Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adult Health One > Chapter 44: care for patients with diabetes > Flashcards

Chapter 44: care for patients with diabetes Flashcards

1
Q

Diabetes mellitus is a group of disorders characterized by elevated blood glucose levels and results from defects in what?

A

insulin production, insulin action, or both.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what three sources does glucose arrive in the blood from?

A

carbs eaten, glucose released from stored glycogen in muscles and liver cells, glucose or gluconeogenesis newly created in the liver or in the kidney cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where is glucose in the blood stream transported to?

A

target cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

insulin is released from where?

A

pancreatic beta cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when there is a disruption in the production of insulin or in the effective action of insulin glucose cannot cross the cell membrane effectively and stays where?

A

glucose remains in the blood stream and blood glucose levels rise above normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

insulin facilitates the transport of what?

A

the transport of glucose across the cell membrane into the cell’s interior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is glucose metabolized as in the cell?

A

fuel releasing energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happens when blood glucose levels get too high?

A

more insulin is secreted by the pancreas. when blood glucose is driven into the cell and metabolized the glucose levels in the blood fall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what happens when blood glucose gets too low?

A

insulin release is suppressed and glucose will remain in the bloodstream instead of being pushed into the cells. glucagon is released from the pancreatic alpha cells and stimulates the production and release of glucose from glycogen storage in the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the different groups of diabetes mellitus?

A

Prediabetes; type 1 and type 2. and gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is type one diabetes triggered by?

A

an autoimmune process where insulin producing beta cells of the pancreas are destroyed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the disease process of type one diabetes in children and young adults

A

the process is usually rapid, with a total insulin deficiency occurring within one year. after this lifelong insulin injections are required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the disease processes of type one diabetes in an adult.

A

the autoimmune destruction of beta cells has a more variable, but generally slower time frame.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are some clinical manifestations of type one diabetes

A

polydipsia, polyuria, polyphagia, fatigue, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the required level of FPG for type 1 or 2 diabetes?

A

greater than 126 mg/dl with 8 hour fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the required level of OGTT for type 1 or 2 diabetes?

A

2 hour 75g OGTT greater than 300 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the required level of random plasma glucose for type 1 or 2 diabetes?

A

greater than 200 mg/dl with classic symptoms of hyperglycemia or hyperglycemic crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what level of A1C is considered prediabetic?

A

5.7-6.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the target fasting glucose level?

A

A goal of 70-130 mg/dl for an HgbA1c goal less than 7%. target blood glucose readings can be higher or lower depending on individualized HgbA1c goal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the target 2 hour postprandial level?

A

average 2 hour postprandial blood glucose value less than 180mg/dl.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can a 2 hour post prandial reading be helpful for?

A

It is helpful for adjusting mealtime medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

lowering hgbA1c to below or around 7% has been shown to do what?

A

reduce microvascular and neurological complications of type 1 and type 2 diabetes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

modern insulin analog and pumps closely mimic what

A

the actions of a healthy pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why are oral insulin administrations noneffective?

A

it is broken down and rendered ineffective during the digestive process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what two diets could you educate a patinet with diabetes on?

A

ADA and DASH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what type of exercise could you educate a diabetic patient about

A

150 minutes of aerobic exercises a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how often should you check blood glucose levels?

A

ACHS (before meals and at bedtime)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what type of treatment plan is the most effective at maintaining tight glucose control?

A

treatment plans that mimic the response of the healthy pancreas to blood glucose levels during the course of a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is an alternative approach to insulin administration?

A

continuous subcutaneous insulin pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how often should a patinet with well controlled diabetes have their HgbA1C checked?

A

at least twice a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

if glycemic target has not been met or if a patient is having treatment changes how often should HGBA1C be checked?

A

every 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what could an increased serum BUN/creatinine level indicate?

A

decreased renal function associated with microvascular changes that develop in the kidneys due to sustained hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Decreased perfusion secondary to microvascular changes may manifest as what?

A

delayed capillary refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Using the same site for insulin administration will result in what?

A

Insulin lipodystrophy due to buildup of scar tissue in the area. This results in resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

who is type 2 diabetes more common in?

