Chapter 46 Diabetes Flashcards
______ cells secrete insulin —> lowers blood glucose
beta
________ cells secrete glucagon —> raises blood glucose
alpha
_____ cells secrete somatostatin
Delta
The hallmark sign of Diabetes Mellitus is elevated ________ ________ levels. DM is the leading cause of non-traumatic amputations, blindness, and end-stage renal disease
glucose levels
Type 1 diabetes is characterized by the destruction of the pancreatic ______ cells
beta
Type 2 diabetes is characterized by impaired insulin _____________ and insulin ______________
secretion
resistance
Patients with T1DM have to take life long _________ because their pancreas is not making any
insulin
Diabetic Ketoacidosis occurs due to a deficit of ________ resulting in disorders in the metabolism of carbs, proteins, and fats
insulin
Causes of DKA (4)
Sepsis
Stress
Skipping Insulin
Surgery
What are the manifestations of DKA? 4Ks
Ketonuria
Decreased K+
Ketotic breath (sweet smell)
Kussmaul Respirations (deep rapid breathing)
Type 2 diabetes is due to the decreases sensitivity to insulin or decreased insulin ____________
production
What is the first line of treatment for type 2 diabetes?
Diet and exercise
Insulin resistance and impaired insulin secretion are the main causes of type ____ diabetes
2
DKA is super rare in Type ___ diabetes
2
T2DM Clinical Manifestations (3Ps)
polyuria — large amount of dilute urine
polydipsia — excessive, abnormal thirst
polyphagia — extreme hunger
HHNS stands for:
Hyperglycemic Hyperosmolar Non-ketonic Syndrome
HHNS is a complication of T_DM. It included Hyperosmolality and hyperglycemia with alterations in LOC.
2
HHNS is ______ blood sugar. The blood sugar is greater than >_____
high
600
Osmolarity causes a build up of glucose, sodium and other substances into the blood, pulling fluid from other parts of the body (True or false)
true
Diabetic ketoacidosis if a higher sugar of _____ and higher
250
The four K’s of DKA is:
Ketonuria
Decreased K+
Ketotic breath (sweet smell)
Kussmal respirations (deep breathing
Meticulous _____ care is very important for patient education for diabetes
foot
Consistency in the amount of _________ and _____________ ingested at each meal is essential
calories
carbohydrates
___________ is vital in managing diabetes
exercise
A target AC blood glucose is between ___ and _____mg/dl
70-130
Urine testing for ________ and glucose may also be performed
ketones
Ketones in urine is often seen in T___DM when there is a persistently elevated BG
1
Rapid acting insulin:
Humalog
Short acting insulin:
Normal
Intermediate lasting insulin:
NPH
Long acting insulin:
Glargine (Lantaus) and Detemir (Levemir
Insulin promotes:
*Storage of __________ as glycogen
* Increased ________ and fat synthesis
*____________ the breakdown of glycogen, protein, and fat
* Assists in balancing _________ & _______________
glucose
protein
Decreases
fluid and electrolytes
As an RN, it is essential that you know the onset and peak times for insulin
*This knowledge is used to guide _____________ and snacks
* This knowledge will help you understand when your patient is at highest risk for _______glycemia
*All T1D patients require insulin because ….?
mealtimes
HYPOglycemia (HYPOgly the brain might die!)
They do not make insulin
The __________ Effect is where prolonged hypoglycemia is untreated, then stress due to low BS can result in high blood glucose rebound. When the BG level falls below normal, the body responds by release the endocrine hormone glucagon as well as the stress hormones epinephrine, cortisol, ,and GH. Glucose facilitates the release of glucose from the liver that raises the BG immediately; the stress hormones cause insulin resistance for several hours, sustaining elevated BS
Somogyi
The ________ phenomenon is a natural morning rise in BS in response to waning insulin and GH surge.
Dawn
Oral hypoglycemic mediations appear to work by improving both tissue _______________ to insulin and/or the ability of the pancreatic cells to _________ insulin
responsiveness
secrete
Oral hypoglycemic medications are usually prescribed to patients with T___DM
2
Nursing considerations for oral hypoglycemic medications
*Monitor serum __________ levels
*Instruct patients to avoid __________
*Instruct and educate patients on diabetes, dietary control, sx of hypo and hyper glycemia
* Good ______ care
glucose
alcohol
skin
Hypoglycemia is a BS that is ____ or less
65
High blood sugar kills faster than low blood sugar (true or false)
FALSE — Low sugar kills faster than high sugar (HYPOgly the brain might die)
Signs and symptoms of a hypoglycemic episode
tachycardia
palpitations
sweating
tremulousness
nausea
hunger
weakness
bizarre behavior
coma
seizures
slurred speech
hypotension
cool and clammy (Cool and clammy give them some candy)
Hypoglycemic Awareness: patient develops frequent hypoglycemia episodes and they get _______ signs each time it happens
fewer
The goal with hypoglycemic patients is to consume ____ grams of carbs every ____ minutes until resolution of hypoglycemia
15
15
Diabetic macrovascular complications include :
* A_____________
* C___
* MI
*S_______
*P____
Atherosclerosis
CAD
Stroke
PVD
Diabetic retinopathy is when damage is done to the blood vessels in the back of the ______
eye
Diabetic nephropathy is when there is damage is done to the blood vessels in the ____________
kidneys
DM retinopathy can lead to severe ________ loss and is the leading cause of new onset __________ in the US
vision
blindness
Risk factors of diabetic retinopathy is:
* Poor __________ control
* _______tension
* ________lipidemia
*Nephropathy
*Anemia
*Sleep apnea
* Smoking
Glycemic
Hyper
Hyper
Presence of Microalbuminuria is the earliest indicator of _______ damage and should be tested for at the time of DM diagnosis and then annually.
renal
<___mg is normal
____-_____ mg may indicate early kidney disease (microalbuminuria)
>_____mg indicates more advanced kidney disease (macroalbuminuria)
30
30-300
300
________ creates special risks for patients with diabetes r/t impaired ________
Surgery
healing
________________ creates a risk for unstable blood sugar levels (stress of illness)
Hospitalization
lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)
are all examples of ________ acting insulin
**Highest risk for ______glycemia
rapid
HYPO
Regular insulin (Humalin R and Novolin R) are examples of _______ acting insulin
** This is the only insulin that can given ______
short
IV
NPH (Humalin N and Novolin N) are examples of _____________ acting insulin
** This insulin should ever be given ______
intermediate
IV
glargine (Lantus)
detemir (Levemir)
degludec (Teresita)
Are all examples of ________ acting insulin
** These insulting have the ________ risk for hypoglycemia
long
lowest
