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Med-Surg > Diabetes > Flashcards

Diabetes Flashcards

1
Q

diabetes mellitus

A

a disorder of glucose metabolism r/t absent or insufficient insulin supply or poor utilization of the insulin that is available

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2
Q

insulin

A

allows uptake of cells into liver, muscle, and fat and is converted to glycogen to make energy

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3
Q

insulin is required for

A

glucose to make energy and for glucose to get into cells

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4
Q

insulin prevents

A

utilization of fat as an energy source

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5
Q

insufficient insulin

A

increases protein catabolism, increases production of glucose, decreases use of glucose, increases fat catabolism

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6
Q

DM type 1

A

absolute lack of endogenous insulin

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7
Q

DM type 1 is caused by

A

destruction of pancreatic beta cells

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8
Q

origin of DM type 1

A

autoimmune or idiopathic of origin

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9
Q

DM type 1 is most common before age of

A

30 years

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10
Q

DM type 1 has 3 classic onset symptoms

A

polydypsia, polyuria, polyphagia

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11
Q

without exogenous insulin _____ occurs

A

ketoacidosis

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12
Q

DM type 2

A

insulin resistance, decreased ability of pancreas to produce insulin, inappropriate insulin production in liver

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13
Q

risk factors for DM type 2

A

obesity, pre diabetes, advanced age, race/ethnicity, physical inactivity

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14
Q

DM type 2 is a metabolic disorder characterized by

A
  • varying degrees of insulin resistance
  • impaired glucose production by the liver
  • impaired insulin secretion by the pancreas
  • alteration in the production of hormones and cytokines by adipose tissue
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15
Q

diagnosis of DM

A
  • fasting glucose
  • hmg A1C
  • random plasma glucose
  • 2 hr oral glucose tolerance test
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16
Q

diabetes would be diagnosed if fasting plasma glucose (fpg) value is

A

fpg >/= 7.0 mmol/L

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17
Q

diabetes would be diagnosed if hmg A1C is

A

hmg A1C >/= 6.5%

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18
Q

diabetes would be diagnosed if random plasma glucose is

A

> /= 11.1 mmol/L with “classic symptoms”

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19
Q

diabetes would be diagnosed if 2 hr glucose tolerance test is (OGTT)

A

OGTT >/= 11.1 mmol/L

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20
Q

prediabetes impaired fasting glucose (IFG) = ____ and impaired glucose tolerance (IGT) = _____

A

IFG = 6.1 - 6.9 mmol/L
IGT = >/= 7.8 mmol/L but less than 11.1 mmol/L

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21
Q

anti diabetic drugs include

A

metformin, glyburide, pioglitazone, sitagliptin

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22
Q

insulin types

A

novrapid, humulin N, humulin R, lantus, humulin 70/30

23
Q

nutritional therapy for type 2

A

emphasis on achieving glucose, lipid, and bp goals
- calorie reduction

24
Q

nutritional therapy for type 1

A

meal plan based on individuals usual food intake and is balanced with insulin and exercise patterns

25
Q

carbohydrates should be

A

45-65% of total energy intake

26
Q

low carb diets are ______ for diabetics

A

not recommended

27
Q

glycemic index

A

term used to describe rise in bg levels after consuming carbohydrate containing food

28
Q

fats should compromise no more than ______ of meal plans total calories

A

25-30%

29
Q

protein should contribute ____% of total energy consumed

A

<10%

30
Q

acute complications of DM

A

hypoglycemic crisis
hyperglycemic crisis - diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolarstate (HHS)

31
Q

most common diabetic complication

A

hypoglycemic crisis

32
Q

hypoglycemic crisis

A

abnormally low bg level of <4mmol/L
OR below pts normal when they start showing signs of hypoglycemia

33
Q

common predisposing factors for hypoglycemia

A
  • excessive medication
  • increased activity level
  • lack of dietary intake
  • critical illness
34
Q

clinical manifestations of hypoglycemia

A

cool, clammy, diaphoretic, shaky

35
Q

if hypoglycemic and unresponsive give

A

dextrose 50% in 50ml IVP and then recheck bg in 15 min

36
Q

goal of pt management with hypoglycemic

A

rapid restoration of intravascular fluid levels and normal serum glucose levels

37
Q

DKA results from

A

an absolute or relative deficiency in insulin

38
Q

characteristics of DKA

A
  • uncontrolled hyperglycemia
  • ketosis
  • metabolic acidosis
39
Q

DKA most often occurs in

A

type 1, sometimes type 2, <45 years

40
Q

precipitating factors for DKA

A
  • any condition or situation that increases insulin deficit
  • infection is most common factor
  • psychologic stress
41
Q

clinical presentation DKA

A
  • hyperglycemic; increase in glucose >17mmol/L, increase urine glucose
  • ketosis; increase serum and urine ketones
  • ketone “fruity” breath
  • osmotic diuresis
42
Q

osmotic diuresis

A
  • hypotension
  • polyuria and polydypsia
  • dehydration - increase serum BUN and creatinine
  • electrolyte alterations - increase serum osmolality
43
Q

hyperosmolar hyperglycemic state (HHS)

A

results from insulin deficiency and insulin resistance

44
Q

characteristics of HHS

A
  • extreme hyperglycemia
  • osmotic diuresis
  • neurological alterations
  • absence of ketosis
45
Q

clinical manifestations HHS

A
  • fewer symptoms than DKA
  • bg levels high
  • increase serum osmolality = increase neurological manifestations
46
Q

precipitating factors DKA

A
  • infection
  • inadequate fluid intake
  • impaired thirst sensation
  • functional inability to replace fluids
  • increasing mental depression and polyuria
47
Q

usual bg in pt with DKA

A

> 13.9 mmol/L

48
Q

usual bg in pt with HHS

A

> 33.3mmol/L

49
Q

management of hyperglycemic crisis

A

1) restore intravascular fluid volume
2) correct electrolyte imbalances
3) clear ketones and correct acidosis
4) normalize serum glucose
5) monitor pts status
6) prevent further complications
7) identify precipitating cause

50
Q

what is given to correct hydration status and serum Na level

A

IV fluids - 0.9% NaCl

51
Q

what can high or low potassium levels cause

A

arrhythmias

52
Q

what labs are looked at to assess kidney and electrolyte status

A

glucose, BUN, and creatinine, and all electrolytes

53
Q

types of insulin therapy in management of hyperglycemic crisis

A

continuous low dose IV insulin infusion
- sc insulin
- sliding scale insulin
- intensive insulin therapy

54
Q

Long term consequences of diabetic crisis’

A
  • end-organ disease resulting from damage to the blood vessels - angiopathy
  • macrovascular complications
  • microvascular complications (retinopathy (eyes), nephropathy (kidneys), dermopathy (skin, shin spots))

Med-Surg (15 decks)

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