A

adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what was type 2 diabetes once called?

A

adult onset diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are 2 risk factors for type 2 diabetes?

A

genetics and lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is a warning sign for type 2 diabetes?

A

prediabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what BMI is considered underweight?

A

BMI is less than 18.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what BMI is normal weight?

A

BMI is 18.5 to 24.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what BMI is overweight?

A

BMI is 25 to 29.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what BMI is obese?

A

30 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what level of HDL is considered a modifiable risk factor?

A

< or = 35 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what level of triglycerides is considered a modifiable risk factor?

A

> or = 250 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are some high-risk ethnic populations for type 2 diabetes?

A

AA, Latino, Native american, asian american, pacific islander

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is a non-modifable risk factor dealing with mothers?

A

Women who delivered a baby weighing greater than or equal to 9 lbs or who were diagnosed with gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what level of hypertension is considered a non-modifiable risk factor?

A

greater than or equal to 140/90 mmHg or on therapy for hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what level of hgbA1C is considered a non-modifiable risk factor?

A

greater than or equal to 5.7 on previous testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what prevents the normal action of insulin?

A

defects at the cell membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

insulin resistance develops which requires what

A

an increase in the levels of insulin to drive glucose into the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

over time the pancreas cannot keep up with the increased demand for insulin and what happens?

A

beta cell failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

in late stages of type II DM insulin production greatly declines. 30% of patients will require what?

A

exogenous insulin delivery to maintain normal blood glucose levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

which has a slower onset of manifestations type I or II DM?

A

type II diabetes?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are some examples of clinical manifestations of type II diabetes?

A

polydipsia, polyphagia, polyuria, fatigue, poor wound healing, and recurring infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are many of the manifestations of type II diabetes due to?

A

microvascular and microvascular complications of long-term hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are some pharmacologic interventions for type II diabetes?

A

Oral medications that increase insulin production, lower insulin resistance, and slow the absorption of carbohydrates or medications that help with lower blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

which type of insulin has an onset of 1-2 hours?

A

long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

which type of insulin has an onset of 15 minutes

A

rapid acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what type of insulin has an onset of 2-5 hours

A

intermediate acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what type of insulin has an onset of 30-60 minutes

A

short acting

61
Q

what are examples of rapid acting insulin

A

Humalog and novalog

62
Q

what are examples of short acting insulins

A

regular-humulin and novolin

63
Q

what is an intermediate acting insulin

A

NPH

64
Q

what are examples of long acting insulins

A

Lantus and levemir

65
Q

which type of insulin has no peak or valley

A

long acting

66
Q

what insulin peaks within 2-3 hours

A

short acting

67
Q

what type of insulin peaks within 4-10 hours

A

intermediate acting

68
Q

what type of insulin peaks within 60-90 minutes?

A

rapid acting

69
Q

which type of insulin has a duration of 10-16 hours

A

intermediate acting

70
Q

which type of insulin has a duration of 3-4 hours

A

rapid acting

71
Q

which type of insulin has a duration of 18-24 hours

A

long acting

72
Q

which type of insulin has a duration of 3-6 hours

A

short acting

73
Q

what type of insulin is a basal insulin

A

long acting

74
Q

what type of insulin is used for meals eaten within 30-60 minutes after admin

A

short acting

75
Q

which type of insulin is used for half of the day or even overnight

A

intermediate acting

76
Q

what type of insulin is used right after a meal or used as correction

A

rapid acting

77
Q

what types of insulin can you pair with long acting

A

short acting or rapid acting

78
Q

what types of insulin can you pour with rapid or short acting insulins

A

intermediate or long acting

79
Q

what is the composition go humulin and novolin

A

70% intermediate acting and 30% regular acting

80
Q

what insulin is 50% intermediate and 50% regular insulin

A

humulin

81
Q

what’s the composition of NovoLog

A

70% intermediate and 30% rapid acting

82
Q

what is the MOA for biguanides (metformin)

A

decreases the glucose production in the liver, it also increases insulin sensitivity in the skeletal muscle which increasers glucose uptake by muscles

