Diabetes Flashcards
What is the difference between DM1 and DM2?
DM1 - lack of insulin
DM2 - insulin resistance
What is diabetes insipidus?
Polyuria and polydipsia –> dehydration due to low ADH
HIGH urine output
LOW urine specific gravity
HIGH serum specific gravity
Fluid volume deficit
What is SIADH?
Low UO, no thirst, weight gain
LOW urine output
HIGH urine specific gravity
LOW serum specific gravity
Fluid volume overload
Type 1 diabetes is called…. Type 2 diabetes is called…
Type 1 - insulin dependent, ketosis prone
Type 2 - non-insulin dependent, non-ketosis prone
What are the s/s of diabetes?
Polyuria
Polydipsia
Polyphagia (swallow/eat a lot)
Treat for DM type 1
They will DIE without treatment
Diet (least important)
Insulin (most important)
Exercise
Treatment for DM type 2
They are DOA without this
Diet (most important)
Oral hypoglycemic
Activity
What should the diet for DM2 look like?
Calorie restriction divided into 6 small meals a day because it keeps blood sugar more stable
BUT the calorie restriction is the most important
What does the R stand for in Regular insulin? Onset, Peak, Duration?
R = Rapid, Run IV
Clear solution
O: 1 hour
P: 2 hours
D: 4 hours
1-2-4
What does the N stand for in NPH insulin? Onset, Peak, Duration?
N = not so fast (intermediate), not so clear, not in the bag
O: 6 hours
P: 8-10 hours
D: 12 hours
6-8-10-12
When should Lispro (Humalog) be given? Onset, Peak, Duration?
WITH meals. Not before meals
O: 15 minutes
P: 30 minutes
D: 3 hours
What kind of insulin is glargine (Lantus)? Onset, Peak, Duration?
Long acting insulin
Little to no risk for hypoglycemia so only on that can safely be given at bedtime
O:
P: no peak
D: 12-24 hours
What should be checked before giving insulin?
Does it ever change?
Check the expiration date
Once the package is open, the expiration date changes from the manufacture date to 30 days after the insulin was opened (label with OPEN date and EXP date)
Does insulin need to be refrigerated?
In hospital, insulin should be refrigerated prior to open and can be unrefrigerated after opening
Should tell your patients to always refrigerate their insulin at home
What is exercise considered in a diabetic? What should you do d/t this?
Exercise is another shot of insulin
Decrease dosage of insulin and give a rapidly metabolized carb
What 2 problems does any sick diabetic have?
Hyperglycemia and dehydration
Sickness stresses out the body –> serum glucose levels increase
Even if not eating, still take insulin
Take sips of water
What does hypoglycemia look like?
DRUNK AND SHOCK
Staggering gait, slurred speech, cerebral impairment (labile - emotions all over the place), slow reaction time, decrease social inhibition (loud)
Tachycardia, low BP tachypnea, cold/clammy. mottled skin
What is the treatment for hypoglycemia?
Sugars/rapdily metabolized carbs with a starch of protein (apply juice and turkey, 1/2 cup skim milk)
Glucagon IM if patient is at home
Dextrose (D10 or D50) if in ER
DKA occurs in which patient? What is the #1 cause of it?
Type 1 diabetes - ketosis prone
Upper respiratory infection within last 2 weeks
What are the s/s of DKA?
Dehydration (dry, poor skin elasticity, poor turgor, warm)
Ketones in serum, Kussmauls, High K
Acidosis, Acetone breath,, Anorexia d/t nausea
Does ketones in urine mean DKA?
NO
Ketones in serum means DKA
How is DKA treated?
IV Regular insulin
IV fluids - 200ml/hour
Which diabetic does HHNK/HHS/HHNS affect? What should you think with this acute complication? Treatment?
Type 2 diabetic
Severe dehydration - skin flushed, decreased turgor, increased HR, warm
Treat by rehydrating
Between DKA and HHNK, which has the high mortality and which is the higher priority?
HHNK has the higher mortality because it is caught too late and does not readily respond to treatment
DKA is the priority because if left untreated it will kill the patient faster and it responds very quickly to insulin
What are the 2 reasons for long term complications of diabetes?
Poor tissue perfusion
Peripheral neuropathy
Examples: Renal failure, Gangrene, Heart failure, Urinary incontinence, Pt can’t feel a burn on the foot
What does an A1C test? What is normal? Out of control? Borderline?
Best indicator of long term blood glucose level
Normal - less than 6
Borderline - 7 (pt should come in for eval)
Out of control - 8 and above
