Diabetes

Question 1

DM 1

Answer 1

Autoimmune (destruction of pancreatic beta cells)
(+) Anti Islet Cell Antibodies (blood test)
70-85%
Disappear shortly after diagnosis
Immune system vulnerable to trigger event
Heredity (genetics)
Environmental
possibly arises when a person with a genetic predisposition is exposed to a precipitating event such as a viral infection (specifically coxsackie B, mumps, congenital rubella)
Does not respond to any oral hypoglycemics

Question 2

insulin therapy- goal for glucose range?

Answer 2

Glucose monitoring
goal range 80 to 120 mg/dl
Lab measurement of hemoglobin A1c

Question 3

Urine testing for ketones - when glucose is over what?

Answer 3

Urine testing for ketones
Ketones are substances that are made when the body breaks down fat for energy
Not routinely used except:
New diagnosis as a teaching tool
During illness (Q 3 hr)
Whenever glucose is ≥200 mg/dl when illness not present

Question 4

Rapid-acting insulin - onset? and ex?

Answer 4

Rapid-acting (Lispro, NovoLog)
Onset within 10-15 minutes

Question 5

Short-acting (regular) insulin - onset?

(short at 30)

Answer 5

Short-acting (regular)
onset within 30 minutes

Question 6

Intermediate-acting insulin - name and onset?

(NPH is intermediate)

Answer 6

Intermediate-acting (NPH, Lente)
Onset 1-3 hours

Question 7

Long-acting insulin - onset - and the example?

(long lantus)

Answer 7

Long-acting (Lantus, Levemir, Ultralente)
Onset 1-2 hours

Question 8

insulin made from

Answer 8

Human insulin from bacterial and yeast cultures
Highly purified pork
Rarely used now but used to be standard

Question 9

Subcutaneous (sub-Q)

Answer 9

Intermittent injections
Twice-daily or multiple-dose (3-4)
Jet propelled
Insulin infusion pump
Bolus or continuous

Question 10

Implantable pump - where does it deliver insulin?

Answer 10

Delivers insulin directly into the peritoneal cavity

Question 11

Intranasal

Answer 11

Aerosolized insulin combined with surfactant
Higher dosage d/t less potent/poor absorption

Question 12

Conventional management

Answer 12

Combining rapid-acting (regular) and intermediate-acting (NPH or Lantus) insulin drawn up in the same syringe and injected before breakfast and evening meal

Question 13

If mixing 2 types - insulin - which one to draw up first?

Answer 13

Draw up rapid or short-acting 1st
Prevents diluting vial with NPH
Peakless basal insulin causes precipitation if mixed with other insulins

Question 14

Timing of food consumption

Answer 14

Regulated with time and amt of insulin
Meals and snacks eaten according to peak insulin action

Question 15

Based on carbohydrate content

Answer 15

Foods grouped by nutrient content
Exchanges occur in the same food groups
Portion size

Question 16

causes of hypoglycemia

Answer 16

Bursts of physical activity without additional food, or delayed/omitted/incompletely consumed meals

Symptoms caused by increased adrenergic activity and impaired brain function

Question 17

treatment for hypoglycemia

Answer 17

Milk, fruit juice, “insta-glucose”, carbonated drinks, sherbet, gelatin, cake icing
All children with DM should carry rapid acting glucose glucose tabs, sugar cubes, sugar candy (Life-savers)
Followed by complex carbs and proteins
Cheese , peanut butter, crackers

Question 18

treatment for hypoglycemia - Emergency reaction - and how to give it?

Answer 18

Glucagon
Mixed at time of use
Give IM or SQ
May cause vomiting

Question 19

ketoacidosis

Answer 19

When glucose is unavailable for cellular metabolism, the body breaks down alternate sources of energy

Ketones released and excess ketones eliminated in urine (ketonuria) or by the lungs (acetone breath)

Question 20

diabetic ketoacidosis (DKA - from hypo or hyperglycemia?

Answer 20

Pediatric emergency
Prolonged hyperglycemia
Progressive deterioration
Dehydration
Electrolyte imbalance
Metabolic acidosis
Coma
Death

Question 21

diabetic ketoacidosis management - what is added to IV infusion?

Answer 21

Potassium Chloride is added to maintenance IV infusion after hydration and insulin drip begun….Insulin drives K+ into cells

Question 22

future of type 1 diabetes

Answer 22

Islet cell transplant
Whole Pancreas transplant

Question 23

patient education

Answer 23

Nature of the disease
Meal planning
Carbohydrate counting
Aerobic exercise program
Glucose monitoring
Insulin therapy
types of insulin, duration, onset and peak action, mixing and administration, rotation of injection sites
Recognition and treatment of hypoglycemia and hyperglycemia
Management of “minor” illnesses
Record keeping
Hygiene
Family support
Acute care

Question 24

insulin drip rate

Answer 24

Order: Infuse insulin to give the child 0.1 unit/kg/hr (child weighs 20 kg)

Weight x 0.1 unit/kg/hr = units/hr needed
0.1 unit /20 kg/hr = 2 units/hr

If there is 0.1 unit/ml of Normal Saline :

I want to give Insulin 2 units/hr
So,
2 units x 1 ml / 0.1 units = 20 mls/hr rate

Question 25

keytones - acidic or basic? and what happens to the pH?

Answer 25

Ketones in blood are strong acids that lower serum pH and produce ketoacidosis

Question 26

diabetic ketoacidosis - what is added to increase pH?

Answer 26

Buffers (Sodium Bicarbonate) may be added to maintenance IV fluids to increase the serum pH

Question 27

diabetic ketoacidosis - when is dextrose added?

Answer 27

Dextrose is added to the IV fluid infusion after Blood Glucose is <300mg./dl.
Combined with the IV Insulin administration while patient is NPO and blood/urine ketones are (+)
Only time insulin given IV (regular insulin only)

Question 28

diabetic ketoacidosis - high or low pH?

Answer 28

low pH

Question 29

d