Diabetes

Question 1

what occurs in the body when you dont have diabetes?

Answer 1

1. The food that is consumed, moves into the blood stream as glucose
2. Insulin from the pancreas is released in response to the increase of glucose in the bloodstream. Insulin is the key for unlocking cell receptors and allowing glucose to move into the cells

Question 2

Insulin

Answer 2

• A hormone that is secreated by the beta cells in the islet of langerhans
• secreted by the beta cells of the pancreas
• stimulus for insulin is high blood glucose levels

Question 3

pre-diabetes

Answer 3

impaired glucose intolerance
* occurs when glucose levels are higher than normal, but not high enough for a diagnosis of diabetes
* high risk for developing type 2 diabetes & CV diease

Question 4

Gestational diabetes

Answer 4

• occurs during pregnancy
• high risk women include= obese, advanced age,family history of diabetes
• increased risk for c-section, prenatal death, and fetal injury
• screening at 24-28 weeks using OGTT
• blood sugar returns to normal within 6 weeks postpartum

Question 5

type 1 diabetes

Answer 5

• autoimmune disease
• insulin dependent
• genetic deposition
• more common in yong indiv
• 5-10% of all diabetes
• no or little insulin production

Question 6

what occurs with type 1 diabetes

Answer 6

• the pancreas stops making insulin
• glucose builds up in the blood
• cells have no glucose for energy
• body breaks down fat and protein
• ketons are made

Question 7

how do you manage type 1 diabetes

Answer 7

Replace insulin
1. background insulin
2. bolus insulin

Question 8

type 2 diabetes

Answer 8

• most prevalent
• gradual onset

2 main problems
1. insulin resistance=body has decreases sensitivity to insulin
2. inpaired beta cells functioning, which results in decreased insulin production

Contriubuting problem
* muscles- making up glucose for energy effeciency; imparied insulin secretion
* Fat- altered production of hormones and cytokines by adipose tissue

Question 9

Risk factors for diabetes

Answer 9

• family history of diabetes
• obesity
• BMI >27
• race/ethnicity
• HTN
• triglycerides > 200 mg/dl
• previous impaired glucose tolerance

Question 10

clinical manifestations for diabetes

Answer 10

• polyuria
• polydipsia
• polyphagia
• weakness/fatigue
• dry mouth
• numbness in hands/feet
• high blood sugars
• dry itchy skin
• cellulites
• blurred vision
• high blood pressure
• weight loss or gain

Question 11

Diagnostic studies

Answer 11

1. A1C of 6.5% OR higher
2. fasting plasma glucose level of > 126 mg/dl with no calorie intake for 8hr
3. two hr OGTT level >200 mg/dl using a 75g glucose load

Question 12

Tools for self measurment for diabetes

Answer 12

1. medication
2. good nutrition
3. incresed physical activity
4. monitoriting blood glucose

Question 13

Drug therapy for diabetes

Answer 13

• drugs+nutrition+exercise= GOOD
• medication may need to increase as disease progresses
• injectables: insulin and noninsulin
• oral medications

Question 14

insulin

Answer 14

3 major characteristics of insulin
1. onset
2. peak
3. duration of action
* can only be given subQ
* comes in a vial or pen device
* can be delivered by insulin pump

Question 15

componets of insulin regimen

Answer 15

Basal insulin- background coverage
bolus insulin- mealtime coverage
correction- bolus insulin used to correct occasional high BG excursions

intensive insulin therapy is the use of both basal and bolus insulin consisting of multiple daily injections

Question 16

long acting (basal) insulin

Answer 16

• keeps blood glucose levels consistant when not eating
• covers hepatic glucose production
• migrates dawn production
• characterized by hyperglycemia that is present on awakening in the morning due to the release of counter-regulatory hormones in the predawn hours

Question 17

types of basal insulin

Answer 17

long acting- Lantus & Levemir
* no peak
* 1-2 injections per day
* low incidence of hypoglycemia

intermediate- NPH
* breakfast and dinner or bedtime
* peaks between 4-10 hours
* high variability, high incidence of hypoglycemia

Question 18

mealtime (boulus) insulin

Answer 18

• lowers blood glucose after meals
• used in insulin pumps for continual basal and bolus dosing
• timing of injection is important to help control post meal blood glucose

Question 19

rapid acting insulin

Answer 19

• starts working within 5-15 min & works with food and is gone within 3-5 hours
• inejct right before eating

Question 20

short acting insulin

Answer 20

• starts working within 30-60 min and can last up to 6 hours
• inject 30 min prior to eating

Question 21

nutrition management

Answer 21

• BMI of 25-29 is considered overweight
• BMI over 30 is considered obese

Question 22

nutritional therapy

Answer 22

• meal planning and weight management are foundations of diabetes self-management
• nutritional therapy has the greatest impact on the persons diabetes if provided at the onset of the diagnosis
• need to control total caloric intake to attain or maintain a reasonable body weight & have good glycemic control

