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Med Surg > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Criteria for diagnosing DM

A

Fasting blood glucose 126 mg/dL or more
Casual glucose exceeding 200 mg/dL
A1C equal to or > 6.5% (48 mmol/mol)

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2
Q

What occurs with Type I Diabetes?

A

insulin is not secreted from pancreas

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3
Q

Risk factors for Type I diabetes

A

early-onset, familial, genetic predisposition, possible immunologic or environmental (viral toxins)

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4
Q

How are insulin-producing beta cells in the pancreas destroyed?

A

by genetics, immunology, and environmental factors

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5
Q

Type 1 diabetes results in

A
  • decreased insulin production
  • unchecked glucose production by the liver
  • fasting hyperglycemia
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6
Q

What % of diabetic adults are affected by type 1?

A

5%

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7
Q

What occurs in type II DM?

A

Deficiency in insulin’s action

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8
Q

risk factors for DM2

A

obesity, age, previous identified, impaired fasting glucose or impaired, glucose tolerance, hypertension ≥140/90, mm Hg, HDL ≤35 mg/dL or triglycerides, ≥250 mg/dL, history of gestational, diabetes or babies over 9 pound, Microvascular versus macrovascular complications

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9
Q

DM2 results in

A

Insulin resistance and impaired insulin secretion

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10
Q

What % of diabetic adults are affected by DM2?

A

95%

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11
Q

DM has an average onset of

A

over 30 years

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12
Q

DM 2 is increasing in children

A

r/t obesity

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13
Q

This condition is slow, progressive glucose intolerance and may go undetected for years

A

DM2

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14
Q

Macrovascular complications result from

A

changes in medium and large blood vessels

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15
Q

What occurs during microvascular complications?

A

Walls thicken, sclerosis, and plaque build up

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16
Q

What are the top 3 macrovascular complications

A

Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease

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17
Q

Microvascular complications are a result of

A

capillary basement membrane thickening

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18
Q

What two areas are affected by microvascular complications?

A

eyes and kidneys

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19
Q

Examples of microvascular complications:

A

Diabetic retinopathy

Nephropathy

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20
Q

ORAL DIABETIC MEDICATIONS: glipizide is an example of a

A

second generation sulfonylurea

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21
Q

ORAL DIABETIC MEDICATIONS: metformin is an example of a

A

Biguanide

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22
Q

DKA occurs when a patient is diabetic and has

A

•Intoxication
•Infection
OR
•Insulin deficit

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23
Q

insulin deficit results in

A

abnormal metabolism of carbohydrate, protein, and fat

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24
Q

The three clinical features of DKA are:

A
  • Hyperglycemia
  • Dehydration
  • Acidosis
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25
Q

blood glucose levels in DKA:

A

> 300 to 1000 (Severity of DKA not only due to blood glucose level)

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26
Q

What does ketoacidosis in DKA include?

A

low pH; low Bicarb, low PCO2,

•Ketone bodies in blood and urine

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27
Q

Electrolyte imbalances in DKA

A

vary according to degree of dehydration
•HyperKalemia
•increase in creatinine, Hct (dilutional), BUN

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28
Q

Treatment of DKA

A

Rehydration with IV fluid
IV continuous infusion of regular insulin
reverse acidosis and restore electrolyte balance
Note: Rehydration leads to increased plasma volume and decreased K; insulin enhances the movement of K+ from extracellular fluid into the cells - montior K levels and replace as needed.
monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload

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29
Q

management of DKA is aimed at:

A

correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin

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30
Q

What distinguishes HHS from DKA?

A

ketosis and acidosis generally do not occur in HHS, partly because of differences in insulin levels

31
Q

In DKA, no insulin is present, and this promotes:

A

the breakdown of stored glucose, protein, and fat, which leads to the production of ketone bodies and ketoacidosis

32
Q

In HHS, the insulin level is too low to prevent hyperglycemia (and subsequent osmotic diuresis), but it is high enough to

A

prevent fat breakdown

33
Q

Patients with HHS do not have the ketosis-related gastrointestinal symptoms that lead them to seek medical attention. Instead, they may:

A

tolerate polyuria and polydipsia until neurologic changes or an underlying illness (or family members or others) prompts them to seek treatment.

34
Q

In DKA, fluid replacement enhances the excretion of:

A

excessive glucose by the kidneys (the patient may need as much as 6 to 10 L of IV fluid to replace fluid losses caused by polyuria, hyperventilation, diarrhea, and vomiting)

35
Q

Which fluid is given for treatment of DKA?

A

Initially, 0.9% sodium chloride (normal saline [NS]) solution is given at a rapid rate, usually 0.5 to 1 L per hour for 2 to 3 hours. Half-strength NS (0.45%) solution (also known as hypotonic saline solution) may be used for patients with hypertension or hypernatremia and those at risk for heart failure

36
Q

When BG’s in DKA being treated by fluid replacement reach 300 mg/dL (16.6 mmol/L) or less, the IV solution may be changed to

A

dextrose 5% in water (D5W) to prevent a precipitous decline in the blood glucose level

37
Q

Which fluid is used to treat HHS?

