ch. 29: endocrine and metabolic disorders Flashcards
What are the 3 Ps of HYPERGLYCEMIA?
P olyphagia: excessive hunger
P olydipsia: excessive thirst
P olyuria: excessive voiding
During the first trimester, insulin requirements ____
DECREASE due to dietary changes (n/v) to prevent hypoglycemia
During the 2nd and 3rd trimester insulin requirements _____
INCREASE to prevent hyperglycemia
How many calories should pts consume each day during the first trimester?
2,200 cal
How many calories should pts consume each day during the 2nd and 3rd trimester?
2,500 cal
How many meals and snacks should pts eat?
3 meals and 3 snacks
How much exercise is encouraged?
30-60 min/ day
In what intervals should pts check their BLOOD GLUCOSE LEVEL during EXERCISE?
before, during, and after
What should the pt do if their BG level is < 100 mg/dl while exercising?
consume 15-30 g of carbs to prevent hypoglycemia
When should pts AVOID EXERCISE?
-if BG level > 200 mg/dl OR ketones in urine
-bc HYPERGLYCEMIA AND KETOSIS CAN WORSEN W/ PHYSICAL ACTIVITY
What is the target FASTING glucose level during pregnancy?
60- 105
What is the target POSTMEAL 1 HR glucose level during pregnancy?
< 140
What is the target POSTMEAL 2 HR glucose level during pregnancy?
≤ 120
What is the target BG level at 2am to 6 am?
> 60
What are the s/s of HYPOGLYCEMIA?
“COLD AND CLAMMY”
-nervousness
-HA
-fatigue
-shaking
-irritability
-tachycardia
-hunger
-blurred vision
-sweaty
-tingling of mouth/ extremities
What should a pt do if their BG level is < 70 mg/dl after feeling symptoms of hypoglycemia?
immediately eat 2-4 glucose tabs
What should pts do if glucose tabs are unavailable?
eat/drink 15 g of simple carbs:
-1/2 cup unsweetened OJ
-1/2 cup of regular sode
-5 to 6 hard candies
-1 cup of skim milk
What should a pt do if the glucose stabilizes their BG level?
eat a meal
What should a pt do if the glucose DOES NOT stabilizes their BG level?
-eat another 2 to 4 glucose tabs
-wait 15 min and recheck BG level
-if still < 70, NOTIFY HCP
What is the first step of the ORAL GLUCOSE TOLERANCE TEST (OGTT)?
-administer 50 g of oral glucose and RECHECK BG level in 1 HR
What BG level is a NEGATIVE result in STEP 1 of OGTT?
< 130-140
What BG level is a POSITIVE result in STEP 1 of OGTT?
> 130-140
What is step 2 of the OGTT screen?
-positive step 1
-fast night b4
-check BG level before exam
-check BG level at 1, 2, 3 hrs
What is considered a POSITIVE result in step 2 of OGTT screen?
if 2 or more values are MET or EXCEEDED
What is the FASTING BG level range for step 2 of OGTT screen?
95 or 105
What is the 1 hr BG level range for step 2 of OGTT screen?
180 or 190
What is the 2 hr BG level range for step 2 of OGTT screen?
155 or 165
What is the 3 hr BG level range for step 2 of OGTT screen?
140 or 145
What are maternal risks of gestational diabetes?
-↑ risk for preeclampsia, HTN, preterm birth
-miscarriage
-↑ risk for macrosomia (BW> 4000-4500 g)
-polyhydramnios
-↑ risk for skin and vaginal infections and UTIs
-DKA
What are fetal risks of gestational diabetes?
-intrauterine fetal demise
-fetal congenital malformation
-hyperglycemia can affect organ formation
-macrosomia
-hypoglycemia at first 1-6 hrs after birth
-respiratory distress syndrome (RDS)
What type of insulin is Lispro (Humalog)?
rapid acting
What is the ONSET of RAPID acting insulin?
15 min
What is the PEAK of RAPID acting insulin?
30- 90 min
What is the DURATION of RAPID acting insulin?
4- 5 hr
What type of insulin is Humulin NPH?
Intermediate acting
What is the ONSET of INTERMEDIATE acting insulin?
1- 2 hr
What is the PEAK of INTERMEDIATE acting insulin?
6- 12 hr
What is the DURATION of INTERMEDIATE acting insulin?
18- 24 hr
What type of inulin is Glargine (Lantus)?
long acting
What is the ONSET of LONG acting insulin?
1 hr
What is the PEAK of LONG acting insulin?
NONE
What is the DURATION of LONG acting insulin?
24 hr
Why is a pre-bedtime snack important?
to prevent hypoglycemia at night
-must include protein and complex carb
What insulin can be mixed w/ Humulin NPH?
Lispro (Humalog)
-CLEAR(rapid) TO CLOUDY (NPH)
What should pts do if illness occurs?
-take insulin even if appetite decreases
-call HCP w/ s/s, temp, BG level, urine ketones, time of last insulin dose
-↑ fluids, rest
-if unable to reach HCP and u have BG level> 200 & moderate ketones in urine, SEEK EMERGENCY TREATMENT TO AVOID DKA
