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NUR Theory 155 Exam 2 > 48. Diabetes Mellitus > Flashcards

48. Diabetes Mellitus Flashcards

1
Q

Diabetes has been classified as simultaneous presence of _____ factors know to increase risk for developing ____ ___ _____ and _______ disease

A

metabolic
type 2 diabetes
cardiovascular

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2
Q
  1. Diabetes is a major contributing factor to:

2. Prediabetes can lead to:

A
  1. heart disease and stroke
  2. Type 2 Diabetes, heart disease, stroke, impaired fasting glucose (IFG) 100-125 mg/dL and impaired glucose tolerance (IGT) 140-199 mg/dL
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3
Q

DIABETES VALUES
1. Normal (non-diabetic) glucose range

  1. TYPE 1 DIABETES: Fasting and post meal glucose that may indicate Type 1 Diabetes
  2. DIAGNOSIS OF: impaired glucose tolerance (IGT), impaired fasting glucose (IFG)
A
  1. 70-110 mg/dL
  2. Fasting = above 125mg/dL, Post-Meals = 200 mg/dL
  3. IGT = 2 hour oral glucose tolerance test OGGTT caluse are 140-199mg/dL,
    IFG = fasting glucose levels are 100-125mg/dL
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4
Q

Function of glucose in the metabolism and:

  1. Insulin
  2. Liver and muscle cells
  3. Overnight fasting facilitates
A
  1. Promotes glucose transport from the bloodstream into cell cytoplasm. Where glucose is broken down to make energy. Insulin promotes anabolic or storage hormone.
  2. Liver and muscle cells store excess glucose and glycogen.
  3. Release of stored glucose from the liver, protein from muscle, and fat from adipose tissue
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5
Q
  1. What are the conterregulatory hormones

2. How do they increase glucose

A
  1. glucagon, epinephrine, growth hormone and cortisol

2. stimulates glucose production and release by the liver, decreasing the movement of glucose into other cells

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6
Q

Measuring ___ in the serum and urine is a useful clinical indicator of pancreatic B-Cell function.

A

C-Peptide

when insulin is made it is split from proinsulin producing insulin and C-peptide

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7
Q

Type 1 Diabetes:

  1. generally affects people
  2. ___ disorder:
  3. Factors
  4. A reduction of islet cells reduce __-__ until manifestations and hyperglycemia is seen.
  5. When do symptoms occur
A
  1. under 40 years of age but can occur at any age
  2. autoimmune (body develops antibodies against insulin and pancreatic B-cells and symptoms don’t occur for months to years)
  3. genetic predisposition, exposure to a virus and carrying a certain HLA type
  4. 80-90%
  5. When the pancreas can no longer produce sufficient amounts of insulin, symptoms are rapid = impending or actual ketoacidosis
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8
Q
  1. What is Idiopathic diabetes

2. What is Latent autoimmune diabetes in adults

A
  1. a form of type 1 diabetes strongly inherited and not related to autoimmunity (Hispanic, African or Asian ancestry)
  2. slowly progressing autoimmune form of type 1 diabetes, occurs in adults often mistaken for type 2 diabetes
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9
Q

Define:

  1. polydipsia
  2. polyuria
  3. polyphagia
A
  1. dipsia - excessive thirst
  2. uria - frequent urination
  3. phagia - excessive hunger
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10
Q

The individual with Type 1 Diabetes requires:

A

exogenous insulin / outside source insulin, without it the pt will develop diabetic ketoacidosis

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11
Q

Newly diagnosed patients with Type 1 may experience

A

remission or “honeymoon period” for 3-12 months after treatment is initiated. During this time little insulin injection is required because B-cell production is sufficient. Eventually B-Cells are destroyed and glucose levels increase which is when the honeymoon period ends and the patient will require insulin on a permanent basis

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12
Q

TYPE 2 DIABETES

  1. Risk factor:
  2. More prelevant in what race than whites
  3. Characterized as:
A
  1. overweight or obese, being older and having a family history of type 2 diabetes (will be seen more in children as childhood obesity)
  2. African and Asian Americas, Hispanics, Native Hawaiians or other Pacific Islanders and Native Americans
  3. inadequate insulin secretion and insulin resistance
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13
Q

Is endogenous present in Type 1 or 2:

