Chapter 53: Diabetes Flashcards
1
Q
long acting insulin onset, peak, and duration
A
onset: 0.8-4 hr
peak: no pronounced peak
duration: 24+ hr
2
Q
environmental factors include obesity and lack of exercise
A
type 2 diabetes
3
Q
primary defect is absent or minimal insulin production
A
type 1 diabetes
4
Q
involves BG over 600 mg/dL and increased serum osmolality
A
hyperosmolar hyperglycemic syndrome (HHS)
5
Q
these diabetes medications do not cause hypoglycemia when used alone and are good for insulin resistance
A
thiazolidinediones: pioglitazone (Actos), rosiglitazone (Avandia)
6
Q
hypoglycemia is defined by a BG level less than ____
A
70 mg/dL
7
Q
pathogenesis of foot complications from diabetes
A
sensory neuropathy–> loss of protective sensation–> unawareness of injury
8
Q
neurogenic bladder can cause ______________, to treat, empty frequently, using _____________; also use _____________ and _____________
A
urinary retention, Credé’s maneuver, medications, self-catheterization
9
Q
manifestations include dehydration; lethargy and weakness early; skin dry and loose; eyes soft and sunken; abdominal pain; anorexia; nausea/vomiting; Kussmaul respirations; sweet, fruity breath odor
A
diabetic ketoacidosis (DKA)
10
Q
can affect nearly all body systems, such as gastroparesis, cardiovascular abnormalities, sexual function, and neurogenic bladder
A
autonomic neuropathy
11
Q
islet cell antibodies are often present at onset
A
type 1 diabetes
12
Q
most common cause of new cases of adult blindness
A
diabetic retinopathy
13
Q
cardiovascular abnormalities of autonomic neuropathy (3)
A
postural hypotension, resting tachycardia, and painless MI
14
Q
examples of 15 g quick-acting carbohydrate snacks (5)
A
- 4-6 oz of regular soda, orange juice
- 5-8 lifesavers
- 1 tbsp syrup or honey
- 4 tsp jelly
- commercial dextrose products
15
Q
Somogyi effect is treated with _____________
A
a bedtime snack
16
Q
Microvascular and macrovascular diseases increase risk for injury and infection of _______
A
feet
17
Q
two drugs that can delay progression of diabetic nephropathy with albuminuria present
A
ACE inhibitors
Angiotensin II receptor agonists
18
Q
Neurontin (gabapentin)
A
treats sensory neuropathy
19
Q
symptoms: often none but include fatigue, recurrent infections, may have polyuria, polydipsia, polyphagia
A
type 2 diabetes
20
Q
laser destroys ischemic areas of retina
A
laser photocoagulation
21
Q
characterized by red-yellow lesions
A
necrobiosis lipoidica diabeticorum
22
Q
diagnosis of diabetes involves these four criteria
A
- A1C 6.5% or higher
- fasting plasma glucose level: 126 mg/dL or higher
- 2-hour plasma glucose level of 200 mg/dL or greater during OGTT using glucose load of 75 g
- In a patient with classic symptoms and random plasma glucose level of 200 mg/dL or greater (repeat testing not needed)
23
Q
life-threatening syndrome that occurs with type 2 diabetes
A
hyperosmolar hyperglycemic syndrome (HHS)
24
Q
vascular/neurological complications frequent
A
type 1 diabetes, type 2 diabetes
25
ketosis not present except during infection or stress
type 2 diabetes
26
when taking metformin, cannot have _____________ with a CT scan (must be off for __________)
increases risk for _______________, which can worsen lactic acidosis
contrast dye that contains iodine (48 hours before and after)
contrast-induced nephropathy (CIN)
27
bone and joint changes that occur secondary to loss of sensation
neuropathic arthropathy (Charcot's foot)
28
microvascular damage to retina
diabetic retinopathy
29
delay exercise if BG is less than ________ after eating ________ and rechecking after _____________
100, 15 g snack, 15-30 minutes
30
defect in mobilization of inflammatory cells and impaired phagocytosis can cause this diabetes complication
infection
31
how many criteria required for diagnosis of diabetes
2 criteria from first 3; 4th criteria alone
32
intermediate acting insulin onset, peak, and duration
onset: 1.5-4 hrs
peak: 4-12 hrs
duration: 12-18 hrs
