Alterations In Glucose Metabolism

Question 0

Type 2 diabetes

Answer 0

Usually older than 30 and obese. Decreased sensitivity to insulin (insulin resistance) or decreased insulin production. Ketosis rare. Treated with diet and exercise. supplemented with oral hypoglycemic agents

Question 1

Type 1 diabetes

Answer 1

Acute onset before age 30. Insulin- producing pancreatic Beta cells destroyed by autoimmune process. Requires insulin injection
ketosis prone

Question 2

Risk factors for type 2 diabetes

Answer 2

Parents or siblings of diabetes, obesity (20% or more above ideal bodyweight) African-American, Hispanic, Native American, or Asian-American, older than 45 years, Previously impaired fasting glucose, hypertension
Hdl cholesterol levels less than or equal to 35mg/DL; triglyceride levels greater or equal to 250mg/DL
History of gestational diabetes or delivery of baby greater than 9lbs

Question 3

Hypoglycemia

Answer 3

Blood sugar less then 50-60mg/DL
Irritability, confusion, tremors, blurring of vision, coma, seizures, hypotension, tachycardia her. Skin cool and clammy, diaphoresis

Implementation- liquids containing sugar if conscious, skim milk is ideal if tolerated dextrose 50% IV

If unconscious, Glucagon 1 mg IM, SQ follows additional carbohydrate in 15 minutes. Determine and treat client

Causes: too much insulin or oral hypoglycemia agent. Inadequate food, excessive physical activity

Question 4

Hyperglycemia/diabetic ketoacidosis

Answer 4

Blood sugar 300- 800 mg/dl
Headache, drowsiness, weakness, stupor, coma. Hypertension, tachycardia, skin warm and dry, dry mucous membranes, elevated temperature. Polyuria progressing to oliguria, polydipsia, polyphagia, Kuszmaul’s respirations (rapid and deep)
Fruity odor to breath
Implementations- major complication is fluid deficit.
1 L of .9% NaCl per hour during first 2 to 3 hours followed by .45 NaCl 200- 500 ml/hr. Then DW or D 1/2 NS 55
Regular IV insulin 5 units/H. Potassium replacement. EKG Q 2-4h
Check k+ q 2-4 h
Assess loc
You’re in output, temperature hourly. Assess vital signs Q 15 minutes until stable. Assess CVP Q 30 minutes. Check blood glucose levels hourly.

Causes are to creased are missed insulin. Illness or infection. Untreated diabetes

Question 5

Mixing insulin

Answer 5

Always draw up reg first. Clear first. Then nph

Question 6

Sick day rules for diabetic

Answer 6

Illness can raise glucose levels.
Teaching::
Take insulin as ordered, check blood glucose Q3/4 hours, check urine ketones and if vomiting, diarrhea, are fever, report to physician and take liquids every 30 minutes to one hour

Question 7

Oral hypoglycemic agents

Answer 7

Not insulin, may increase release of insulin from Beta cells (secretagogues)
May decrease insulin resistance of tissues, may do both

Question 8

Skin and foot care for diabetes mellitus

Answer 8

Inspect feet daily
Wear well fitting shoes; break in new shoes slowly
Don’t walk barefoot or use heating pad on feet
Cut toenails straight across

Question 9

Hyperglycemic hyperosmolar nonketotic syndrome)

Usually Type 2 client
Older on TPN (ex)

Answer 9

Assessment
Glucose > 800 mg/dl
Usually older adult with type 2
Ketosis, acidosis do not occur- usually have some insulin on board, so they don't have to break down fats
Hypotension
Dry mucous membranes
Seizures

Implementation-
Restore fluid volume with .9 NaCl, regular insulin IV, check vital signs, monitor glucose levels, determine and treat cause