diabetes

Question 1

what is diabetes

Answer 1

• an error in glucose metabolism: glucose is the primary source of fuel
• cells cant use glucose so they die

Question 2

diabetes insipidus

Answer 2

• DI –> high and dry
• high urine output (up to 20 L/ day) and dry body (dehydrated)
• dry inside

Question 3

S/S of DI

Answer 3

• polyuria
• bedwetting
• super thirsty: polydipsia
• dehydration from the low ADH
• high blood serum osmolality
• labs will be high
• low specific gravity
• light urine
• decreased BP
  -weight loss
• fluid volume deficit

Question 4

SIADH

Answer 4

• too much anti diuretic= body will hold onto fluids
• soaked inside

Question 5

S/S of SIADH

Answer 5

• low urine output : oliguria
• deep pitting edema
• increased BP
• not thirsty
• low labs (especially na+)
• high urine specific gravity
• low blood osmolality
• fluid volume excess
• gains weight

Question 6

major cause of DI

Answer 6

• head trauma (or any damage to brain)

Question 7

tx for DI

Answer 7

• focus on the dehydration and low BP
• drugs that end in pressin to keep bp up
• watch for HTN and decreased sodium (headache and seizures)

Question 8

major cause if SIADH

Answer 8

• small cell lung cancer

Question 9

tx of SIADH

Answer 9

• prevent seizures and low sodium
• IV hypertonic solution (3%)
• seizure precautions
• diuretics (“ide”)
• daily weights

Question 10

relationship between urine and specific gravity

Answer 10

• inverse
• the less urinating the higher the specific gravity is

Question 11

DM type one

Answer 11

• insulin dependent
• ketosis prone
• juvenile onset

Question 12

TX of DM type one

Answer 12

• Insulin (most important)
• exercise
• diet (least important)

Question 13

DM type 2

Answer 13

• non insulin dependent
• non ketosis prone
• adult onset

Question 14

tx of DM type 2

Answer 14

• diet (most important): calorie restriction ( ex: 1600 calories per day, 6 small feedings per day)
• oral hypoglycemic pill
• activity
• calorie restriction

Question 15

S/S od diabetes mellitus (type one and two)

Answer 15

• polyuria
• polydipsia
• polyphagia

Question 16

Regular insulin

Answer 16

• short acting
• R at the end
• O: 1 hour
• P: 2 hours
• D: 4 hours
• Taken before a meal
• Clear, can be IV
• memory trick: regular, run (IV): R stands for rapid, run IV, regular

Question 17

NPH

Answer 17

• intermediate acting
• has N at the end
• O: 6 hours
• P: 8-19 hours
• D: 12 hours
• taken after a meal
• cloudy, suspension, NEVER IV
• memory trick: NPH- N stands fro: not so fast, not IV, nine hours

Question 18

Humalog/lispro

Answer 18

• rapid acting
• o: 15 minuties
• p: 30 minutes
• D: 3 hours
• give insulin with meals (not before or after meal)

Question 19

lantis/glargine

Answer 19

-long acting
- slowly absorbed
- has no peak
- low risk of hypoglycemia
- safely given at bedtime
- memory trick: lantus/larg: long, late at night, low risk

Question 20

when would you check for hypoglycemia

Answer 20

• at the peak

Question 21

insulin admin and education

Answer 21

• check expiration date: once open it expires in 30 days (label it)
• refrigerate insulin at home (can come out of the fridge once opened at the hospital)
• eat a snack before exercise (rapidly metabolized carb like sugar)
• take even when sick (because glucose increases when sick) and make sure to take sips of water or else will get dehydrated

Question 22

can you mix insulin in the same syringe

Answer 22

• yes
• clear before cloudy (Regular before NPH)
• inject air into NPH, then air into regular, the draw up regular, then the NPH

Question 23

two problems of a sick diabetic

Answer 23

• dehydration
• hyperglycemia

Question 24

hypoglycemia causes

Answer 24

• caused by: too much insulin, not enough food, too much exercise

Question 25

what can hypoglycemia cause

Answer 25

• brain damage

Question 26

S/S of hypoglycemia

Answer 26

• drunk and in shock
• drunk: staggering gait, slurred speech, impaired judgement, delayed reaction times, labile (emotions all over the place)
• shock: low BP, tachycardia, tachypnea, pallor, clammy, mottled skin

Question 27

tx of hypoglycemia

Answer 27

• give sugar and starch/protein (ideal combo is sugar and protein
• rapidly metabolized carbs (sugar), juice(orange or apple), soda, candy, 1/2 skim milk, turkey
  *if unconscious: give glucagon IM (at home) or D10W/D50W IV

Question 28

hyperglycemia in type one

Answer 28

• DKA = bs > 500 (more often in children)
• higher priority than HHS
• caused by: #1 cause is acute viral upper respiratory infection within the last 2 weeks OR too much food, not enough exercise, not enough meds)

Question 29

DKA s/s

Answer 29

• DKA
  -D: dehydrated (hot flushed skin
  -K: ketones in blood, kussmaul, increased k+
  -A: acidotic (metabolic), acetone breath (fruity), anorexia from the nausea, abdominal pain
• decreased BP

Question 30

tx of DKA

Answer 30

• treat the dehydration
• IV fluid- NS, fast rate (200 ml/hr w/ regular insulin)
• add k+ (even if normal because the insulin will lower it)
• once sugar 200: stop iv insulin and start SQ and iv dextrose

Question 31

hyperglycemia in type 2

Answer 31

• HHNK, HHS, HHNS (in older adults), bs> 600
• very deadly
• caused by: dehydration

Question 32

HHNS tx

Answer 32

• treat the dehydration
• IV fluids NS isotonic
• stabilize sugar with insulin

Question 33

s/s of HHS

Answer 33

• hot flushed skin
• appear drunk with LOC change
• decreased bP
• no ketones (fruity breath) and no acidosis
• fluid volume deficit

Question 34

complications of DM

Answer 34

• poor tissue perfusion and peripheral neuropathy
• heals slowly
• cant feel when hurt themselves

Question 35

best test for long term glucose

Answer 35

• A1C
• good= 6 and lower
• needs work up/evaluation: 7
• out of control: 8 and up