A

Type 2

it is absent in type 1

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14
Q

TYPE 2 DIABETES
1. What would make you 10x more likely to develop type 2 diabetes

  1. Name the four factors of type 2 diabetes
A
  1. first-degree relative with the disease
  2. 1) insulin resistance, 2) pancreatic inability insufficiency, 3) inappropriate glucose production by the liver and 4) altered production of hormone and cytokines by adipose tissue
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15
Q

METABOLIC SYNDROME

  1. Individuals with metabolic syndrome are at an increased risk for the development of
  2. Five components of metabolic syndrome
  3. Who can reduce their risk
A
  1. type 2 diabetes
  2. elevated glucose levels, abdominal obesity, elevated bp, high levels of triglycerides and decrease levels of HDL
  3. overweight individuals - weight loss and regular physical activity
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16
Q

Onset of Disease : Type 2 Diabetes

  1. onset is usually
  2. Diagnosed during routine lab test and rx of other conditions
A
  1. gradual

2. and elevated glucose or glycosylated hemoglobin (A1C) levels are found

17
Q

PREDIABETES

  1. increased risk for
  2. defined as
  3. When is prediabetes dx
A
  1. developing type 2 diabetes
  2. impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both
  3. blood glucose levels are elevated but not high enough to meet diagnostic criteria for diabetes
    IGT of 140-199mg/dL 2 hour fasting &/or
    IFG blood glucose 100-125mg/dL
18
Q

Nursing interventions for the prediabetic:

  1. Encourage them to:
  2. Regularly monitor:
  3. Maintain:
A
  1. encourage them to have their blood glucose and A1C checked
  2. regularly and monitor for symptoms of diabetes (fatigue, frequent infections or slow healing wounds
  3. maintain a healthy weight, exercise regularly and make healthy food choices
19
Q

GESTATIONAL DIAVETES

  1. Develops during
  2. Higher risk for (mom and baby)
  3. Women who are at increased risk
  4. Diagnostic test
  5. Postpartum when do normal glucose levels return
A
  1. pregnancy
  2. cesarean delivery and their babies have increase risk of perinatal death, birth injury and neonatal complications, increased chance of developing type 2 diabetes within 16 years
  3. family hx of diabetes, obese and advanced maternal age
  4. OGTT at 24-28 weeks of gestation (glucose tolerance test)
  5. 6 weeks
20
Q

Conditions that may cause diabetes

A 
Cushing syndrome
Hyperthyroidism
Recurrent pancreatitis
Cystic fibrosis
Hemochromatosis
Parenteral nutrition
21
Q

Medications that induce diabetes can:

A

Corticosteroids (prednisone)
Thiazides
Phenytoin *Dilantin)
Atypical antipsychotics

can resolve when the underlying condition is treated or the medication discontinued

22
Q

Clinical Manifestations

  1. Type 1 Diabetes Classic, other and complication
  2. Type 2 Diabetes
A
  1. Classic: polyuria, polydipsia (
23
Q

DIAGNOSTIC STUDIES - diabetes is diagnosed using one of these four test

  1. A1C of
  2. Fasting plasma glucose (FPG)
  3. Two hour plasma glucose level greater than or equal to ___ during an ___ using a glucose load of ___.
  4. In a patient with:
  5. WHAT DOES A NURSE DO IF REPEAT TESTING IS NEEDED?
A
  1. 6.5% or higher
  2. greater than or equal to 126 mg/dL (FASTING FOR AT LEAST 8 HOURS)
  3. 200 mg/dL during an OGTT using a glucose load of 75g
  4. classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis a random plasma glucose greater than or equal to 200 mg/dL **REPEAT TESTING NOT WARRANTED OTHERWISE CRITERIA 1-3 SHOULD BE CONFIRMED BY REPEAT TESTING TO RULE OUT LAB ERROR)
  5. repeat test to be the same test used initially
24
Q
  1. A1C provides a measurement for
A
  1. Blood glucose levels over the previous 2-3 months

2. more convenient b/c fasting is not required and disease affecting RBC’s can influence the A1C

25
Q

TEACH PATIENTS WITH DIABETES AND PREDIABETES:

  1. Monitor what and maintain what values
  2. what risk is reduced if ___ is maintained
  3. pt with prediabetes detects
A
  1. have A1C monitored regularly to determine the success of the current treatment plan and make changes, Goal is less than 7.0% American college of endocrinology recommends less than 6.5%
  2. if A1C is maintained development of microvascular and macrovascular complications is greatly reduced
  3. Pt with prediabetes detects overt diabtes and feedback to prevent diabetes
26
Q

Goals of diabetes management are to

A

reduce symptoms, promote well-being, prevent acute complications related to hyper and hypoglycemia and prevent or delay the onset and progression of long-term complications

27
Q
  1. Name the types of insulin:

2. How do they differ:

A
  1. rapid, short, intermediate and long acting insulin

2. onset, peak action, and duration

28
Q

BASAL BOLUS REGIMEN
1. Uses what type of insulin

  1. The goal is to achieve a glucose level of:
  2. Mealtime Insulin (bolus)
    a) rapid and b) short acting
  3. Which is more likely to cause hypodlycemia
A
  1. rapid or short (bolus) acting insulin before meals and intermediate or long acting (basal) background insulin once or twice a day
  2. 80-130 mg/dL before meals
  3. a) injected within 15 mins of meal time, closely mimic natural insulin secretion in response to a meal,
    b) injected 30-45 minutes before a meal to ensure onset of action coincides with meal absorption
  4. short acting
29
Q

INSULIN PREPERATIONS:
a)drug names, b) onset peak duration

  1. Rapid acting
  2. Short acting
  3. Intermediate acting
  4. Long acting
A
  1. Rapid acting = a) lisopril (Humalog), Aspart (Novolog); Gluilsine (Apidra)
    b) O 10-30min, P 30min- 3hr, D 3-5hr
  2. a) Regular (Humulin R, Novolin R)
    b) O 30min, P 2-5 hr, D 5-8hr
  3. a) NPH (Humulin N, Novolin N)
    b) O 1.5-4hr, P 4-12hr, D 12-18hr
  4. a) Glargine (Lantus), Detemir (Levemir), Degludec (Trebia)
    b) O 0.8-4hr, P no pronounced peak steady levels, D 16-24hr
30
Q

Intermediate-Acting Insulin (NPH)

  1. Can result in
  2. Nursing interventions for NPH administration
  3. What insulin is mixed in the same syringe
A
  1. hypoglycemia
  2. It cannot be mixed with short and rapid acting insulin’s and should never be given IV. It is a cloudy insulin prep gently agitate it before administration by rolling between palms
  3. short or rapid acting insulin is mixed with intermediate acting insulin in the same syringe (premixed formula or pen)
31
Q

STORAGE OF INSULIN

    1. Insulin vials and insulin pens currently in use may be left at
      1. Avoid
      2. Store unopened insulin vials and insulin pens:
    1. Prefilled syringes with two different insulins are stable for up to ____ when stored in the ___. One type of insulin is stable for up to ___ ____.
    1. Teach storage of syringes and how to prep prefilled syringes
A
  1. room temp for up to 4 weeks (86-32)
  2. Prolonged exposure to direct sunlight
  3. In a refrigerator
  4. 1 week when stored in the refrigerator, one type is stable for up to 30 days
  5. store syringes in a vertical position needle pointed up (avoid clumping), roll prefilled syringes between palms 10-20x to warm insulin and suspend particles
32
Q

ADMINISTRATION OF INSULIN

  1. Administered by and proper sites
  2. Can insulin be given via oral administration
  3. IM injection can result in
A
  1. sub q injection, regular insulin can be given IV when immediate onset of action is desired. Proper sites: abdomen = best absorption followed by the arm, thigh and buttock
  2. no it is inactivated by gastric fluids
  3. cause hypoglycemia
33
Q

ADMINISTRATION OF INSULIN

  1. Checkerboard
  2. inject what types of insulin in what sites
  3. How to choose syringes
  4. Injections typically give at
A
  1. abdomen is a checkerboard each square is 1/2 inch square, rotate systemically across the board 1/2-1 inch away from previous site
  2. long acting into fast absorption sites, short acting into slow absorption sites
  3. 0.5mL size = 50U or less, 0.3mL syringe = 30U or less&raquo_space;> use 1U increments
  4. Typically & Using shortest needle desired at home = 90 degrees, Extremely thin or muscular pt in the hospital = 45 degrees.

NUR Theory 155 Exam 2 (1 decks)

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