33
rapid acting insulin onset, peak, and duration
onset: 10-30 min
peak: 30 min-3 hrs
duration: 3-5 hrs
34
hyperglycemia is present upon awakening from GH and cortisol; BG levels between 0200 and 0400 are normal
Dawn phenomenon
35
do not use this medication in people who drink excess amounts of alcohol
metformin
36
do not use this diabetes medication in patients with a personal or family history of medullary thyroid cancer
dulaglutide (Trulicity)
37
hyperglycemia rebounds in the morning after period of hypoglycemia between 0200 and 0400
Somogyi effect
38
may be thin, normal, or obese
type 1 diabetes
39
damage to small blood vessels that supply glomeruli of kidney
diabetic nephropathy
40
most widely used oral agent for diabetes
metformin
41
nursing management of diabetic ketoacidosis (DKA)
1. ensure patent airway; administer O2
2. establish IV access; begin fluid resuscitation
3. continuous regular insulin drip, 0.1 units/kg/hr
4. potassium replacement as needed
42
more common in young but can occur at any age
type 1 diabetes
43
manifestations of hypoglycemia (8)
shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor, altered mental functioning (difficulty speaking, visual disturbances, stupor, confusion, coma)
44
do not use metformin in patients with _________ disease, ________ disease, or ______________
liver, kidney, heart failure
45
insulin injections in thigh may increase __________, especially in athletes such as ________
metabolism, bikers
46
glucose lowering from exercise can last up to ____ hours and increases risk of ___________
48, hypoglycemia
47
important to rotate insulin injection sites to prevent _________________ and ______________
lipodystrophy, hypertrophy
48
drug therapy for sensory neuropathy (4)
1. topical creams
2. tricyclic antidepressants (TCAs)
3. selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)
4. antiseizure medications
49
those with type ___ diabetes should not exercise if BG is over _____ with ketones present in urine
1, 250
50
nutrition therapy is essential
type 1 diabetes, type 2 diabetes
51
precipitated by UTIs, pneumonia, sepsis, acute illness, newly diagnosed type 2 diabetes, impaired thirst sensation and/or inability to replace fluids
hyperosmolar hyperglycemic syndrome (HHS)
52
environmental factors include viruses and toxins
type 1 diabetes
53
used to test for nerve damage
monofilament screening
54
leading cause of end-stage kidney disease
diabetic nephropathy
55
exercise recommendations for diabetes are ________ per day at least ____ times a week
30 minutes, 5
56
rare complication of metformin accumulation
lactic acidosis
57
90-95% of diabetes
type 2 diabetes
58
causes of hypoglycemia (4)
1. too much insulin or oral hypoglycemic agents
2. too little food
3. delayed time of eating
4. too much exercise
59
insulin therapy required from some; disease is progressive and insulin treatment may need to be added
type 2 diabetes
60
onset is gradual and may go unnoticed for years
type 2 diabetes
61
characterized by red-brown, round, or oval patches
diabetic dermopathy
62
three ways autonomic neuropathy can affect sexual function (manifestations)
erectile dysfunction, decreased libido, and vaginal infections
63
acute pancreatitis may occur with this medication
dulaglutide (Trulicity)
64
patient teaching to prevent foot ulcers (5)
1. proper footwear
2. avoidance of foot injury
3. skin and nail care
4. daily inspection of feet
5. prompt treatment of small problems
65
intermediate stage between normal homeostasis and diabetes in which BG levels are elevated but not high enough to meet diagnostic criteria for diabetes
prediabetes
66
strenuous exercise can be perceived as _______ by the body and can cause _______________
stress, hyperglycemia
67
how peripheral artery disease increases risk of foot complications from diabetes (3)
decreased blood flow, decreased wound healing, increased risk for infection
68
hypoglycemia is a major side effect of this diabetes medication
glyburide
