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NURS 1355 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

2015, 30 million or __ % of pop has diabetes.

Aprox 1.25 million children have type I

A

9.4%

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2
Q

Of the 30.3 million adults with diabetes 23.1 were diagnosed and 7.2 were undiagnosed

T or F

A

T

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3
Q

12 million seniors age 65 or older have diabetes

T or F

A

T

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4
Q

How many new cases each year

A

1.5 million

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5
Q

2015 how many Americans >18 had pre-diabetic

A

84.1 millon

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6
Q

What is the leading cause of

Blindness, End stage renal disease, Amputation

& the 7th leading cause of death

A

Diabetes

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7
Q

Total cost of diagnosed diabetes ___

Direct medical cost ____

____ $ in reduced productivity

A

Total cost of diagnosed diabetes 327 Billion

Direct medical cost 237 Billion

90 Billion $ in reduced productivity

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8
Q

Groups highest to have diabetes

A

American Indians/ Alaskan

Blacks

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9
Q

___ cells in pancreas secret insulin when eating

___ cells release glucagon

A

B cells

A cells

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10
Q

Insulin function

A

Transports glucose into the cell

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11
Q

Glycogenolysis…

A

Liver breaks down glycogen to glucose

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12
Q

Gluconeogenesis…

A

Conversion of protein to glucose

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13
Q

Lipolysis…

Produces what undesirable substances

A

Break down of fat into glucose

Ketones

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14
Q

Where does the Acid in DKA come from?

A

Breakdown of fat produces acid as a by product

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15
Q

Confusion, fatigue, muscle weakness & cardiac arrhythmias

S/S of…

A

High BS

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16
Q

Polyphagia, Polyuria, Polydipsia

S/S of…

A

Hyperglycemia

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17
Q

Acetone breath & Kussmaul respiration happen with…

A

Hyperglycemia

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18
Q

Which electrolyte is mostly affected with blood glucose levels

A

K

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19
Q

Factors increase risk for type II

Waist circumference

Males
Female

FBS

BP

SBP > or DBP>

Hyperlipidemia

Triglycerides
> ___

HDL

Males <
Female <

A

Waist circumference

Males 40
Female 35

FBS
>100

BP

SBP > 130

DBP> 85 or on meds for HTN

Hyperlipidemia

Triglycerides
> 150 or on meds

HDL

Males < 40
Female < 50

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20
Q

Type I or II

abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath

Frequently none, thirst, fatigue, blurred vision, Microvascular complications

A

Type I
Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath

Type II
Frequently none, thirst, fatigue, blurred vision, Microvascular complications

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21
Q

Glucagon, epinephrine, GH, Cortisol

All do what…

A

Increase blood glucose levels for energy

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22
Q

Type I

Pancreatitic B cells are destroyed by

A

Body’s own T cells

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23
Q

Fasting glucose 100 - 125

2 hour plasma glucose level 140 - 199

A¹C 5.7 - 6.4%

Is…

A

Prediabetes

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24
Q

4 major abnormal metabolic Type II

What happens to Insulin?

What happens to the pancreas

What happens to the liver

Alterations in production of hormones & adipokines

A

Insulin resistance

Páncreas produces less Insulin ???

Liver produces less glucose

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25
Q

Correct

Risk factors

Type II diabetes

(Up / Down)

Insulin levels
Triglycerides
LDL
HDL

A

Insulin levels UP
Triglycerides UP
Healthy <150
Borderline high: 150-199 mg/dL. High: 200 and 499 mg/dL

LDL
Normal: <100 mg/dL
Near-optimal: 100–129 mg/dL
Borderline high: 130–159 mg/dL
High: 160–189 mg/dL
Very high: 190 mg/dL and higher

HDL

High-density lipoprotein (HDL)
Men > 40 mg/dL (1 mmol/L)
Women > 50 mg/dL (1.3 mmol/L)

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26
Q

4 methods to diagnose diabetes

A¹C level ____

Fasting plasma glucose ____

Random glucose measurement ___

2 hour OGTT level ____

A

A¹C level >6.5%

Fasting plasma glucose >126

Random glucose measurement >200

2 hour OGTT level >200
(Oral glucose tolerance test)

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27
Q

Review 1245 for Insulins

A

Onset, Peak, diration

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28
Q

Normal / Elevated blood glucose at bedtime

Decrease at 2 or 3 AM (sweating, lethargic)

Then Hyperglycemic (to counter act hypoglycemia)

This is called ….

