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RN (student) Diabetes > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

Glucose Regulation

A

High BGL–>promotes insulin release
Insulin (made in pancreas)
Glucagon maintains BGL when fasting & raise very low glucose levels (made by alpha cells, in islets of Langerhans in pancreas)
Glucagon –> released into the bloodstream. Glucagon-secreting alpha cells surround insulin-secreting beta cells.
Liver–> stores glucose as glycogen
Liver makes ketones from fats when glycogen storage is low–> ketones burned as fuel for muscles & other body organs, leaving sugar for brain, RBC, & kidney.

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2
Q

Type 1 Diabetes

A

Pancreas produces insulin–> insulin moves glucose to cells.
A diabetic pt–> immune cells destroy beta cells in the pancreas.
The pancreas cannot produce insulin, > glucose in the blood

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3
Q

Type 1 Diabetes

cause:

A

autoimmune destruction Beta cells in pancreas
earlier onset/younger patients
genetic & environmental factors
*Always requires Insulin!

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4
Q

Type I Diabetes

body’s response to insulin deficiency

A

glycogenolysis- glycogen is changed to glucose in the liver
gluconeogenesis- glucose is formed protein (release amino acids)
lipolysis- fats breakdown (free fatty acids released & converted to ketone bodies for energy–> can lead to ketoacidosis).

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5
Q

Type 1 Diabetes

sxs:

A
  • Polyuria/polydipsia/polyphagia (DM “eating” own body once surpass state of DKA, will eat muscle, brain, etc until can’t fx)
  • weight loss
  • frequent infections (pathogens prefer warm, moist areas & lots of energy/sugar)
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6
Q

Type I Diabetes

complications:

A

DKA (diabetic ketoacidosis)
buildup of ketones in bloodstream
often brought on by a stressor, like infection
associated w/ severe hyperglycemia & dehydration
basic sxs: decreased LOC, Kussmaul’s respirations, fruity breath
(DKA= increased BGL & ketones)
DKA–> mostly Type I diabetics
[DM-II goes into HHS (Hyperosmolar hyperglycemic syndrome) > often than DKA]

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7
Q

Type II Diabetes

A
  1. stomach converts food to glucose
  2. glucose enters bloodstream
  3. pancreas produces insulin, but it’s resistant to effective use
  4. glucose unable to enter body effectively
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8
Q

Type II Diabetes

populations at risk:

A

Population @ risk for Type II DM:

  • Native Americans
  • Alaskan Indians
  • African Americans
  • Hispanic Americans
  • White Americans
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9
Q

Type II Diabetes

R/F:

A 
genetic
adult onset
HTN
sedentary lifestyle
certain ethnicities
obesity
poor diet
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10
Q

Metabolic Syndrome

A 
Abd obesity (>40" men; >35 women)
Hyperglycemia (FBS > or = 100; fasting >8 hr)
HTN (BP > or = 130/80)
Hyperlipidemia [trig > or = 150; hdl (healthy chol) < 50 men; < 40 women]
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11
Q

Diabetes

dx:

A

fasting plasma glucose > or = 126 twice or…
A1C > or = 6.5% or…
random BG > 200 or…
glucose tolerance test (given 75 g of glucose in 2 hr, should be < 200)

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12
Q

Diabetes

Determinants of good BG control:

A

Hgb A1C < 7
fasting blood glucose 70-130 mg/dL
post-prandial blood glucose < 180 mg/dL

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13
Q

Glucometer: steps for BG Monitoring

A
  1. wash hands
  2. Load new lancet & test strip
  3. prick finger at side
  4. squeeze finger
  5. touch tip against drop of blood
  6. clean finger, remove test strip
  7. dispose of lancet in sharps container
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14
Q

Diabetes Med Mgmt

A

Metformin: drug of choice for monotherapy (pill)
Tx DM-II
-avoids kidney dz
-monitor GFR for decreased levels
-monitor for increased BUN & creatinine levels
-IV contrast & anesthesia: hold metformin before & 48 hrs after
-metformin–> can cause kidneys to overwork & before restarting metformin check labs & I/Os

