Diabetes

Question 1

Diagnostic Tests for diabetes?

Answer 1

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a:

• Fasting Plasma Glucose Test (FPG)
• Oral Glucose Tolerance Test (OGTT)
• HgA1C

Either test can be used to diagnose pre-diabetes or diabetes.

Question 2

What are the criteria for a diagnosis of diabetes mellitus

Answer 2

• 126 and higher for Fasting Plasma Glucose
• 200 and higher for Oral Glucose Tolerance Test
• 6.5% and higher for HgA1C

Question 3

Define Fasting.

Answer 3

Fasting is defined as no caloric intake for at least 8 hours.

Question 4

How should the Oral Glucose Tolerance Test be performed?

Answer 4

• Two-hour plasma glucose
• The test should be performed using a glucose load containing the equivalent of 75g glucose.

Question 5

Classic symptoms of diabetes?

Answer 5

• polyuria, polydipsia, polyphagia, and unexplained weight loss
• hyperglycemic crisis, a random plasma glucose greater than 200 mg/dL
  
  • random is defined as any time of day without regard to time since last meal

Question 6

Diabetes diagnostic test special note?

Answer 6

Each test must be confirmed on a subsequent day, under similar circumstances

Question 7

When is repeat testing unwarranted?

Answer 7

If a patient is seen with a hyperglycemic crisis or clear symptoms of hyperglycemia with a random plasma glucose greater than or equal to 200 mg/dL, repeat testing is not warranted.

Question 8

Hypoglycemia treatment?

Answer 8

• Recommended treatment of hypoglycemia is the immediate oral administration of a rapidly absorbed form of glucose, which can be repeated as necessary.
• For people who are unconscious or unable to swallow, glucagon may be given intramuscularly or subcutaneously, to raise blood glucose through hepatic glycogenolysis.

Question 9

What is Diabetic Ketoacidosis? (DKA)

Answer 9

• DKA most commonly occurs in a person with type 1 diabetes
• Hyperglycemia- Glucose levels are severely elevated.
• Lack of insulin leads to increased release of fatty acids from adipose tissue- ketoacidosis

Question 10

What is Hyperosmolar Hyperglycemic State? (HHS)

Answer 10

• HHS occurs frequently in people with type 2 diabetes.
• Hyperglycemia- Glucose levels are severely elevated.
• Hyperosmolarity with dehydration
• Absence of ketoacidosis

Question 11

Diabetes manifestations (3 P’s)?

Answer 11

• Polyuria
• Polydipsia
• Polyphagia

Question 12

What is Polyuria?

Answer 12

• Polyuria (frequent and excessive urination) occurs as a result of osmotic diuresis caused by excess glucose in the urine
• As a result of diuresis, sodium, chloride, and potassium are excreted in the urine, and water loss is severe.

Question 13

What is Polydipsia?

Answer 13

After polyuria, dehydration results and polydipsia (excessive thirst) occurs.

Question 14

What is Polyphagia?

Answer 14

• Because cells receive no glucose, cell starvation triggers polyphagia (excessive eating).
• Despite eating vast amounts of food, the person remains in starvation until insulin is available to move glucose into the cells.

Question 15

What happens with insulin deficiency?

Answer 15

• With insulin deficiency, fats break down, releasing fatty acids.
• Conversion of fatty acids to ketone bodies (small acids) provides a backup energy source resulting in ketosis
• Weight loss occurs

Question 16

What does accumulation of ketones cause?

Answer 16

• Because ketone bodies, or “ketones,” are abnormally broken down and products fatty acids, they may accumulate in the blood when insulin is not available.
• This accumulation will cause metabolic acidosis

Question 17

What is Gestational Diabetes?

Answer 17

Any degree of glucose intolerance with the onset of first recognition during pregnancy.

Question 18

What is the Somogyi Effect?

