Chapter 46 Diabetes Flashcards by Makieah Mack

______ cells secrete insulin —> lowers blood glucose

beta

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________ cells secrete glucagon —> raises blood glucose

alpha

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_____ cells secrete somatostatin

Delta

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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

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Type 1 diabetes is characterized by the destruction of the pancreatic ______ cells

beta

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Type 2 diabetes is characterized by impaired insulin _____________ and insulin ______________

secretion
resistance

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Patients with T1DM have to take life long _________ because their pancreas is not making any

insulin

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Diabetic Ketoacidosis occurs due to a deficit of ________ resulting in disorders in the metabolism of carbs, proteins, and fats

insulin

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Causes of DKA (4)

Sepsis
Stress
Skipping Insulin
Surgery

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What are the manifestations of DKA? 4Ks

Ketonuria
Decreased K+
Ketotic breath (sweet smell)
Kussmaul Respirations (deep rapid breathing)

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Type 2 diabetes is due to the decreases sensitivity to insulin or decreased insulin ____________

production

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What is the first line of treatment for type 2 diabetes?

Diet and exercise

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Insulin resistance and impaired insulin secretion are the main causes of type ____ diabetes

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DKA is super rare in Type ___ diabetes

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T2DM Clinical Manifestations (3Ps)

polyuria — large amount of dilute urine
polydipsia — excessive, abnormal thirst
polyphagia — extreme hunger

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HHNS stands for:

Hyperglycemic Hyperosmolar Non-ketonic Syndrome

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HHNS is a complication of T_DM. It included Hyperosmolality and hyperglycemia with alterations in LOC.

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HHNS is ______ blood sugar. The blood sugar is greater than >_____

high
600

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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

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Diabetic ketoacidosis if a higher sugar of _____ and higher

250

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The four K’s of DKA is:

Ketonuria
Decreased K+
Ketotic breath (sweet smell)
Kussmal respirations (deep breathing

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Meticulous _____ care is very important for patient education for diabetes

foot

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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

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

**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

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