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15
Q

Sulfonylureas:

ends in “ides”

A

glipizide, glyburide, glimepiride

  • used for DM-II
  • give w/ or just before meals
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16
Q

Thiazolidinediones (TZDs):

A

pioglitazone, rosiglitazone

  • Tx DM-II
  • contraindicated for clients w/ HF
  • monitor liver function
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17
Q

DPP-4 Inhibitors

A 
Sitagliptin (Januvia), linagliptin
Tx DM-II
-rarely used (FDA warns s.e. joint pain, may be severe)
-s.e. N/V common (warn pt in advance)
-pancreatitis risk
-taken PO
-to block or slow lipoprotein in the gut
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18
Q

Summary of Insulin Tx

rapid

A

Rapid- aspart, lispro

onset: 15-30 min
peak: 30 min-3 hrs

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19
Q

Summary of Insulin Tx

Short; regular

A

Short; Regular “R”

  • used for DKA insulin drip
    onset: 30 min
    peak: 2-5.5 hrs
20
Q

Summary of Insulin Tx

intermediate:

A

NPH, 70/30

onset: 1-4 hrs
peak: 2-14 hrs

21
Q

Summary of Insulin Tx

Long:

A

glargine (Lantus), detemir (Levemir)

  • mimics body’s nat’l rate of insulin
  • can give even if NPO
    onset: 1-4 hrs
    peak: varies (but can last a long time)
22
Q

Who gets Insulin?

A

All Type I diabetics
Any pt w/ A1C > 9 & has s/o complications
Pts who fail max anti-hyperglycemic tx

23
Q

Insulin Preparations

rapid acting:

A

lispro (Humalog)
aspart (Novolog)
gluliscine (Apidra)

24
Q

Insulin Admin- other considerations:

Insulin storage:

A

refrigerate when not in use (un-used insulin)
store at room temp for 28 days
prefilled syringe
store w/ needle UP (so no seepage/don’t want to waste med)
fridge up to 30 days

25
Q

Insulin

mixing?

A

Never mix w/ anything glargine or detemir (Levemir), or any pre-mixed formulations.
Rapid & short-acting insulins CAN be mixed w/ NPH.

26
Q

Insulin Regimens

A
  • once daily
  • twice daily basal (morning/evening)
  • basal bolus “prandial” (before meals, before bed)
27
Q

Insulin Admin:

A

subcutaneous injection
site rotation bc scarring & fat will get dense
do not massage Injection site!
-28-31g (6-12.6 mm needle)
-abd- best 2” away from naval at 90 degree angle

28
Q

Sliding Scale (used in hospitals)

A 
BGL (mg/dL)     Insulin Units
61-150                0
151-200              3
201-250             5
251-300             8
301-350            10
351-400            12

*If pt has BGL > 400 call provider

29
Q

Mixing Insulins:

Order: Administer 12 UNITS Regular insulin and 30 UNITS of NPH subcutaneous before breakfast.

A
  1. NPH vial A (30 units air injected)
  2. Reg vial B (12 units air injected)
  3. Vial B (draw 12 units Reg Insulin)
  4. NPH vial A (30 units NPH insulin withdrawn)
    Then draw up to “42”

Before administering:
check patient for s/s of hypoglycemia. Ask how they feel. sxs: sweaty, clammy, confused, tachycardic
“If clammy give sammy” (sammy=sandwich)
Clean vial alcohol prep/roll gently NPH vial…do NOT shake. “Clear to Cloudy”
Clear: Regular & Cloudy is NPH (RN–>R “reg”—>N “NPH”

30
Q

Complications of diabetes

hypoglycemia:

A

sweating
tremors
tachycardia
palms
anxiety
blurred VI
altered LOC———– Mimics stroke in hospital- call
behavior change—–stroke-1st thing stroke protocol
slurred speech——- is to get blood sugar bc it may be hypoglycemia (give Amp D50)

31
Q

Hypoglycemia

causes:

A

Meds: injected/given wrong time, wrong dose
missed meals
TPN
alcohol
(insufficient food, excess exercise, excess insulin)
> 20-40 BGL –>can have Sz

