Care of Pt. with diabetes

Question 1

Glucose

where is it stored

Answer 1

• “Sugar”
• Fuels the cells of our body
• Stored mainly in liver in form of glycogen
• Needs help of Insulin to enter the cells

Question 2

Insulin

Answer 2

• Hormone which regulates amount of glucose in blood
• Helps body use glucose by allowing it to enter the cell
• Secreted by Beta Cells

Question 3

Glucagon

Answer 3

• Secreted by Alpha Cells

- Hormone that helps the liver turn stored glucose (glycogen) into glucose

Question 4

a&p of Increased blood sugar

Answer 4

• Pancreas releases Insulin → Glucose enters cells to be used or saved for later to lower blood sugar

Question 5

Decreased blood sugar

Answer 5

Pancreas releases Glucagon → Liver releases glycogen (stored glucose) to increase blood sugar

Question 6

what is diabetes Mellitus

Answer 6

• common, chronic, complex disorder
• results from inability to produce insulin and the bodys resistance to insulin
• results in hyperglycemia

Question 7

type 1 dm

Answer 7

• autoimmune- destruction of beta cells
• known as juvenille onset or insluin dependdent diabetes mellitus
• onset before 30
• management: dependent on insulin, diet, and exercise

Question 8

type 2 dm

Answer 8

• progressive disorder: initial resistance to insulin, progresses to decrease secretion
• known as adult onset diabetes or non insulin dependent mellitus
• onset is any age
• Management: diet, exercise, oral hypoglycemics, 20-30% require insulin

Question 9

3 initial symtoms of dm

Answer 9

• polyuria
• polydipisa- thirst
• polyphagia

Question 10

polyuria

Answer 10

• increased urination

- Kidneys attempt to filter high blood glucose → Excreted from body in urine

Question 11

polydipsia

Answer 11

• increased thirst/ drinking

- Increased water consumption to make up from water loss by frequent urination

Question 12

polyphagia

Answer 12

• increased hunger

- Cells are starved of glucose leads to increased huger/eating

Question 13

hyperglycemia causes and symptoms

Answer 13

• BG > 115 mg/dL

Causes

• Stress
• Skipped Insulin
• Steroids

Symptoms

• Warm/Dry
• Tachycardia

Question 14

hypoglycemia causes and symptoms

Answer 14

BG < 70 mg/dL

Causes

• Lack of eating
• Intense exercise
• Too Much Insulin

Symptoms

• Sweating
• Cool/Clammy
• Irritable/Anxious
• Hunger
• Double Vision

Question 15

Diabetic Ketoacidosis (DKA)

Answer 15

• More Common in Type 1 Diabetics

- Insulin deficiency → Cellular Starvation → Breakdown of Fats → Ketones → Acidotic State

Question 16

Diabetic Ketoacidosis (DKA) Signs/Symptoms

Answer 16

• Nausea/Vomiting
• Excessive Thirst
• Kussmaul’s Respirations
• Fruity Breath
• Changes in LOC
• Metabolic Acidosis
• BG > 300 mg/dL

Question 17

Hyperglycemic Hyperosmolar Syndrome (HHS)

Answer 17

• More Common in Type 2 Diabetics

- Insulin deficiency combined with profound dehydration → Blood Glucose Elevation

Question 18

Hyperglycemic Hyperosmolar Syndrome (HHS) s/s

Answer 18

• Blurred Vision
• Headache
• Changes in Mental - Status
• Seizures
• BG > 600 mg/dL

Question 19

diagnostic testing for dm

Answer 19

Glycosylated hemoglobin (A1C)

• Identifies average blood glucose over time
• Previous 120 days
• Reference Range 4 – 6%
• Diabetics: 6.5 – 8%
• Preference 7% or less

Fasting Blood Glucose (FBG)
- Two separate results >126 mg/dL

Question 20

Long term cardio/cerebrovascular disease complications

Answer 20

HTN, MI, Stroke

Nursing
- BP Control, smoking cessation, lipid-lowering medications and ASA

Education
- Cholesterol checks, regular activity, low-fat diet

Question 21

long term diabetic rentiopathy complications

Answer 21

Impaired Vision, Blindness

Education
- Yearly Eye Exam, report vision changes

Question 22

long term diabetic neuropathy complications

Answer 22

Peripheral Neuropathy: change in sensation- cant feel
- Most commonly affects feet/lower extremities