What is the Intervention…

A

Somogyi effect

Intervention: Decrease bedtime insulin/ Give bedtime snack

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29
Q

In this problem

At night the glucose levels stay normal/ high

Begin to rise at 3AM

Hyperglycemia present in the morning

Due to counter regulatory hormones

Name condition…

Name intervention…

A

Dawn phenomenon

Intervention:
Give long-acting insulin after 11 pm

May need to increase dose of night time insulin

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30
Q

Acidosis pH <7.30
Serum bicarbonate <18
Presence KETONURIA / KETONEMIA
Anion Gap >10 MEQ/L
Plasma glucose >250 mg/dl

Describes

A

DKA

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31
Q

Sulfonylureas work by…

A

stimulating the release of insulin
from pancreatic beta cells, which lowers blood glucose concentrations

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32
Q

Glipizide (Glucotrol) & glimepiride (Amaryl)

Type of medication

Effects

A

Sulfonylureas

stimulating the release of insulin
from pancreatic beta cells
, which lowers blood glucose concentrations

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33
Q

Meglitinides

A

stimulate the pancreas to release insulin, which lowers blood glucose levels.

Nateglinide:(Starlix®)

Repaglinide:(Prandin®)

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34
Q

Repaglinide (Prandin®), Mitiglinide (Glufast®), and Nateglinide (Starlix®)

Class of medication

Effects

A

Meglitinides

Stimulate the pancreas to release insulin

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35
Q

Biguanides

Work by (2)

A

Decreasing the amount of glucose your liver produces and releases into your bloodstream

Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy

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36
Q

Biguanides

Work (2) ways

A

Decreasing the amount of glucose your liver produces and releases into your bloodstream

Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy

37
Q

Metformin & phenformin are…

How do they work

A

Biguanides

Decreasing the amount of glucose your liver produces and releases into your bloodstream

Making your skeletal muscle
tissue more sensitive to insulin so it can absorb glucose for energy

38
Q

a-Glucosidase inhibitors work by…

A

Delaying the digestion and absorption of complex carbohydrates.

39
Q

Acarbose (Precose), Miglitol (Glyset), and Voguebose.

Examples of which type of medication

Action…

A

a-Glucosidase inhibitors

Delaying the digestion and absorption of complex carbohydrates.

40
Q

Thiazolidinediones work by…

A

Insulin sensitizers that act on intracellular metabolic pathways to enhance insulin action and increase insulin sensitivity in critical tissues.

TZDs also increase adiponectin levels, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake in muscle and fat

41
Q

rosiglitazone and pioglitazone

Class of medication

Action…

A

Thiazolidinediones

Insulin sensitizers that act on intracellular metabolic pathways to enhance insulin action and increase insulin sensitivity in critical tissues.[4] TZDs also increase adiponectin levels, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake in muscle and fat

42
Q

Sulfonylureas have an increased chance of prolonged hypoglycemia

T or F

A

F

Exp.

Glipizide (Glucotrol)
Glimepiride (Amaryl)

43
Q

When should Repaglinide (Prandin)
/ Nateglinide (Starlix) be taken?

