Diabetes

Question 1

What is diabetes?

Answer 1

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

Question 2

What is type 1 diabetes?

Answer 2

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

Question 3

What is type 2 diabetes?

Answer 3

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

Question 4

What is gestational diabetes?

Answer 4

Glucose intolerance during pregnancy

Question 5

What are the 3 P’s and why do they happen?

Answer 5

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

Question 6

Manifestations of hypoglycemia:

Answer 6

Weakness, difficulty thinking, confusion, sweating, cool and pale skin
“Cool and clammy, need some candy”
*more urgent than hyperglycemia

Question 7

Manifestations of hyperglycemia

Answer 7

Warm and moist skin, fruity breath
— LOC is not changed unless severe

Question 8

What is your first action when your patient is experiencing symptoms of hypoglycemia?

Answer 8

Check BG immediately
— methods to increase BG are dependent on how low the current level is
*give oral carbs if patient is still conscious

Question 9

What do you do if your patient is hypoglycemic and unconscious? (After you check BG)

Answer 9

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

Question 10

What are causes of hypoglycemia?

Answer 10

— deficient intake
— excessive insulin
— exercise
— alcohol (decreases liver glucose production)
— decreased gastric emptying

Question 11

What do you do after giving short-acting insulin?

Answer 11

Check on the patient within 20 minutes

Question 12

What should the nurse know about insulin?

Answer 12

— 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

Question 13

What should be included in patient education?

Answer 13

— 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

Question 14

A hyperglycemic patient comes into the ED with high respirations, what is happening?

Answer 14

The respiratory symptoms are a result of compensation for the metabolic acidosis

Question 15

What is DKA (diabetic keto acidosis)?

Answer 15

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

Question 16

What type of insulin does this patient need for his emergency?

Answer 16

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

Question 17

What is HHS (hyperglycemic hyperosmolar state)?

Answer 17

— gradual onset
— altered CNS; neurological symptoms
— severe dehydration + electrolyte loss
— glucose 600+

Question 18

What are microvascular complications of diabetes?

Answer 18

Retinopathy (damage to vessels in the eyes)
Neuropathy (damage to nerves; tingling sensations)
Nephropathy (damage to kidneys)

Question 19

What are macrovascular complications?

Answer 19

CV disease
Stroke
Peripheral vascular disease

Question 20

What leads to these micro and macrovascular complications?

Answer 20

— 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

Question 21

What is our primary goal for clients diagnosed with diabetes?

Answer 21

— maintaining BG in expected range
— preventing acute and chronic complications
*best way to prevent complications is to keep tight control of BG

Question 22

Because diabetes is a complex disorder, what are other things that can contribute to glucose control?

Answer 22

— 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

Question 23

What is the most common complication of diabetes?

Answer 23

Foot injury