83
Q

what is the dosing like for metformin

A

BID with meals

84
Q

what are some precautions and risks when taking metformin

A

Caution in patients with renal & liver impairment, digestive side effects include abdominal pain, N/V, & diarrhea, no risk of hypoglycemia, no weight gain

85
Q

what is the MAO of sulfonylureas (glipizide, glycburide)

A

increase insulin secretion by stimulating the pancreatic beta cells to produce more insulin

86
Q

what is the dosing for sulfonylureas (glipizide, glycburide)

A

daily or BID

87
Q

what are two risks when taking sulfonylureas (glipizide, glycburide)

A

risk of hypoglycemia and risk of weight gain

88
Q

what is the MOA of meglitinides (prandin, starlit)

A

increases insulin secretion by stimulating the pancreatic beta cells to produce more insulin

89
Q

what is the dosing for meglitinides (prandin, starlit)

A

TID before meals

90
Q

what are the two risks when taking meglitinides (prandin, starlit)

A

risk of hypoglycemia and weight gain

91
Q

what is the MOA for Thiazolodonediones (actos, Avandia)

A

decreases glucose production in the liver and increases insulin sensitivity in skeletal muscle which increases glucose uptake by the muscles

92
Q

what is the dosing for Thiazolodonediones (actos, Avandia)

A

daily

93
Q

what are some precautions and risks to keep in mind when taking Thiazolodonediones (actos, Avandia)

A

may increase the risk of HF, monitor for heptaotoxicity, may increase the risk of bone fractures, no risk for hypoglycemia, weight gain.

94
Q

what is the MOA for DPP-4 inhibitors (tradjenta, Januvia)

A

prevents the breakdown of naturally occurring GLP-1, compound responsible for stimulating insulin release from the pancreas.

95
Q

how does DPP-4 inhibitors (tradjenta, Januvia) decrease postprandial blood glucose?

A

increasing insulin secretion in response to blood glucose levels or decreasing glucagon secretion by pancreas

96
Q

what is the dosing for DPP-4 inhibitors (tradjenta, Januvia)

A

daily

97
Q

what is a risk for DPP-4 inhibitors (tradjenta, Januvia)

A

may cause nasopharyngitis (there is no risk for hypoglycemia or weight gain)

98
Q

what is the MOA for GLP-1 receptor agonists (Victoza, ozempic)

A

increases insulin secretion, reduces glucose release from the liver after meals, delays food emptying from the stomach, promotes satiety

99
Q

how is GLP-1 receptor agonists (Victoza, ozempic) administered

A

subcutaneously

100
Q

how often is Victoza administered

A

daily

101
Q

how often is ozempic administered?

A

weekly

102
Q

what are some precautions and risks when taking GLP-1 receptor agonists (Victoza, ozempic)

A

abdominal pain, N/V, diarrhea, weight loss. there is no risk for hypoglycemia.

103
Q

what is the MOA for SGLT2 inhibitors (sodium glucose cotransporter 2 inhibitors ) (Invokana, Farxiga)

A

increases glucose excretion in the urine by blocking reabsorption in the kidneys

104
Q

how often do you administer SGLT2 inhibitors (sodium glucose cotransporter 2 inhibitors ) (Invokana, Farxiga)

A

daily before the first meal of the day

105
Q

what are some risks and precautions when taking SGLT2 inhibitors (sodium glucose cotransporter 2 inhibitors ) (Invokana, Farxiga)

A

increase in UTIs, weight loss, lowers blood pressure (monitor for dehydration. no risk for hypoglycemia.

106
Q

what are some complications of type 1 and 2 diabetes mellitus?

A

hypoglycemia, dawn pneomenon, somogyi effect, HHS, DKA, microvascular and macros vascular complications

107
Q

why could hypoglycemia be a life-threatening emergency?

A

due to the potentially devastating effects on the central nervous system

108
Q

what is the dawn phenomenon?

A

an abrupt increase in serum glucose levels between the hours of 5am-9am from surge of hormones like cortisol

109
Q

why could a patient experience dawn phenomenon?

A

taking their insulin too early in the evening.

110
Q

what could you educate a patient on to try to prevent dawn phenomenon?

A

delay the evening dose of insulin and make sure they are having a snack at bedtime

111
Q

what is the somogyi effect?