A

Meglitinides- increase insulin production from pancreas

30 minutes before meal

DONT TAKE IF SKIP MEAL

44
Q

Renal toxic-monitor
BUN / creatine

Hold 48 hrs before & after IV contrast

A

Metformin (Glucophage)

Biguanide

45
Q

Most common oral diabetes agent

Reduced glucose production by liver

Enhance sensitivity (insulin) at tissues

Improve glucose transport into cells

Don’t promote weight gain

A

Biguanides

Metformin (Glucophage)

46
Q

Target organ for Biguanides
Metformin (Glucophage)

A

Liver: reduces glucose production

47
Q

normal creatinine level 0.7 to 1.3 mg

Normal BUN level 8 - 22

Take into consideration before using this type of medication

A

Biguanides

Metformin (Glucophage)

48
Q

normal creatinine level ____
Normal BUN level ___

A

0.7 to 1.3 mg

8 - 22

49
Q

Most effective in those who have insulin resistance

Improve insulin sensitivity, transport, and usage.

Example: Pioglitazone (Actos)

A

TZD

Thiazolidinediones

50
Q

Sitagliptin (Januvia)
Saxagliptin (Onglyza)

Class

Action

Caution

A

Class: DDP-4 inhibitor

Action: slows the inactivation of incretin hormones (gut peptides secreted after nutrient intake and stimulate insulin secretion)

Potential: Hypoglycemia

51
Q

Class: DPP-4 inhibitor

Action: Inhibit the enzyme DPP-4.

DPP-4 destroys the hormone incretin

Incretin produces more insulin & reduces the amount of glucose produced by the liver when not needed

Potential: Hypoglycemia

Name (2) meds

A

Sitagliptin (Januvia)
Saxagliptin (Onglyza)

52
Q

Hormone secreted by B cell of the pancreas

Cosecret3d with insulin

For type I & II

SubQ admin

SLOWS GASTRIC EMPTYING

Class…

A

amylin analog
Pramlintide (Symlin)

53
Q

Pramlintide (Symlin)

Class

Action

A

Amylin

Pramlintide (Symlin)

antihyperglycemics.

Slowing the movement of food through the stomach.

54
Q

Incretin mimetics

Stimulate B cell release more insulin

Supress liver

Slows gastric emptying

Example:

Caution:

A

glucagon-like peptide-1 (GLP-1) agonist

Byetta

Don’t use with insulin

55
Q

Beta blockers “lol”

Have this Undesired effect

Have this desired effect

A

Undesirable: Mask symptoms of hypoglycemia

Desirable: Prolonged effect of insulin

56
Q

How do Thiazide / Loop diuretics potentiate hyperglycemia

A

Inducing K ion loss:

Lead to decreased insulin secretion or reduced insulin sensitivity

57
Q

Diet percentages

Protein

Fat

Carb

A

Protein 15 - 20 Less if renal impairment

Fat 30

Carb 50- 60

58
Q

Is moderate alcohol intake with food safe for diabetics

A

Yes

1 women

2 men

59
Q

Sick day management

Continue insulin & all oral medications

Even if not eating properly

T or F

A

F

Continue all medicine Except

Metformin

60
Q

Hypoglycemia Manifestaciones

A

DRUNK

Pallor, hunger, blurred vision, confused, Diaphoresis, Drowsy, Unconscious, coma

61
Q

Blood glucose level for hypoglycemia

A

<70

Manifestaciones

DRUNK in appearance

62
Q

Intervention for a diabetic who appears drunk and is conscious

A

Give 15 - 20 g simple sugar

Recheck blood glucose after 15 minutes

Until sugar is >70

Then

Eat regularly scheduled meal/ snack

Check sugar again 15 - 30 minutes

63
Q

Patient is Hypoglycemic and cannot swallow

Intervention

A

1mg Glucagon IM or SubQ

In acute care settings:

20 - 50 mL 50% Dextrose IV push

64
Q

mimicking the actions of the naturally occurring hormone amylin,

_______ complements insulin by regulating the appearance of glucose into the circulation after meals via three primary mechanisms of action:

Slowing gastric emptying
Suppressing inappropriate post-meal glucagon secretion
Increasing satiety.

A

Class: amylin analog

pramlintide
(Symlin)

65
Q

stimulate the pancreas to release insulin, which lowers blood glucose levels.

Which two classes

Give examples

A

Sulfonylureas: Glimepiride.
Glipizide.

Meglitinides: Nateglinide (Prandin) Repaglinide (Starlix)

66
Q

People with (high/ low) potassium levels will release less insulin, which causes higher blood sugar levels, and increases the risk of developing type 2 diabetes

A

Low

67
Q

Hyperglycemia = (Hypokalemia/ Hyperkalemia)

A

Hyperkalemia

68
Q

Hyperglycemia & Hyperkalemia

Insulin is given what happens do K and glucose

A

Both go into the cell

69
Q

Most common reasons for a diabetes patient to come into Dr office

A

Wounds not healing / poor vision

70
Q

Oral thrush & yeast infections are seen more commonly in

TYPE I or II

A

Type II

71
Q

Somogyi effect

Describe

Intervention

A

Somogyi =

Normal BS before bed

BS drops in middle night

Rebound to High BS

Intervention: Reduce insulin before bed & Give snack before bed

72
Q

Byetta (incretin mimetic) / glucagon-like peptide-1 (GLP-1) agonistis given via

A

Dosed Pen

73
Q

Polyphagia
Polydipsia
Polyuria
Acetone breath
Kussmaul respirations
Confusion, fatigue, muscle weakness, cardiac arrhythmias

A

S/S of hyperglycemia

74
Q

High blood sugar does what to K levels

A

Riases them

75
Q

Symptoms of diabetes

Type ( I or 2)

-Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath

Type (1 or 2)

-Frequently none; thirst, fatigue, blurred vision, microvascular complications

Also (both)

-Slow healing, infections, mental status changes

A

Symptoms of diabetes

Type I

-Abrupt onset, thirst, hunger, weight loss, increased urine output, acetone breath

Type 2

-Frequently none; thirst, fatigue, blurred vision, microvascular complications

Also (both)
-Slow healing, infections, mental status changes

76
Q

Gluconeogenesis

-conversion of protein to glucose

-Acid by-product

Lipolysis

-breakdown of fat to glucose

-Ketones

T or F

A

T

77
Q

Can potentiate hyperglycemia
•By inducing potassium loss

A

Thiazide/ Loop diuretics

78
Q

Alcohol intake can cause Hypoglycemia/ Hyperglycemia

A

Hypoglycemia

79
Q

Teaching safe exercise

-Best time after a meal
-Check BS before (& after)
-<100 ____
->250 ____
-Safe if ketones absent
-If present, do not exercise vigorously
Carry fast acting sugar
Drink water
Hypoglycemia can occur hours later

A

eat

check ketones

80
Q

ID normal blood glucose

98
<135
113
128

A

98

81
Q

ID impaired blood glucose level

113
95
70
145

A

113 Impaired = Prediabetes

82
Q

Flail chest = This type of motion

Inspiration = (inward / outward)
Expiration = (inward/ outward)

A

Oppsite of normal

Inspiration = inward
Expiration = outward

83
Q

________ = life-threatening

Occurs when air accumulates in the pleural space, compressing the lungs and heart.

It can develop from chest wall injuries that allow air into the pleural space, but not out.

Also caused by aggressive mechanical ventilation or resuscitation

A

Tension pneumothorax

84
Q

Open pneumothorax

Chest wall is Punctured and opened to the outside world

The chest wall is opened to the outside world and (Negative/ Positive) pressure collapses the lung

A

Positive

85
Q

Pharyngeal tonsils aka

A

Adnoids

86
Q

This part of the brain controls breathing

A

Medulla

87
Q

Which tonsils are removed during a tonsillectomy

A

Pharynx

88
Q

The trachea is above the larynx

T or F

A

F

The larynx (voice box) is above the trachea (windpipe)

89
Q

Nerve that controls the diaphragm

A

Phrenic nerve

NURS 1355 (12 decks)

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