Question 23

nursing management for diabetes

Answer 23

Health promotion
* education and screening

Acute care

• stress increases blood glucose
• insulin may be ordered for nondiabetics

chronic care
* certified diabetes educator
* assess pt’s goals, understanding and ability
* education about disease process and self-management

Question 24

nursing assessment for diabetes

Answer 24

• pt history
• signs related to diagnosis of DM
• hyperglycemia
• hypoglycemia
• blood sugar monitoring
• status of symptoms
• adherence to treatment regimen
• lifestyle, culture, psychosocial and economic factors
• physical exam

Question 25

nursing diagnosis for diabetes

Answer 25

* deficient knowledge about diabetes, self care skills and information * self care deficit, physical impairment or social factors * hyperglycemia * hypoglycemia * risk for infection * risk for impaired skin integrity * risk for injury * impaired peripheral neurovascular function

Question 26

nursing goals and outcomes for diabetes

Answer 26

* engage in self care behaviors to manage diabetes * few or no hyperglycemia or hypoglycemia emergencies * maintain normal or near-normal blood glucose levels * prevent, minimize or delay complications

Question 27

nursing interventions for acute care diabetes

Answer 27

* diabetes should check their glucose levels every 4 hours during times of sickness * if glucose is over 240 check urine for ketone every 3-4 hours * those who are critically ill may have a higher target goal

Question 28

nursing interventions: ambulatory care

Answer 28

* pt and caregiver education * assess the meaning of having diabetes * determine mutual goals that are based on treatment plan * identify and include support system in pt counseling * flexibility is important

Question 29

nursing management evaluation

Answer 29

* state key elements of the treatment plan * describe self care measures that may prevent or slow progression of chronic complications * maintain a balance of nutrition, activity, and insulin availability that results in stable safe and healthy blood glucose levels * have no injury from decreased sensation in the feet * implement measures to increase peripheral circulation

Question 30

diabetic ketoacidosis

Answer 30

* caused by an absence or inadequate amount of insulin * caused by disorders in the metabolism of fats, CHO, and proteins **signs and symptoms** 1. nausea and vomitting 2. rapid breathing 3. extreme tiredness and drowsiness 4. muscle weakness, fatigue, and malaise 5. hyperglycemia 6. dehydration and electrolyte loss 7. acidosis * insulin deficiency leads to a breakdown of fats into free fatty acids and glycerol * free fatty acids are converted into ketone bodies by the liver * fruity breath, tachycardia and hypotension

Question 31

**diabetic ketoacidosis (DKA) causes, treatment, and potential complications**

Answer 31

caused by: * decreased or missed dose of insulin * illness or infection * undiagnosed or untreated diabetes **Treatment** * IV fluids and electrolytes replacement * administer insulin * establish cause of DKA **Potential complications** * fluid overload * hypokalemia * cerebal edema

Question 32

hyperglycemia hyperosmolar nonketotic syndrome

Answer 32

* blood glucose= 800-1000 * ketosis usually minimal or absent * defect is usually lack of effective insulin (insulin resistance) * persistent hyperglycemia causes osmotic diuresis= loss of water and electrolytes

Question 33

hyperglycemia hyperosmolar nonketotic syndrome | causes, signs//symptoms and treatment

Answer 33

**causes** * acute illness * medication that exacerbate hyperglycemia * dialysis treatment **signs//symtoms** * hypotension * dehydration * tachycardia * variable neurological signs * mortality rate 10-40% **treatment** * fluid replacement * correct electrolytes

Question 34

hypoglycemia

Answer 34

* Abnormally low blood glucose lvls **causes** * too little or oral hypoglycemic agent * too little food or excessive excercise * delayed or skipped meals **S/S** * sweating * tremors * tachycardia * palpitations * nervousness * hunger * inablity to concentrate * numbness of the tounge and lips * slurred speech * visual changes **Management** * teach pts to always carry simple sugars with them * consistent pattern of eating and administering insulin

Question 35

long term complication of DM

Answer 35

* poor vascular circulation * cardiovascular disease * kidney failure * retinopathy * neuropathy * stroke

Question 36

macro-vascular complications

Answer 36

* disease of large and medium sized vessles * atherosclerosis-from altered lipid metabolism * cerebral vascular * peripheral vascular disease

Question 37

microvascular disease

Answer 37

* capillary basement membrane thickening * affects the retina and kidneys

Question 38

diabetic retinopathy

Answer 38

* can lead to vision loss and blindness if not treated * most common cause of blindess in persons ages 20-74 * results from chronic hyperglycemia

Question 39

nephropathy

Answer 39

* diabetes can alter the normal function of the kidneys * leading cause of end-stage renal disease *

Question 40

diabetic neuropathy

Answer 40

* impaired sensation or pain in the feet or hands * slowed digestion of food in the stomach * carpal stomach * more than 60% of non-traumatic lower limb amputations occur in those with diabetes * can be a leading cause of sexual dysfunction for patients with diabetes