diabetes Flashcards
1
Q
what is diabetes
A
- an error in glucose metabolism: glucose is the primary source of fuel
- cells cant use glucose so they die
2
Q
diabetes insipidus
A
- DI –> high and dry
- high urine output (up to 20 L/ day) and dry body (dehydrated)
- dry inside
3
Q
S/S of DI
A
- 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
4
Q
SIADH
A
- too much anti diuretic= body will hold onto fluids
- soaked inside
5
Q
S/S of SIADH
A
- 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
6
Q
major cause of DI
A
- head trauma (or any damage to brain)
7
Q
tx for DI
A
- 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)
8
Q
major cause if SIADH
A
- small cell lung cancer
9
Q
tx of SIADH
A
- prevent seizures and low sodium
- IV hypertonic solution (3%)
- seizure precautions
- diuretics (“ide”)
- daily weights
10
Q
relationship between urine and specific gravity
A
- inverse
- the less urinating the higher the specific gravity is
11
Q
DM type one
A
- insulin dependent
- ketosis prone
- juvenile onset
12
Q
TX of DM type one
A
- Insulin (most important)
- exercise
- diet (least important)
13
Q
DM type 2
A
- non insulin dependent
- non ketosis prone
- adult onset
14
Q
tx of DM type 2
A
- diet (most important): calorie restriction ( ex: 1600 calories per day, 6 small feedings per day)
- oral hypoglycemic pill
- activity
- calorie restriction
15
Q
S/S od diabetes mellitus (type one and two)
A
- polyuria
- polydipsia
- polyphagia
16
Q
Regular insulin
A
- 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
17
Q
NPH
A
- 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
18
Q
Humalog/lispro
A
- rapid acting
- o: 15 minuties
- p: 30 minutes
- D: 3 hours
- give insulin with meals (not before or after meal)
19
Q
lantis/glargine
A
-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
20
Q
when would you check for hypoglycemia
A
- at the peak
21
Q
insulin admin and education
A
- 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
22
Q
can you mix insulin in the same syringe
A
- yes
- clear before cloudy (Regular before NPH)
- inject air into NPH, then air into regular, the draw up regular, then the NPH
23
Q
two problems of a sick diabetic
A
- dehydration
- hyperglycemia
24
Q
hypoglycemia causes
A
- caused by: too much insulin, not enough food, too much exercise
25
what can hypoglycemia cause
- brain damage
26
S/S of hypoglycemia
- 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
27
tx of hypoglycemia
- 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
28
hyperglycemia in type one
- 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)
29
DKA s/s
- 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
30
tx of DKA
- 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
31
hyperglycemia in type 2
- HHNK, HHS, HHNS (in older adults), bs> 600
- very deadly
- caused by: dehydration
32
HHNS tx
- treat the dehydration
- IV fluids NS isotonic
- stabilize sugar with insulin
33
s/s of HHS
- hot flushed skin
- appear drunk with LOC change
- decreased bP
- no ketones (fruity breath) and no acidosis
- fluid volume deficit
34
complications of DM
- poor tissue perfusion and peripheral neuropathy
- heals slowly
- cant feel when hurt themselves
35
best test for long term glucose
- A1C
- good= 6 and lower
- needs work up/evaluation: 7
- out of control: 8 and up
