Case Studies: DM Flashcards
Chronic metabolic disease resulting from either a deficiency in insulin secretion, resistance of insulin action at the cellular level or both
Leading cause of blindness, end stage kidney disease and foot/leg amputations
Seventh leading cause of death in the US
Affects 25.8 million people (8.3%) of the population - lot pop
Chronic metabolic disorder - from the deficiency in inulsin secretion or resistance of insulin or both - results in increased BG or inability regulated BG
Causes microvascular and macrovascular changes - blindness, end stage renal disease, food/leg amputations - seen often
One of leading causes of disability and death
What is Diabetes
Resulting in hyperglycemia and inability to regulate blood glucose
Chronic metabolic disease resulting from either a deficiency in insulin secretion, resistance of insulin action at the cellular level or both
No insulin is produced - has be provided for them from outside body
Autoimmune disorder
Beta cells of the pancreas are destroyed by antibodies
Onset usually occurs <30 years of age; typ Younger age than T2DM
Abrupt onset
3 P’s: Polydipsia, polyuria, polyphagia, and weight loss
Requires insulin - insulin pumps; be on sliding scale
Could be viral in etiology - Post viral infection people will develop diabetes; virus in body and brought on diabetes; does not cause diabetes
T1DM
Reduction of the cells to respond to insulin (insulin resistance) and decreased secretion of insulin from beta cells - reduction in response to insulin
Predisposing factors are obesity, physical inactivity and genetics (in family)
Onset usually occurs >50 years of age - Can be younger but typ older adults
Could have no symptoms or polydipsia, fatigue, blurred vision, vascular and neural complications
Accounts for 90% of diabetic patients - quite few pats have this
Increase in pediatric T2DM and diabetes - bad diet and less exercise - increase childhood obesity making more prevalent
T2DM
Glucose intolerance during pregnancy
Not mean will be diabetic after delivery - put at higher risk for T2DM down line
Gestational
carb/glucose (candy, juice)
Insulin (all supplies with it)
Glucameter
Water
Glucameter supplies
BP cuff
Stethoscope
Cell phone
Oxygen
Commode
Stuck in an elevator that has T1DM what 10 things want with us
Insulin
Glucameter and supplies
carbohydrate/glucose (Juice)
Narrow down to 3 for T1DM
carbohydrate/glucose (Juice) - hypoglycemia bigger emergency than hyperglycemia; have syptoms a lot quicker; take really high BG to have symptoms of hyperglycemia; when get low BG get symptoms quickly - need keep tight good BG control but not want too low; brain uses glucose and without glucose it starves - s/s of it starving
Narrow down to 1 for T1DM
Polydipsia
Polyuria
Polyphagia
3 P’s - what are they and why does it happen
Excessive thirst
Caused by dehydration
Polydipsia
Frequent and excessive urination
Caused by osmotic diuresis secondary to excessive serum glucose
Polyuria
Excessive hunger
Really high BG but not pushed into cells those cells are starving
Excessive eating
Caused by cell starvation
Polyphagia
Given in subcutaneous tissue
Do not mix long acting insulin or premixed insulin
Regimens are used to duplicate the basal and prandial release pattern of the pancreas
Can be given by a continuous subcutaneous infusion
Regular insulin is the only insulin that can be administered IV - Reg insulin only one administered via IV: insulin drip; not Lantis or Humalog
What should the nurse know about insulin
Abdomen, back of arm, buttocks, thigh
Abdomen, back of arm typ; can do other places
Ask places where would like it
Sometimes want back of arm and want break abd to get a break if take insulin all time
Given in subcutaneous tissue
Short and long acting - doing diff things - always have insulin and glucose control - but when have meals have big spikes and want prevent big spikes and big declines that causes hypoglycemia
Regimens are used to duplicate the basal and prandial release pattern of the pancreas
Externally worn pump - Can wear pump - typ T1DM
Can be given by a continuous subcutaneous infusion
To prevent hypoglycemia and if a client is having a hypoglycemic episode it is important to know what type of insulin is on board so that we know how long the hypoglycemia could occur
Rapid Acting Insulin (ex. aspart (Novolog); lispro (Humalog)); not give without having tray; need tray in front of them
Short Acting Insulin (ex. regular U100; regular U500) - regular insulin
Intermediate Acting Insulin (ex. NPH; 70/30; 50;50)
Long Acting Insulin (ex. glargine (Lantus); detemir (Levemir)) - okay if not have meal tray in front of them
Reg insulin - typ insulin drip and in area where can closely regulate it (ICU) - where need have continuous - not people who have pump - in emergency situations; going through IV; can give subQ and but only type can also go through IV
Why is it important for a nurse to know onset, peak and duration of insulin?
Refrigerate insulin not in use
Insulin in use may be kept at room temperature for up to 28 days
Discard unused insulin after 28 days
Prefilled syringes are stable up to 30 days when refrigerated
Have a spare bottle of each type of insulin used on hand
Inspect the insulin before each use - look at it
Use disposable needles one time - only one time even if just for self
Follow infection control measures
What should be included in patient edu
Lantus should always be stored in a refrigerator
Multipatient vials - clean top; some pats have pens where easier for them
Insulin in use may be kept at room temperature for up to 28 days
Store upright
Prefilled syringes are stable up to 30 days when refrigerated
Cleaning with alcohol pads, washing hands and pat understands that
for insulin injections as well as blood sugar checks
Follow infection control measures
2 acute comps related to diabetes
HHS and DKA –
give fluids first; more profound dehydration typ
HHS -
Serum glucose
Osmolarity
Serum ketones
Serum pH
Serum HCO3
Serum Na+
BUN
Creatinine
Urine ketones
DKA
> 300
Serum glucose
Variable
Osmolarity