Answer 18

• Occurs as a compensatory mechanism for hypoglycemia between 2-4 am.
• Hypoglycemia is due to large doses of insulin
• Person wakes to an elevated blood sugar level because the body is compensating for the hypoglycemia.
• May have headaches upon awakening, night sweats, or nightmares.

Question 19

Somogyi Effect nursing interventions?

Answer 19

Provide a bedtime snack and prepare for insulin dosages to be adjusted.

Question 20

What is the Dawn Phenomenon?

Answer 20

• Also wakes to an elevated blood sugar level.
• Due to increase release of cortisol of growth hormone that occurs at night.
• Usually occurs in teens and adults.

Question 21

Dawn Phenomenon nursing interventions?

Answer 21

• Check blood sugar levels between 2-4 am.
• Prepare for insulin adjustment

Question 22

What is Pre-Diabetes?

Answer 22

• Pre-diabetes (impaired glucose tolerance/IGT or impaired fasting glucose (IFG) is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.
• Usually don’t have symptoms, however long-term damage may still occur.

Question 23

What should you encourage individuals with Pre-Diabetes to do?

Answer 23

• Implement lifestyle changes
• Get blood glucose and HgA1c checked at regular intervals.
• Monitor for symptoms of diabetes
  
  • Fatigue
  • Frequent infections
  • Slow healing wounds

Question 24

Long-term complications of Macrovascular?

Answer 24

• Coronary artery disease
  
  • Angina
  • Myocardial Infarction
• Cerebral vascular disease
  
  • Transient Ischemic Attack (TIA)
  • Stroke
• Peripheral vascular disease
  
  • Decreased blood flow
  • Delayed wound healing
  • Amputations

Question 25

Other complications of Macrovascular?

Answer 25

• Foot ulcers
• Infections
• Disorders of gastrointestinal motility

Question 26

Long-term complications of Microvascular?

Answer 26

• Nephropathy
  
  • Renal disease/failure
• Neuropathy
  
  • Decreased/Loss of Sensation
• Retinopathy
  
  • Impaired/Loss of Vision

Question 27

What is Neuropathy?

Answer 27

• Neuropathy reduces the perception of pain; thus, injuries and infections often go undetected.
  
  • Poorly fitting shoes, improper weight bearing, hard objects or pebbles in the shoes, or infections such as athlete’s foot.

Question 28

What can Neuropathy lead to?

Answer 28

• When this abnormal focus of pressure is coupled with loss of sensation, a foot ulcer can occur.
• Common sites of trauma are the
  
  • Back of the heel
  • Plantar metatarsal area, or the great toe

Question 29

What is Lipodystrophy?

Answer 29

• Lipodystrophy can develop in the form of lipoatrophy or lipohypertrophy.
  
  • Lipoatrophy – loss of subQ fat and appears as slight dimpling or pitting of subQ fat.
  • Lipohypertrophy- development of fibrofatty masses at the injection site.

Question 30

How to prevent Lipodystrophy?

Answer 30

Rotate insulin site to prevent lipodystrophy

Question 31

Diabetes manifestations?

Answer 31

• Fatigue
• Recurrent infection
• Recurrent vaginal yeast/candida infections
• Prolonged wound infections
• Visual changes

Question 32

Describe vision and fatigue of Diabetes manifestations?

Answer 32

• Recurrent blurred vision
  
  • Blurred vision develops as the lens and retina are exposed to hyperosmolar fluids.
• Fatigue
  
  • Lowered plasma volume produces weakness and fatigue.

Question 33

What kind of infections occur in people with Diabetes?

Answer 33

• Hyperglycemia and glycosuria favor the growth of bacterial and yeast organisms.
  
  • Chronic bacterial and yeast infections often occur in people with type 2 DM.
  • Candida infections are common initial complaints in women with diabetes.

Question 34

What is Acanthosis Nigricans?

Answer 34

• Diabetes manifestation
• This is a common condition of the skin where brown or tan, raised spots appear in some places.
• They usually occur in the regions of the sides of the neck, groin and armpits.
• In some cases it is also seen on the elbows, knees and hands.