Diabetes Flashcards
What is diabetes?
A chronic metabolic disease resulting from either a deficiency in insulin secretion, or resistance to insulin
— inability to regulate blood glucose
— leading cause in blindness, end stage kidney disease, and foot/leg amputations
What is type 1 diabetes?
No insulin is being produced; autoimmune disorder (beta cells of the pancreas are destroyed by antibodies)
— abrupt onset
— 3 P’s + weight loss
— occurs before the age of 30
What is type 2 diabetes?
Insulin resistance; decreased secretion of insulin from beta cells
— factors include: obesity, physical inactivity, and genetics
— occurs usually after the age of 50
— 90% of diabetic patients
What is gestational diabetes?
Glucose intolerance during pregnancy
What are the 3 P’s and why do they happen?
Polyuria: frequent and excessive urination
— caused by osmotic dieresis; excessive serum glucose
Polydipsia: excessive thirst
— caused by dehydration
Polyphagia: excessive eating
— caused by cell starvation
Manifestations of hypoglycemia:
Weakness, difficulty thinking, confusion, sweating, cool and pale skin
“Cool and clammy, need some candy”
*more urgent than hyperglycemia
Manifestations of hyperglycemia
Warm and moist skin, fruity breath
— LOC is not changed unless severe
What is your first action when your patient is experiencing symptoms of hypoglycemia?
Check BG immediately
— methods to increase BG are dependent on how low the current level is
*give oral carbs if patient is still conscious
What do you do if your patient is hypoglycemic and unconscious? (After you check BG)
Give glucagon IM or SQ; or give dextrose 50% IV
*know that replacing glucose PO is more preferred; make sure to give an oral glucose once the patient is awake and alert
What are causes of hypoglycemia?
— deficient intake
— excessive insulin
— exercise
— alcohol (decreases liver glucose production)
— decreased gastric emptying
What do you do after giving short-acting insulin?
Check on the patient within 20 minutes
What should the nurse know about insulin?
— given in SQ tissue (abdomen, back of arm, buttocks, thigh)
— do not mix long acting insulin or premixed insulin
— regimens are used to duplicate the *basal and *prandial release pattern of the pancreas
— can be given by continuous SQ infusion (externally worn pump)
*regular insulin is the only insulin that can be administered IV
*basal = small amount all the time
*prandial = relating to the eating of food
What should be included in patient education?
— refrigerate insulin when not using
— insulin in current use can be kept at room temp for up to 28 days
— discard unused insulin after 28 days
— prefilled syringes are stable up to 30 days when refrigerated
— have a spare bottle of each type of insulin used on hand
— inspect insulin before each use
— use disposable needles only once
— follow infection control measures
A hyperglycemic patient comes into the ED with high respirations, what is happening?
The respiratory symptoms are a result of compensation for the metabolic acidosis
What is DKA (diabetic keto acidosis)?
Uncontrolled hyperglycemia, metabolic acidosis, and increased production of ketones
Causes: infection, stress, inadequate insulin
*sudden onset, dehydration and electrolyte loss; 3 P’s
Glucose above 300
What type of insulin does this patient need for his emergency?
The patient needs regulated insulin therapy through IV
— regular insulin is the only insulin administered IV
— SQ insulin does not absorb fast enough and will not help in the emergency situation
*the patient needs IV fluids to correct fluid deficit that places pt at risk for hypovolemic shock
What is HHS (hyperglycemic hyperosmolar state)?
— gradual onset
— altered CNS; neurological symptoms
— severe dehydration + electrolyte loss
— glucose 600+
What are microvascular complications of diabetes?
Retinopathy (damage to vessels in the eyes)
Neuropathy (damage to nerves; tingling sensations)
Nephropathy (damage to kidneys)
What are macrovascular complications?
CV disease
Stroke
Peripheral vascular disease
What leads to these micro and macrovascular complications?
— changes to blood vessels secondary to hyperglycemia
— HYPERglycemia affects cell integrity
— changes in blood vessels leads to poor tissue perfusion and cell damage and death
What is our primary goal for clients diagnosed with diabetes?
— maintaining BG in expected range
— preventing acute and chronic complications
*best way to prevent complications is to keep tight control of BG
Because diabetes is a complex disorder, what are other things that can contribute to glucose control?
— diabetic medications (oral/insulin)
— nutrition therapy; carb counting, low cholesterol, avoid alcohol
— maintenance of healthy weight
— BP control
— blood lipid control (triglycerides; keep below 150)
— physical activity
What is the most common complication of diabetes?
Foot injury
