Chapter 46 Flashcards
Elevated level of glucose in the blood is called?
Hyperglycemia
What type of diabetes?
Usually young <30 yo
Thin at diagnosis
Ketosis prone when insulin is absent
Genetic
Needs exogenous insulin to preserve life
Type 1 diabetes
What type of diabetes?
usually >30 yo
Obesity
Make control blood glucose through weight loss
Ketosis is uncommon
May need insulin on a short or long term basis
Type 2 diabetes
What type of diabetes?
Onset during pregnancy in the second or third trimester
Caused by hormones
obesity
Age >30
Family history of diabetes 
Gestational diabetes
What type of diabetes has genetic tendencies that have been found and people with certain human leukocyte antigen types?
Type 1 diabetes
When excess glucose is excreted in the urine, it is accompanied by loss of fluids and electrolytes, what is this called?
Osmotic diuresis
A highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin is called? 
Ketones
A metabolic arrangement that occurs more commonly and people with type 1 diabetes
Deficiency of insulin
highly acidic ketone bodies are formed
Metabolic acidosis occurs
diabetic ketoacidosis (DKA)
What are symptoms of DKA?
Polyuria
Polydipsia
n/v
Fatigue
Stupor and coma if not treated 
What are the two main problems related to insulin and type 2 diabetes?
Insulin resistance
Impaired insulin secretion
Symptoms of type 2 diabetes include?
Irritability
fatigue
polyuria
polydipsia
poor wound healing 
vaginal infections
blurred vision
What are long-term diabetes complications
Eye disease
Peripheral neuropathy
peripheral vascular disease
Women at high risk for gestational diabetes should be screened by a blood glucose test when?
At the first prenatal visit
Women with a history of gestational diabetes should be screened when?
Every 3 years
What are the 3 Ps with diabetes
Polyuria
Polydisia
Polyphagia
Polydipsia
Increased thirst
What is a normal hemoglobin A1C
<6.5%
To promote a 1 to 2 pound weight loss per week how much calories are taken away from the daily total? 
500 to 1000 calories
What onset symptom is associated with type 1 diabetes 
Weight loss
What nutrient has the greatest effect on blood glucose levels because they are more quickly digested than other foods and are converted into glucose rapidly
Carbs
What are examples of soluble fibers
Legumes, oats, and some fruits
What does soluble fiber do?
Slows stomach emptying
Type of insulin
Lispro, aspart, glulisine
Onset 15-30 min
Peak 30-90
Rapid acting
Type of insulin
Regular
Onset 30-60 min
Peak 2-3 hr
Can be given IV
Given 15 min before meal
Short acting
Type of insulin
NPH
onset 1-1.5 hr
Peak 4-12 hr
Food should be given around the peak time
Intermediate acting
Type of insulin
Glargine
Onset 3-6hr
Continuous (no peak)
Long acting
Milky cloud insulin
Intermediate acting insulin
If insulin is injected into scarred areas what may happen?
Absorption may be delayed
Characterized by a relatively normal blood glucose level until approximately 3 AM when blood glucose level begins to rise
Dawn phenomenon
Nocturnal hypoglycemia followed by rebound hyperglycemia
Somogyi effect
What is a class of oral antidiabetic medication‘s that reduce insulin resistance and target tissues
Thiazolidinediones
When mixing rapid and short acting insulin‘s in a vial what should be drawn up first?
Short acting (regular)
The speed of absorption with insulin is greatest in what area of the body
Abdomen 
Glucose that falls less than 70mg/dL
Hypoglycemia
What are symptoms of hypoglycemia
 sweating
Tremor
tachycardia
palpitations
nervousness
hunger
In a severe case of hypoglycemia what type of symptoms may the patient have?
Impaired function of the CNS
Disoriented behavior, seizures, loss of consciousness
When blood glucose becomes too low what is recommended for the patient to do? 
Consume 15 to 20 g of carbs
A small juice or soda
And an adult who is glucose level is less than 54mg/dL and who is unconscious what should they take? 
1mg of glucagon
Patients with severe DKA may lose up to how much water
6.5 L
When a patient has nausea and vomiting should they take their regular insulin dose
Take usual dose and consume frequent small portions of carbs
Absence or inadequate amount of insulin
Seen in type 1 diabetes
High sugars
Ketones present
Dehydration
Kussmauls respirations
Abdominal pain
DKA
What is the main goal with treating DKA?
Treat dehydration first w/ 0.9% NS
Then start lowering blood glucose
High sugars of DKA range from what?
250-800 sometimes 1000
Metabolic disorder resulting from relative insulin deficiency initiated by an illness.
Often associated with type 2 diabetes
High sugar
Dehydration
Neuro symptoms (confusion)
Hyperglycemic hyperosmolar syndrome
(HHS)
After HHS is resolved how long will it take for Neuro symptoms to clear up?
3-5 days
What are symptoms of diabetic neuropathy?
Prickling, tingling, burning
Normally in feet
What is a symptom that is associated with autonomic neuropathy?
Urinary retention
Neuropathic condition
Decrease or absence of anhidrosis (sweating) of body
Sudomotor neuropathy
Poor circulation of the lower extremities
Development of gangrene
Peripheral vascular disease
In a hospital setting what can be given to provide calories to avoid hypoglycemia?
IV dextrose
What insulin should be taken alone?
(Glargine)
a peak less basal insulin
With a diabetic foot ulcer what technique should you use when changing the dressing?
Sterile technique