32
Q

Hypoglycemia

txmt: (mild)

A

Mild: < 60
pt will be hungry, irritable, shaky, weak
tx w/ 10-15 g of simple carbs
recheck in 15 min, give one more time

33
Q

Hypoglycemia

txmt: (moderate)

A

Moderate: < 40
pt will be cool, clammy, drowsy
tx w/ 15-30 g pf rapidly absorbed carbs

34
Q

Hypoglycemia

txmt: (severe)

A

Pt is unconscious or unable to swallow
BG usually <20
1 mg glucagon IM/SQ
Repeat in 10 min if pt is still unconscious & notify dr/EMS
-may have Sz
-in hospital- make sure all pts have IV access
- given Amp D50

35
Q

Microvascular & microvascular:

complications of diabetes

A

Microvascular: Macrovascular:
retinopathy MI
nephropathy CVA
polyneuropathy Angina
gastroparesis PVD

36
Q

Complications of diabetes

Dawn Phenomenon:

A

overnight release or growth hormone
rise in glucose
a.m. hyperglycemia
txmt: increased overnight insulin dose (ex: pt to set alarm for midnight give self insulin)

37
Q

Complications of diabetes

Somogyi Phenomenon:

A

Rebound hyperglycemia d/t hypoglycemia from bedtime insulin
a.m. hyperglycemia
txmt: advise pt to eat bedtime snack
decrease insulin dosage

38
Q

Diabetes affects the kidneys:

A

Protein leaking- will increase BUN & creatinine
microalbumemia
-IV contrast makes worse so monitor labs, hold insulin

39
Q

Diabetes

Pt teaching: foot care

A

d/t poor Circulation

  • dont wear same shoes 2 days in a row
  • shoes should be soft, like leather- no sandals!
  • wash feet w/ lukewarm water & soap- no soaking!
  • moisturize feet after bath, avoid b/w toes!
  • check for sores, blister, etc
  • cover any w/ dry, sterile dressing & call doctor!
  • cut toenails straight across; or get podiatrist to cut nails
40
Q

Diabetes Nutrition Mgmt

A

Interdisciplinary: dietician (always use)

  • dev meal plan
  • reduced-calorie meals for DM-II wt loss, if needed
  • stick to the plan: timing of meals, art, food choices
41
Q

Nutrition & Diabetes

general guidelines:

A

carb sources: veg, fruits, whole grains, legumes * daisy

  • at least 25 g of fiber, dairy (bulking agent, feel full & cleans bowels)
  • avoid sugary drinks (HFCS & sources)
  • fates: high quality
42
Q

Nutrition & Diabetes

alcohol consumption:

A

-2 drinks for men, one for women
(12 oz beer, 5 oz. wine)
-ingest w/ or shortly after meals

43
Q

Carb Counting (CHO)

A
  • 15 g of carb for every 1 Unit of rapid-acting insulin
  • Type-I diabetics uses:
    1) rapid-acting insulin by Injection or insulin pump
  • can count carb per meal & give themselves extra insulin, if needed
    2) fixed insulin dosage
  • can count carbs per meal, assure they do NOT exceed the act that their insulin will cover
44
Q

Teaching: exercise & diabetes

A
  • wear appropriate exercise footwear & check feet regularly
  • avoid extreme temps
  • NO exercise w/in 1 hr of insulin Injection or near its peak
  • NO exercise when ketones present (bc fat is being broken broken-down & will increase demand ketones will go up)
  • check glucose frequent & exercise ONLY if bgl 80-250 mg/dL
  • carry simple sugar snack for s/o hypoglycemia
  • carb intake may need increase w/ unplanned exercise
45
Q

Diabetes

sick day rules:

A

“SICK”
S (sugar): check bs q4 hrs
I (insulin): continue to take insulin & DM meds
C (carbs): eat meals at reg. times & drink 8-12 oz fluid q hr
K: (ketones): check urine ketones when bc > 240 mg/dL
*if bs high- choose sugar-free
*if bs low- choose sugary
> 300 baseline for DKA, but ketones, > 240

RN (student) Diabetes (1 decks)

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