Diabetes Flashcards
regular A1C
4-5.6%
fasting glucose
74-106
normal breathing rate
12-20
normal beats per minute
60-100
A1C reflects glucose over
2-3 months
hypoglycemia produces _________ symptoms
autonomic nervous system symptoms
(tremors, irritability, nervousness, faint/dizzy, cold/clammy skin, tachy, numbness in fingers/toes/mouth, hunger, sweating)
When other assessments are normal, a high temp could indicate infection, which can lead to
HHS (Hyperosmolar hyperglycemic syndrome)
Hypoglycemic reactions to insulin treatment most likely occur during _____ time
peak time
When the client is under stress, such as when an infection is present, an increase in the dose of insulin will be required to
facilitate the transport of excess glucose into the cells.
rapid acting insulin onset, peak and duration
onset 10 to 30 min
peak 30 min to 3 hrs
duration 3 to 5 hrs
short acting insulin onset, peak, and duration
onset 30 min to 1 hr
peak 2 to 5 hr
duration 5 to 8 hrs
intermediate acting insulin onset, peak and duration
onset 1.5 to 4 hrs
peak 4 to 12 hrs
duration 12-18 hrs
long acting insulin onset, peak and duration
onset 0.8 to 4 hrs
peak less defined/not pronounced
duration 16-24 hrs
lispro (Humalog)
aspart (Novolog, Fiasp)
gluilsine (Apidra)
rapid acting insulin
Regular (Humulin R, Novolin R)
short acting insulin
NPH (Humulin N, Novolin N)
intermediate acting insulin
glargine (Lantus, Toijeo, Basaglar)
detemir (Levemir)
degludec (Tresiba)
long acting insulin
laboratory values in HHS include
Glucose level greater than 600 mg/dL (33.33 mmol/L)
A marked increase in serum osmolality
Absent or minimal ketone bodies in both blood and urine
HHS intervention includes when glucose levels fall to about 250 mg/dL (13.9 mmol/L), IV fluids containing
dextrose are given to prevent hypoglycemia
Intervention for HHS includes Immediate IV administration of insulin and either
0.9% or 0.45% NaCl
(Usually requires large volumes of fluid replacement which should be done slowly and carefully)
Patients with HHS are often older and may have
heart or kidney problems, requiring hemodynamic monitoring to avoid fluid overload.
Avoid hypoglycemia treatment with carbohydrates that contain fat, such as candy bars, cookies, whole milk, and ice cream. The fat in those foods will
slow glucose absorption and delay the response to treatment
If no significant improvement occurs after 2 or 3 doses of “the rule of 15,”
contact HCP
manifestations of diabetic nephropathy
high bp
ankle/leg swellilng
elevated serum creatinine
manifestations of hypoglycemia
mood swings
difficulty speaking
increased hr
pale skin/pallor
sweating
tachy
headache
anxiety
vision changes
tremors
numbness in fingers and toes
I’M COLD, SWEATY AND CLAMMY, GIVE ME SOME CANDY
_________ is one of the most common illnesses that trigger HHS.
pneumonia
HHS commonly occurs in patients with type _______ diabetes who have some concomitant illness that leads to reduced __________
type 2
reduced fluid intake
Patients with pneumonia most often present with
hyperglycemia as a result of the stress response releasing more glucose into the blood to help fight the infection.
DKA is a complication seen in patients with type _____ diabetes, not type _____ diabetes.
type 1 not type 2
When a patient has symptoms of hypoglycemia, the nurse should follow the
“Rule of 15” by giving the patient 15 g of simple (fast-acting) carbohydrates to increase the blood glucose level.
When a patient exhibits signs of DKA the nurse should
check the patient’s capillary glucose level
and
notify the HCP
Fat does not allow glucose to increase to
eliminate symptoms of hypoglycemia
need carbs
An extra does of rapid-acting insulin during hypoglycemia would
further decrease the glucose level
hyperglycemia symptoms
polyuria
polyphagia
polydypsia
dry mouth
weight loss
blurred vision
proliferative retinopathy
seeing red and black spots
nonproliferative retinopathy
can cause some vision loss but does not usually cause spots
Tachycardia at rest, postural hypotension, decreased libido, and painless miocardial infarction are expected in a patient with
autonomic neuropathy
In which diabetes type can macroangiopathy occur?