A

nocturnal hypoglycemia that is followed by rebound hyperglycemia at around 7 am

112
Q

what could the smoggy effect be caused by

A

taking too much insulin at bedtime

113
Q

what could you educate a patient on to prevent the somogyi effect

A

lower the dose of insulin you are taking in the evening

114
Q

patinets with what type of diabetes are more likely to experience the dawn phenomenon and somogyi effect?

A

type one diabetes

115
Q

what are some causes of hyperglycemia

A

too much food, too little insulin or diabetic pills, illness, or even stress

116
Q

what type of onset does hyperglycemia have

A

slow onset, could lead to a medical emergency if not treated

117
Q

what are some symptoms of hyperglycemia?

A

extreme thirst, need to urinate often, dry skin, hungry, blurry vision, drowsy, slow-healing wounds

118
Q

what are causes of hypoglycemia

A

too little food, skipping a meal, too much insulin or diabetic pills, more active than usual

119
Q

describe the onset of hypoglycemia

A

sudden, may pass out (syncope) if untreated

120
Q

what are some symptoms of hypoglycemia

A

shaky, tachycardia, sweating, dizzy, anxious, hungry, blurry vision, weakness/fatigue, headache, irritable

121
Q

how does the body attempt to obtain energy when in DKA

A

By the rapid breakdown of fat stores, releasing fatty acids from adipose tissues

122
Q

when does DKA develop?

A

When there is inadequate insulin for cells to obtain adequate glucose for normal metabolism.

123
Q

when the liver converts fatty acids into ketones what can these be used as?

A

Can serve as an energy source in the absence of glucose

124
Q

ketone bodies have the ability to lower the pH in the body, what can this result in?

A

metabolic acidosis

125
Q

is DKA seen more often in type one or two diabetes

A

type one

126
Q

when does HHS (hyperosmolar hyperglycemia state) most commonly occur?

A

occurs more commonly in the elderly in response to stress or an infection

127
Q

what type of onset does DKA have

A

rapid

128
Q

what kind of onset does HHS have

A

gradual

129
Q

what types of labs do you need to gather to determine wether a patient is experiencing DKA or HHS?

A

blood glucose levels, arterial pH levels, serum bicarb levels, urine or serum ketones, effective serum osmolarity, anion gap

130
Q

what blood glucose level indicates DKA

A

greater than 250

131
Q

what pH level indicates DKA

A

< 7.30

132
Q

what bicarb level indicates DKA

A

< 18

133
Q

what ketone level indicates DKA

A

positive

134
Q

what serum osmolarity level indicates DKA

A

> 300

135
Q

what anion gap level indicates DKA

A

> 12

136
Q

what blood glucose level indicates HHS

A

greater than 600

137
Q

what pH level indicates HHS

A

> 7.30

138
Q

what serum bicarb level indicates HHS

A

> 15

139
Q

what ketone level indicates HHS

A

negative or very small amounts

140
Q

what serum osmolarity level indicates HHS

A

> 320

141
Q

what anion gap indicates HHS

A

< 12

142
Q

what are two hallmark symptoms of HHS

A

altered levels of consiousness and profound dehydration

143
Q

what can chronic hyperglycemia do to the eyes

A

The delicate blood vessels that supply the retina are susceptible to damage from prolonged hyperglycemia, resulting in retinal hypoxia.

144
Q

what can chronic hyperglycemia do to the gums in the mouth

A

Periodontal disease is more common with diabetes because of the decreased circulation to the gums and increased susceptibility to periodontal bacteria and dental caries

145
Q

what is a common outcome of chronic hyperglycemia on the gums?

A

early tooth loss

146
Q

what is affected in the kidneys with chronic hyperglycemia

A

The vasculature to the kidneys

147
Q

what are some clinical manifestations of diabetic peripheral neuropathy

A

numbness, tingling, or pain

148
Q

autonomic neuropathy can lead to what things

A

diabetic gastroparesis, ED, infections, cardiovascular disease, stroke

149
Q

what are some clinical manifestations of diabetic gastroparesis?

A

bloating, early satiety, nausea, vomiting

Adult Health One (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions