diabetes

Question 1

type one diabetes

Answer 1

pancreas not functioning (insulin dependent), seen in younger populations
only treatment is insulin
S&S: PPP, weight loss, fatigue, frequent infections, muscle wasting/cramps, ketosis (fruity, acetone breath)

Question 2

type 2 diabetes

Answer 2

functioning pancreas, most common form progressive; due to insulin resistance
risks: obesity, inactivity, heredity, sedentary lifestyle, genetics, above age 50, hx of high BP, fatigue, decreased energy, frequent infections

Question 3

hypoglycemia

Answer 3

glucose below 60
give orange juice, honey, hard candy [juice, starch, protein, in that order]
TIRED= tachycardia, irritable, restless, excessive hunger, diaphoresis/depression
assess glucose, urine, mental changes, n/v/d/

Question 4

hyperglycemia (DKA)

Answer 4

dehydration, hypovolemic shock, lactic acidosis
slow onset (4-10 hr)
fruit smell, tachycardia, hypotension, acidosis, high blood sugar, hyperkalemia
D= diuresis, delirium, dizzy, dehydrated
K= kussmaul breaths, ketoic breath
A= abdominal pain

Question 5

DKA Treatment

Answer 5

rehydrate with isotonic saline immediately, reverse shock, restore potassium balance, administer insulin
monitor blood sugar, for ketones and protein in urine

Question 6

hyperosmolar hyperglycemia nonketoic syndrome (HHNS)

Answer 6

type 2 DM
urine test is positive for glucose but negative for ketones, absence of acidosis
glucose range from 600-3000
give fluid and electrolytes with insulin
higher mortality than DKA

Question 7

rapid acting insulin

Answer 7

onset: 5-15 minutes
peak: 30-60 minutes
duration: 2-4 hr
lispro (humalog), aspart (novalog), glulisine
given with meals
can be given IV

Question 8

short acting (regular) insulin

Answer 8

given to cover meals
onset: 30-60 min
peak: 2-3 hr
duration: 4-6 hr
given 30-60 min before meal
can be given IV

Question 9

intermediate acting (NPH)

Answer 9

onset: 2-4 hr
peak: 4-12 hr
duration: up to 12 hr
novolin I (lente) and novolin n (NPH)
given after food

Question 10

long acting insulin

Answer 10

onset: 1-6 hr
no peak, continuous
lavemir lantus (insulin glargine)
DO NOT MIX WITH OTHER INSULINS

Question 11

ADA diabetes recommendations

Answer 11

diet and exercise changes!
exercise for 20-45 min, 3x/day minimum with a stress test prior
eat extra complex carbs to prevent hypoglycemia
10-20% protein, 20-30% fat, 50-60% carbohydrates

Question 12

diabetes diagnosis

Answer 12

fasting glucose: NPO 8-12 hr before, 126mg/dL or higher
oral glucose tolerance= gestational diabetes (3-6 hr intervals, only water is allowed)
post prandial BG= measured exactly 2 hrs after a meal (200mg/dl)
glycosylated hemoglobin (A1C)= average BG over 120 days

Question 13

ketonuria finger stick

Answer 13

urine or fingerstick
wash hand with warm soap and water
hold finger down in dependent position
massage/milk the blood vessels down
use side of the finger

Question 14

diabetes foot care

Answer 14

properly fitting, non restrictive shoes
avoid prolonged sitting, standing, crossing legs, walking barefoot, open toed shoes
inspect feet daily using a mirror
cut nails straight across after bath/shower
avoid lotion between toes, dry thoroughly

Question 15

chronic diabetes complications

Answer 15

MICROVASCULAR: diabetic retinopathy, nephropathy, mononeuropathy, polyneuropathy, autonomic neuropathy
MACROVASCULAR: cerebrovascular disease, HTN, CAD, PVD, infections

Question 16

complications of insulin administration

Answer 16

allergic reactions (local= rash at site, systemic= hives)
lipodystrophy: disturbance of fat metabolism interfering with insulin absorption
lipoatrophy: loss of fat with dimpling
lipohypertrophy: fibro-fatty masses at the site with scarring