Diabetes

Question 1

What is the difference between DM1 and DM2?

Answer 1

DM1 - lack of insulin

DM2 - insulin resistance

Question 2

What is diabetes insipidus?

Answer 2

Polyuria and polydipsia –> dehydration due to low ADH

HIGH urine output
LOW urine specific gravity
HIGH serum specific gravity
Fluid volume deficit

Question 3

What is SIADH?

Answer 3

Low UO, no thirst, weight gain

LOW urine output
HIGH urine specific gravity
LOW serum specific gravity
Fluid volume overload

Question 4

Type 1 diabetes is called…. Type 2 diabetes is called…

Answer 4

Type 1 - insulin dependent, ketosis prone

Type 2 - non-insulin dependent, non-ketosis prone

Question 5

What are the s/s of diabetes?

Answer 5

Polyuria
Polydipsia
Polyphagia (swallow/eat a lot)

Question 6

Treat for DM type 1

Answer 6

They will DIE without treatment

Diet (least important)
Insulin (most important)
Exercise

Question 7

Treatment for DM type 2

Answer 7

They are DOA without this

Diet (most important)
Oral hypoglycemic
Activity

Question 8

What should the diet for DM2 look like?

Answer 8

Calorie restriction divided into 6 small meals a day because it keeps blood sugar more stable

BUT the calorie restriction is the most important

Question 9

What does the R stand for in Regular insulin? Onset, Peak, Duration?

Answer 9

R = Rapid, Run IV
Clear solution

O: 1 hour
P: 2 hours
D: 4 hours

1-2-4

Question 10

What does the N stand for in NPH insulin? Onset, Peak, Duration?

Answer 10

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

Question 11

When should Lispro (Humalog) be given? Onset, Peak, Duration?

Answer 11

WITH meals. Not before meals

O: 15 minutes
P: 30 minutes
D: 3 hours

Question 12

What kind of insulin is glargine (Lantus)? Onset, Peak, Duration?

Answer 12

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

Question 13

What should be checked before giving insulin?

Does it ever change?

Answer 13

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)

Question 14

Does insulin need to be refrigerated?

Answer 14

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

Question 15

What is exercise considered in a diabetic? What should you do d/t this?

Answer 15

Exercise is another shot of insulin

Decrease dosage of insulin and give a rapidly metabolized carb

Question 16

What 2 problems does any sick diabetic have?

Answer 16

Hyperglycemia and dehydration

Sickness stresses out the body –> serum glucose levels increase
Even if not eating, still take insulin

Take sips of water

Question 17

What does hypoglycemia look like?

Answer 17

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

Question 18

What is the treatment for hypoglycemia?

Answer 18

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

Question 19

DKA occurs in which patient? What is the #1 cause of it?

Answer 19

Type 1 diabetes - ketosis prone

Upper respiratory infection within last 2 weeks

Question 20

What are the s/s of DKA?

Answer 20

Dehydration (dry, poor skin elasticity, poor turgor, warm)
Ketones in serum, Kussmauls, High K
Acidosis, Acetone breath,, Anorexia d/t nausea

Question 21

Does ketones in urine mean DKA?

Answer 21

NO

Ketones in serum means DKA

Question 22

How is DKA treated?

Answer 22

IV Regular insulin

IV fluids - 200ml/hour

Question 23

Which diabetic does HHNK/HHS/HHNS affect? What should you think with this acute complication? Treatment?

Answer 23

Type 2 diabetic

Severe dehydration - skin flushed, decreased turgor, increased HR, warm

Treat by rehydrating

Question 24

Between DKA and HHNK, which has the high mortality and which is the higher priority?

Answer 24

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

Question 25

What are the 2 reasons for long term complications of diabetes?

Answer 25

Poor tissue perfusion

Peripheral neuropathy

Examples: Renal failure, Gangrene, Heart failure, Urinary incontinence, Pt can’t feel a burn on the foot

Question 26

What does an A1C test? What is normal? Out of control? Borderline?

Answer 26

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