Both
Macroangiopathy contributes to
cerebrovascular, cardiovascular, and peripheral vascular disease
when microangiopathy affects the eyes its called
retinopathy
when microangiopathy affects the kidneys its called
nephropathy
when microangiopathy affects the skin it can lead to
diabetic foot ulcers
Sexual impotency and slowed gastric emptying result from
microangiopathy and neuropathy
Renal damage resulting from changes in small-sized blood vessels can be prevented by
careful glucose control.
___________ is the most common skin lesion in diabetic patients
Dermopathy
_________ is characterized by reddish-brown, round or oval patches that are scaly initially and then flatten out. They are common on shins but can also appear in other places.
dermopathy
Acanthosis nigricans is a manifestation of
insulin resistance that appears as velvety light brown to black skin thickening.
This condition appears as red-yellow lesions, with atrophic skin that becomes tiny and transparent.
Necrobiosis lipoidica diabeticorum
aphasia is a symptom of
HHS (and other disease processes)
glaucoma may develop due to
retinopathy
Paresthesia is a symptom of
sensory neuropathy
gastroparesis is one example of
autonomic neuropathy
symptoms of autonomic neuropathy
gastroparesis
postural hypotension
silent MI
ED
neurogenic bladder
hypoglycemia unawareness
beta blockers can mask
hypoglycemia
what drug should be given to a patient with type 2 diabetes and the presence of albumin in the urine?
presence of albumin in the urine indicates nephropathy in patients with diabetes
angiotensin-converting enzyme inhibitors such as linsinopril may delay the progression of nephropathy in diabetic patients
the presence of albumin in the urine indicates _______ in patients with diabetes
nephropathy
duloxetine is a selective serotonin reuptake inhibitor that is used for symptomatic treatment of
sensory neuropathy
pregabalin is an antisiezure med used for
neuropathic pain in diabetic patients
bethanechol is a cholinergic agonist that is indicated for the treatment of
neurogenic bladder
manifestations of hyperglycemia
increased urination
abdominal cramps
nausea and vomitting
Administration of which prescribed intervention may help to prevent further complications in an unconscious patient with hypoglycemia (65 mg/dL) and no IV access?
infusion of 0.9% sodium chloride (NaCl)
route for glargine is
subcutaneously only
Peripheral Arterial Disease (PAD) symptoms
cold feet
loss of hair
dependent rubor
Peripheral arterial disease causes diseased blood to flow to
the lower extremities
urinary retention and bowel incontinence are symptoms of
autonomic neuropathy
What treatment will reduce serum ketones for a patient in DKA?
insulin therapy is useful for reducing serum ketone levels
when the body cannot utilize glucose for energy it
burns fat for energy, resulting in the production of ketones
electrolytes are given to correct
electrolyte imbalance
sodium bicarbonate is given to treat
metabolic acidosis, but does not reduce ketones
IV fluids are indicated for correction of
dehydration
what happens to potassium in the presence of insulin?
decrease, moves from blood to cells
what happens to potassium in the presence of acidosis?
increases, moves out of cells into blood as hydrogen moves out of blood into cells
what happens to potassium in the presence of alkalosis?
decreases, moves into cells out of the blood as hydrogen moves out of cells into the blood
how many mg in a g
1,000
how many mcg in a g
1,000,000
how many lb is 1 kg
1 kg = 2.2 lbs
Symptoms, manifestations, and assessment findings of DKA
lethargy
frequent urination
nausea and vomiting
low bp
dry mucous membranes
weakness
mild disorientation
history of type 1
dehydration
soft and sunken eyes
sweet fruity odor of breath
skin flushed and dry
Kussmaul respirations (deep and fast)/hyperventilation to correct acid-base imbalance to remove CO2
symptoms, manifestations, and assessment findings of HHS
altered level of consciousness
profound dehydration triggers increased cardiac output (tachy)
hypotension
cool, clammy skin
severe drowsiness
seizures
excessive fluid loss/urination
aphasia and hemiparesis
can resemble stroke, important to check blood glucose
the ______ is the organ responsible for producing insulin
pancreas
hypoglycemia is fasting glucose less than
70
diagnostics to rule in DM
A1C 6.5% or higher
elevated fasting plasma glucose (FPG)
abnormal Glucose Tolerance Test (GTT)
classic symptoms of hyper or hypo glycemia, or a random blood glucose of greater than 200 mg/dL
insulin subq sites
abdomen, anterior thigh, posterior upper arm, upper buttock
we never give intermediate or long acting insulin by ______
IV
