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3130 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Functions of insulin

A
  • Transport and metabolize glucose for energy
  • stimulate storage of glucose in the liver and muscle as glycogen
  • signals liver to stop the release of glucose
  • enhances storage of dietary fat in adipose tissue
  • accelerates transport of Amino acids from protein into cells
  • inhibits breakdown of stored glucose, protein, and fat
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2
Q

Prediabetes

A
  • impaired fasting glucose or impaired glucose tolerance
  • high risk for developing type 2
  • teach s/s
  • start modifications asap
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3
Q

Type 1

A
  • manifestation do not appear for months to years until beta cells destruction is severe
  • acute onset
  • need insulin to survive
  • honeymoon phase
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4
Q

Destruction of beta cells results in

A
  • decreased insulin production
  • increased glucose from liver
  • hyperglycemia
  • DKA
  • ketones produced
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5
Q

Type 2

A
  • gradual onset
  • complications may be present before diagnosis
  • at risk for HHNS
  • decreased production of insulin
  • insulin resistance
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6
Q

Type 2 risk factors

A
  • family history
  • obesity
  • race
  • age (over 40)
  • BP (over 140/90)
  • hx of gestation DM or baby born over 9lbs
  • metabolic syndrome
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7
Q

Metabolic syndrome

A
  • central obesity
  • high blood pressure
  • high triglycerides
  • low HDL cholesterol
  • insulin resistance
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8
Q

Manifestations of type 1

A
  • rapid onset
  • 3Ps
  • weight loss
  • weakness, fatigue
  • later, possible ketoacidosis
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9
Q

Manifestations of type 2

A
  • insidious onset
  • may experience 3Ps
  • fatigue
  • recurrent infections
  • recurrent vaginal yeast infections
  • prolonged wound healing
  • visual changes
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10
Q

Diagnosis of DM

A
  • positive if meets one of four criteria
  • A1C over 6.5
  • FPG over 126 on 2 separate days
  • OGTT over 200
  • random glucose over 200
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11
Q

5 components of diabetic management

A
  • nutrition/weight management
  • exercise
  • self monitoring glucose
  • pharmacological therapy
  • education
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12
Q

Diet teaching

A
  • fiber decreases insulin requirements
  • sugar free not really sugar free
  • sweeteners in moderation
  • limit saturated fats
  • limit alcohol
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13
Q

Exercise management

A
  • lowers glucose
  • in areas uptake of glucose by muscles
  • improves insulin utilization
  • if at risk for hypoglycemia then CHO snack before or after exercise
  • avoid vigors activity if BS over 250 with ketones
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14
Q

Diabetic vital signs

A
  • normal serum glucose 70-100

- ADA target 70-130 or 180 after meals

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15
Q

Ketone testing

A
  • tests in urine

- warning of a deteriorating control of BS

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16
Q

When to test for ketones

A
  • BS persistently elevated (over 240 two times in a row)
  • during illness
  • pregnancy
  • glycosuria is present
17
Q

Pt education

A
  • s/s of hyper and hypoglycemia, ranges, how to monitor
  • how to admin injections, store insulin, pump insulin, take meds
  • diet, exercise, risk factor management
  • foot care
18
Q

Sick Day Rules

A

S (sugar) check glucose every 2-3 hours
I (insulin) always take insulin even when sick
C (carbs) take in enough carbs and fluids
K (ketones) check blood or urine levels every 4 hours

19
Q

When to call MD

A
  • BS over 240
  • vomit persistency
  • temp over 102 with Tylenol
  • persistent diarrhea
  • disorientation/confusion
  • unable to tolerate liquids
  • rapid breathing (Kussmaul)
  • illness lasts longer than 2 days
20
Q

Acute care treatment

A
  • blood glucose target range of 140-180
  • insulin is preferred over oral meds to bring down BS
  • insulin protocols are crucial for insistence and effectiveness
  • scheduled glucose checks, meals, and insulin doses to encourage stability of levels
21
Q

Which patients get glucose checks

A
  • all pts with DM
  • certain meds (steroids)
  • pts on TPN
  • pts with tube feedings
  • pts excessively stressed from illness/surgery
22
Q

Hospitalize patient challenges

A
  • increase in hyperglycemia
  • diet changes (npo, clear liquids, parenteral nutrition, enteral tube feeding)
  • stress
23
Q

Common complications of hyperglycemia caused by

A
  • illness
  • injury
  • surgery
  • stress
  • non compliance
24
Q

Common complications of hypoglycemia caused by

A
  • alcohol
  • exercise
  • increase fiber
  • diabetes meds
25
Q

Hypoglycemia implications mild

A
  • shaky/tremors
  • pounding heart
  • diaphoresis
  • anxious
  • chills
  • hungry
26
Q

Hypoglycemia implications moderate

A
  • tingling
  • blurred vision
  • weakness
  • slurred speech
  • confusion
  • irriational
  • drowsiness
27
Q

Hypoglycemia implications severe

A
  • disorientation
  • seizure
  • stupor
  • coma
  • death
28
Q

What to do for hypoglycemia if able to swallow

A
  • 15 to 20 gym of simply CHO PO if able to swallow get a snack
  • recheck in 15 min
  • if less than 70 repeat snack
  • if over 7- give high protein snack with starch or meal
29
Q

What to do for hypoglycemia if not able to swallow

A
  • if no IV give glucagon 1mg SQ or IM (roll on side for vomit)
  • if IV present amp of D50W 25 or 50 IVP
  • usually standing order
30
Q

Hypoglycemia pt teaching

A
  • know s/s
  • carry simple sugar at all times*
  • educate family, co-workers, ID bracelet
  • medication interactions (beta blockers)
  • when to call HCP
31
Q

Macrovascular complications

A
  • cardiovascular (pain, MI)
  • cerebrovascular (increased risk of TIA/CVA, more like to die, hyperglycemia may mimic sx of CVA
  • peripheral vascular (intermittent claudication, decreased pulses, decreased wound healing
32
Q

Microvascular complications

A
  • unique to DM
  • affects micro circulation and retina
  • diabetic retinopathy (no cure)
  • can prevent it if not then slow progression
33
Q

Nephropathy (microvascular)

A
  • earliest sign is microalbuminuria (monitor urine)

- closely manage HTN (it will cause acceleration)

34
Q

Diabetic neuropathy (microvascular)

A
  • sensory: affects the peripheral nervous system often lower extremity
  • s/s: numb, pain, burning, loss of sensitivity to touch and temp
  • high risk for injury
  • chariot’s joints: joint changes and foot drop
35
Q

Diabetic neuropathies complications

A
  • autonomic neuropathy: affect almost all of body

- can cause: orthostatic hypotension, ED/low libido, gastroparesis, GERD, urinary retention, diarrhea

36
Q

Foot and leg problems

A
  • 3 diabetic complications contribute
  • neuropathy, PVD, immunocompromise
  • always asses skin and pulses
  • neuropathy, ischemia, sepsis, gangrene , amputation
37
Q

Diabetic foot care

A
  • proper bathing
  • lubricate
  • daily inspection
  • check inside shoes
  • closed toed and well fitting shoes
  • clean socks
  • avoid high risk behavior
  • careful toenail cutting
  • podiatrist as needed
  • prompt HCP evaluation

3130 (13 decks)

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