A

0.9% or 0.45% NS, depending on the patient’s sodium level and the severity of volume depletion

38
Q

In HHS potassium is added to IV fluids when:

A

urinary output is adequate and is guided by continuous ECG monitoring and frequent laboratory determinations of potassium

39
Q

Insulin plays a less important role in the treatment of HHS because:

A

it is not needed for reversal of acidosis

40
Q

In HHS insulin is usually given at a continuous low rate to treat?

A

hyperglycemia, and replacement IV fluids with dextrose are given (as in DKA) after the glucose level has decreased to the range of 250 to 300 mg/dL (13.8 to 16.6 mmol/L)

41
Q

Hyperosmolar hyperglycemia (HHS) is caused by:

A

a lack of sufficient insulin

42
Q

In HHS ketosis is?

A

minimal or absent

43
Q

Hyperglycemia (in HHS) causes:

A
  • osmotic diuresis
  • loss of water and electrolytes
  • hypernatremia
  • increased osmolality
44
Q

Hypotension, profound dehydration, tachycardia, variable neurologic signs caused by cerebral dehydration are all manifestations of?

A

Hyperosmolar hypertension (HHS)

45
Q

The mortality rate of HHS is:

A

high

46
Q

Rehydration, insulin administration, and monitoring fluid volume and electrolyte status is used in the treatment of?

A

HHS

47
Q

Prevention of HHS includes:

A

BGSM (blood glucose self-monitoring)
•Diagnosis and management of diabetes
•Assess and promote self-care management skills

48
Q

deficiency of insulin results in?

A

diabetes

49
Q

Why are older adults more prone to diabetes?

A

doesn’t have as much muscle to store insulin (goes in bloodstream)

50
Q

features of type I and II diabetes are both shown in what kind of diabetes?

A

Latent autoimmune diabetes

51
Q

Three P’s of diabetes (manifestations):

A

Polyuria, polydipsia, polyphagia

52
Q

sudden weight loss occurs in type ___ diabetes

A

1

53
Q

Hemoglobin A1C is an indicator of how well:

A

hemoglobin is saturating with glucose

54
Q

nutritional therapy, exercise, monitoring, pharmacologic therapy, and education are all involved in

A

Diabetes management

55
Q

diabetic diet

A

50-60% carbs, 30% fat, non-animal sources of protein

56
Q

insulin lipodystrophy is the:

A

fatty hardening from giving insulin injections in same place (so rotate your sites)

57
Q

Metformin is an oral drug for

A

Type II diabetes

58
Q

Second-generation sulfonylureas and Biguanides are:

A

Oral drug classes for diabetes

59
Q

insulin injection sites:

A

abdomen, thigh, upper arm, upper glutes

60
Q

The abdomen is the pressed site for insulin section because:

A

it is absorbed more slowly and consistently than the other sites

61
Q

Type I diabetes is associated with:

A

DKA

62
Q

Type II diabetes is associated with:

A

HHS

63
Q

A BG of 50-60mg/dL is

A

hypoglycemia

64
Q

Symptoms of hypoglycemia:

A

hypoglycemia:

diaphoresis, increased pulse, restlessness, extreme hunger (DIRE)

65
Q

DKA is triggered by:

A

Hyperglycemia

66
Q

Glucose levels in HHS

A

> 600 mg/dL

67
Q

Glucose levels in DKA

A

> 250mg/dL

68
Q

The following are all diagnostics for which disorder?

BG 300-800+
Acidosis (low pH, low bicarb, low PCO2)
Electrolyte imbalance d/t water loss
Increased BUN, creatnine & HCT

A

DKA

69
Q

In _________ lack of insulin causes decreased utilization of glucose by muscle, fat, and liver. This leads to hyperglycemia and
Increased breakdown of fat, increased fatty acids, and increased ketone bodies

A

DKA

70
Q

Clinical manifestations of DKA include:

A

Hyperglycemia

polyuria, polydipsia, fatigue, blurred vision, weakness, headache

Volume depletion

hypotension, rapid pulse

Ketois/acidosis

GI symptoms (N/V, abd pain ACETONE BREATH & KUSSMAUL RESPIRATIONS)

71
Q

BG (600-1200 mg/dL) electrolytes, BUN, CBC, serum osmolality (>320 mOsm/kg) , ABG

These are diagnostics for which disorder?

A

HHS

72
Q

Metabolic disorder of T2D

Insulin deficiency; illness that raises the demand for insulin

A

HHS

73
Q

Clinical manifestations of HHS include?

A

Hypotension
Profound dehydration
Tachycardia
Variable neurologic signs caused by cerebral dehydration (lethargy, seizures, coma)

74
Q

Treatment for ______ includes fluid replacement, correct electrolytes, insulin administration

A

HHS

Med Surg (5 decks)

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