Diabetes Flashcards
Diagnostic Tests for diabetes?
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.
What are the criteria for a diagnosis of diabetes mellitus
- 126 and higher for Fasting Plasma Glucose
- 200 and higher for Oral Glucose Tolerance Test
- 6.5% and higher for HgA1C
Define Fasting.
Fasting is defined as no caloric intake for at least 8 hours.
How should the Oral Glucose Tolerance Test be performed?
- Two-hour plasma glucose
- The test should be performed using a glucose load containing the equivalent of 75g glucose.
Classic symptoms of diabetes?
- 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
Diabetes diagnostic test special note?
Each test must be confirmed on a subsequent day, under similar circumstances
When is repeat testing unwarranted?
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.
Hypoglycemia treatment?
- 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.
What is Diabetic Ketoacidosis? (DKA)
- 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
What is Hyperosmolar Hyperglycemic State? (HHS)
- HHS occurs frequently in people with type 2 diabetes.
- Hyperglycemia- Glucose levels are severely elevated.
- Hyperosmolarity with dehydration
- Absence of ketoacidosis
Diabetes manifestations (3 P’s)?
- Polyuria
- Polydipsia
- Polyphagia
What is Polyuria?
- 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.
What is Polydipsia?
After polyuria, dehydration results and polydipsia (excessive thirst) occurs.
What is Polyphagia?
- 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.
What happens with insulin deficiency?
- 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
What does accumulation of ketones cause?
- 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
What is Gestational Diabetes?
Any degree of glucose intolerance with the onset of first recognition during pregnancy.
What is the Somogyi Effect?
- 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.
Somogyi Effect nursing interventions?
Provide a bedtime snack and prepare for insulin dosages to be adjusted.
What is the Dawn Phenomenon?
- 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.
Dawn Phenomenon nursing interventions?
- Check blood sugar levels between 2-4 am.
- Prepare for insulin adjustment
What is Pre-Diabetes?
- 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.
What should you encourage individuals with Pre-Diabetes to do?
- Implement lifestyle changes
- Get blood glucose and HgA1c checked at regular intervals.
- Monitor for symptoms of diabetes
- Fatigue
- Frequent infections
- Slow healing wounds
Long-term complications of Macrovascular?
- Coronary artery disease
- Angina
- Myocardial Infarction
- Cerebral vascular disease
- Transient Ischemic Attack (TIA)
- Stroke
- Peripheral vascular disease
- Decreased blood flow
- Delayed wound healing
- Amputations
Other complications of Macrovascular?
- Foot ulcers
- Infections
- Disorders of gastrointestinal motility
Long-term complications of Microvascular?
- Nephropathy
- Renal disease/failure
- Neuropathy
- Decreased/Loss of Sensation
- Retinopathy
- Impaired/Loss of Vision
What is Neuropathy?
- 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.
What can Neuropathy lead to?
- 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
What is Lipodystrophy?
- 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.
How to prevent Lipodystrophy?
Rotate insulin site to prevent lipodystrophy
Diabetes manifestations?
- Fatigue
- Recurrent infection
- Recurrent vaginal yeast/candida infections
- Prolonged wound infections
- Visual changes
Describe vision and fatigue of Diabetes manifestations?
- Recurrent blurred vision
- Blurred vision develops as the lens and retina are exposed to hyperosmolar fluids.
- Fatigue
- Lowered plasma volume produces weakness and fatigue.
What kind of infections occur in people with Diabetes?
- 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.
What is Acanthosis Nigricans?
- 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.