69
affects hands and/or feet bilaterally (specific type) with loss of sensation, abnormal sensations, pain, and paresthesias
distal symmetric polyneuropathy
70
reduced nerve conduction and demyelinization
diabetic neuropathy
71
Dawn phenomenon is treated by _____________
increasing or adjusting insulin schedule
72
in treating DKA, decrease BG slowly by ________ to prevent ______________
36-54 mg/dL/hr, cerebral edema
73
only type of insulin that can be given IV
regular/rapid
74
most common treatment for diabetic retinopathy
laser photocoagulation
75
characterized by velvety light brown to black skin
acanthosis nigricans
76
loss of protective sensation in lower extremities with major risk for amputation (specific type)
sensory neuropathy
77
characterized by hyperglycemia, ketosis, acidosis, dehydration
diabetic ketoacidosis (DKA)
78
drugs to treat hypoglycemia in unconscious patient (2)
1. 1 mg glucagon IM or SUBQ
2. 50% dextrose, 20-50 mL IVP
79
moderate to high ketones with urine are present with this condition
diabetic ketoacidosis (DKA)
80
5-10% of all diabetes
type 1 diabetes
81
complication more likely to occur in type 1 diabetes
diabetic ketoacidosis (DKA)
82
most common form of diabetic neuropathy
distal symmetric polyneuropathy
83
islet cell antibodies absent
type 2 diabetes
84
diabetic neuropathy occurs in ____% of patients with diabetes (to some degree)
60-70
85
endogenous insulin initially increased in response to insulin resistance; secretion decreases over time
type 2 diabetes
86
this condition is typically asymptomatic but damage to heart and vessels may already be occurring
prediabetes
87
major risk factors for amputation with foot complications (2)
other risk factors for amputation with foot complications (4)
major: sensory neuropathy, peripheral artery disease (PAD)
other: clotting abnormalities, impaired immune function, autonomic neuropathy, smoking
88
leading cause of diabetes-related death
angiopathy
89
short acting insulin onset, peak, and duration
onset: 30 min-1 hr
peak: 2-5 hr
duration: 5-8 hr
90
fluids for management of DKA
0.45% or 0.9% NS
Add 5-10% dextrose when BG approaches 250 mg/dL
91
normal fasting BG level
74-106 mg/dL
92
insulin therapy required
type 1 diabetes
93
more common in adults but can occur at any age (incidence is increasing in children)
type 2 diabetes
94
endogenous insulin absent
type 1 diabetes
95
Dawn phenomenon occurs most likely in __________
children
96
drugs for diabetic retinopathy block the action of ______________
vascular endothelial growth factor (VEFG)
97
symptoms usually abrupt but disease may be present for several years
type 1 diabetes
98
most common skin problem from diabetes
diabetic dermopathy
99
primary defect is insulin resistance, decreased insulin production over time, changes in adipokinase production
type 2 diabetes
100
nerve damage due to metabolic derangements of diabetes
diabetic neuropathy
101
symptoms include polydipsia, polyuria, polyphagia, fatigue, weight loss without trying
type 1 diabetes
102
inhaled insulin should not be used in these people
children
people with asthma, COPD, bronchospasms
103
ketosis present at onset
type 1 diabetes
104
treatment that involves aspiration of blood, membrane, and fibers inside eye
vitrectomy
105
therapy for hyperosmolar hyperglycemic syndrome (HHS) (4)
1. IV insulin and NaCl infusions
2. more fluid replacement needed
3. monitor serum potassium and replace as needed
4. correct underlying precipitating cause
106
damage to blood vessels secondary to chronic hyperglycemia
angiopathy
107
prediabetes is defined as impaired glucose tolerance (IGT) __ hour OGTT __________ mg/dL, impaired fasting glucose (IFT) with fasting BG _________ mg/dL, or both
2, 140-199, 100-125
108
injectable drug taken once a week with diet and exercise for diabetes
semaglutide (Ozempic)
109
complication caused by profound deficiency of insulin
diabetic ketoacidosis (DKA)
110
nutrition: often overweight or obese
type 2 diabetes
