to life threatning
  • caused by metabolism of fats for energy (source #2 for energy; ketones released; body at extremely high glucose for extended period for this to happen)
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12
Q

DKA lab findings

A
  • hyperglycemia
  • glucosuria
  • ketonuria
  • metabolic acidosis/ketoacidosis
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13
Q

DKA s/s

A
  • kussmaul respirations (deep, rapid)
  • dehydration
  • acetone breath (sweet, fruity)
  • poor perfusion
  • impaired consciousnessi
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14
Q

illness/stress response + diabetics

A

check blood sugar, monitor to prevent DKA

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15
Q

nursing interventions for DKA

A
  • manage hyperglycemia
    (regular insulin, IV, 75 - 150 mg/dl/hr)
  • fluid and electrolyte
    (restore volume, maintain perfusion to brain/heart/kidneys)
  • education
    (reason for diagnosis, prevent further episodes)
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16
Q

Type 2 DM etiology

A
  • strong genetic basis exacerbated by environment factors including inactivity, weight gain, stress
  • most people overweight at time of diagnosis; weight loss can prevent/delay development
  • all age groups
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17
Q

Type 2: increased risks

A
  • overweight
  • parent/sibling with diabetes
  • 40+ yo
  • htn
  • African American, Latino, American Indian
  • diabetes during pregnancy
  • stress of illness, injury
  • had baby weighing more than 9 pounds at birth
18
Q

hyperglycemic-hyperosmolar state (HHS)

A

mainly type 2

  • blood sugars EXTREMELY high (up to 600 mg/dl)
  • body tries to rid excess by passing through urine
  • initially lots of UOP, becomes dark
  • very thirsty
  • if condition continues: severe dehydration -> seizures, coma, death
19
Q

nursing intervention of HHS

A

fluid therapy
- replacement to increase blood volume

medical therapy
- IV insulin after adequate fluid replacement. 50-70 mg/dL/hr

20
Q

management of DM

A 
meds (insulin + PO)
monitoring
meal plan
exercise plan
EDUCATION!
21
Q

medicinal management of Type 1

A

insulin: basal, rapid acting

22
Q

basal insulin

A

Levemir, Lantus (work up to 24 hours)

23
Q

rapid acting insulin

A

Novolog, Humalog (meal time and correction doses)

24
Q

medicinal management of Type 2

A

biguanides: Metformin (glucophage) - increases insulin sensitivity; decreases hepatic production of glucose from glycogen; decreases absorption of glucose from small intestine
sulfonylureas: Glyburide, Glucotrol (glipizide) - directly stimulate pancreas to secret insulin

25
Q

monitoring management of diabetes

A
  • self-monitoring of blood glucose (SMBG)
  • HbA1C
  • urine testing for ketones
26
Q

HbA1C

A
  • glycoselated hemoglobin
  • reflects glycemic control for previous 3 months
  • target: 7% (American Diabetes Association), 6.5% (American Association of Clinical Endocrinologists)
  • normal: 6%
27
Q

A1C components

A

post-prandial glucose + fasting glucose

ginormous table correlating blood sugar and A1C

28
Q

urine testing for ketones

A
  • when blood glucose is > 240 mg/dl
  • on sick days

Ketones indicate that current insulin levels are not adequate; NO EXERCISE IF KETONES PRESENT

29
Q

meal plan management for diabetes

A
  • consistency in intake to match insulin regimen
  • adequate energy for growth, development
  • prevent longterm complications
30
Q

carbohydrates

A
  • main source of fuel
  • 4 calories per gram
  • almost 100% eaten turns into blood glucose
  • simple vs complex
31
Q

exercise management of diabetes

A
  • daily!
  • important to overall growth, development
  • extra snacks may be needed
32
Q

hypoglycemia s/s

A

COOL AND CLAMMY NEED SOME CANDY
rapid onset

  • shaking
  • sweating, clammy
  • headache, dizzy
  • tachycardia
  • confusion, seizure, coma
33
Q

hypoglycemia causes

A
  • delayed/skipped meal/snack
  • too much med
  • too much/unexpected activity
  • drinking alcohol on empty stomach
34
Q

*hypoglycemia treatment

A

mild-moderate: 3 glucose tablets or fruit juice if BG < 60 whether or not s/s.
- rest 15 minutes, recheck to make sure BG > 70

severe: patient unresponsive; glucagon emergency kit

35
Q

hyperglycemia

A

WARM AND DRY, SUGAR’S HIGH
gradual onset

  • frequent urination, ketonuria
  • lethargy, weakness
  • n/v/abdominal pain
36
Q

hyperglycemia treatement

A
  • adjust insulin
  • increase fluids
  • dietary changes
  • if signs of ketoacidosis: SEEK MEDICAL CARE
37
Q

diabetic retinopathy

A

recommend professional dilated eye examination once a year

38
Q

neuropathy and amputation: foot care

A
  • examine feet daily for discoloration, swelling, skin cracks, pain, numbness
  • hygiene
  • control water temperature
  • avoid going barefoot or shoes without socks
  • ask for help if reduction of visual acuity
39
Q

cardiovascular care for diabetics

A
  • higher risk for MI (leading cause of death for diabetics)
  • aggressive management of hyperglycemia, hypertension, hyperlipidemia
  • education: diet, exercise, med management
40
Q

diabetic nephropathy

A

annual testing for microalbuminuria recommended for Type 1 patients (5+ years long) and ALL Type 2

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