Nursing

• Foot care: check every day
• Gabapentin

Education
- Annual podiatrist apt, daily foot inspection/care, report numbness/tingling

Question 23

long term diabetic nephropathy complications

Answer 23

ESRD/ESKD
- #1 cause of ESRD in US

Nursing

• monitor kidney function, I&Os, report output less than 30ml/hr monitor bp
• diuretics

education
- consume 2-3l of fluid/day, avoid soda, alochol, acetaminophen, NSAIDS, report decreased output

Question 24

hypoglycemia unconscious

Answer 24

• Place in lateral position – prevents aspiration

Administer

• Glucagon SQ/IM: tells liver to take out sugar out of cell
• D50 or IV Dextrose

Question 25

hypogylcemia conscious

Answer 25

Provide readily absorbable carb - 4-6oz fruit juice or regular soft drink - Glucose tablets/gel - Hard candies Recheck 15 Min After Intervention

Question 26

hyperglycemia action type 2 dm

Answer 26

Oral Hypoglycemics - Reserved for Type 2 patients - NOT Insulin Action: - Stimulate Pancreas to Produce more Insulin - Increase Tissue Sensitivity to Insulin - Slow carbohydrate absorption in intestines

Question 27

examples of oral hypoglcemics

Answer 27

Metformin – Most Common - Stop 24-48 hours before imaging with iodinated contrast dye, resume 48 hours after Glipizide - When given with beta-blockers can mask tachycardia

Question 28

insulin routes sites timing

Answer 28

- given for hyperglycemia Administration Routes - SQ - IV Sites - Rotate frequently to prevent tissue damage - Abdominal tissue provides fastest absorption * Do NOT inject within 2-inches of umbilicus Timing - Onset – Time from administration to lowering of BG - Peak – When insulin is working the hardest * BG is at its lowest - Duration – Length of time before all the insulin is used up

Question 29

Rapid

Answer 29

lispro (humalog) onset: 15min Peak: 1-2 hours duration: 3-4hr admin time: before or with meals

Question 30

short

Answer 30

regular (humulin-r) onset: 30-60 min peak: 2-4hr duration: 5-7hr admin time: 30-60 min before meals

Question 31

intermediate

Answer 31

NPH (humulin-N) onset: 2-4hr peak: 4-10hr duration: 10-16hr admin time: between meals or at night

Question 32

long

Answer 32

lantus (glargine) onset: 3-4hr peak: none Duration: 24 hours admin time: once a day

Question 33

non-pharmacological management: nutritonal therapy

Answer 33

- Patient should work with Registered Dietitian/Nutritionist Carbohydrates - Limit Simple Sugars - Stick to Complex Carbs - Low Fat/Sodium - Be Consistent

Question 34

non-pharmacological management: exercise

Answer 34

150 Minutes/Week – Evenly spaced every other day Precautions - Check BG before - exercising - Eat snack if BG <100 mg/dL - Carry Fast Snack - Do NOT admin insulin in areas being exercised * Affects absorption

Question 35

what kind of insulin therapy does type 1dm need while npo

Answer 35

- Type 1 diabetics will need continued insulin administration even while NPO - Preventing DKA

Question 36

what kind of insulin therapy does type 2dm need while npo

Answer 36

- Type 2 diabetics may have less insulin requirements when NPO or on a clear liquid diet - Preventing hypoglycemia

Question 37

when is short acting insulin often given

Answer 37

at the time of clear liquid meals or enteral feedings to prevent hyperglycemia

Question 38

clients on continous feedings get sugars checked when?

Answer 38

- Clients receiving continuous feedings require blood glucose monitoring at evenly spaced intervals - Usually every 6 hours

Question 39

pt. teaching

Answer 39

Ensure - Ensure patient demonstrates appropriate technique for obtaining fingerstick blood glucose Determine - Determine patients understanding of how to respond to results of blood glucose testing Validate - Validate the patient can perform correct self administration of insulin Remind - Remind patient metabolic demand changes with illness, insulin requirements may change