Diabetes Flashcards
1
Q
Type 1 diabetes
A
autoimmune destruction of the beta cells in the pancreas
- 12 years of age, can be idiopathic
- autoimmune = T-cell mediated disease that DESTROYS BETA CELLS
- no endogenous insulin
2
Q
Type 2 diabetes
A
beta cells in the pancreas become worn out, cells in the body become immune or resistant to insulin, liver increase gluconeogenesis, stimulate the liver to make more insulin
- INSULIN RESISTANT
3
Q
T1DM
A
- more common in younger people
- s/s more abrupt
- 5-10% of all diabetic cases
- NO endogenous insulin production
- MUST HAVE insulin replacement
- 3 P’s most common presentation
4
Q
3 Ps
A
Polyuria
Polydipsia
Polyphagia
5
Q
Polyuria
A
excessive urination
- d/t osmotic diuresis
- Excreting water
- Loss of electrolyte- K, NA, Cl, others
6
Q
Polydipsia
A
excessive thirst
d/t increased serum osmolality
7
Q
Polyphagia
A
increased hunger
d/t catabolism of fat and protein and cellular starvation
8
Q
Diabetic ketoacidosis (DKA)
A
More common in type 1 diabetics
Serious complication related to insulin deficiency
Characterized by hyperglycemia, acidosis, and ketonuria
9
Q
Hyperosmolar hyperglycemic syndrome (HHNS)
A
Type 2 complication
Extremely high hyperglycemia and osmolality, normal pH
Less profound insulin deficiency than DKA but more significant fluid deficiency
10
Q
T2DM
A
- more common in adults (with risk factors)
- can go undiagnosed for YEARS
- Drs often just screen for risk factors, not s/s
- Insulin RESISTANT
- Often treat with oral/sub-q diabetic pharm
- some can need insulin replacement
11
Q
S/S of T1DM
A
- fatigue
- 3 p’s
- slow wound healing
- recurrent infections (sick)
ACUTE, very rapid onset
12
Q
S/S of T2DM
A
Gradual
- slow wound healing
- recurrent infections
- can have 3 Ps but not really
- fatigue
- blurred vision
- numbness or tingling in hands/feet
- increased hunger
- wt gain or wt loss
13
Q
Non-modifiable risk factors for T2DM
A
- race/ethnicity
- age over 40 yrs
- family hx of diabetes
- hx of gestational diabetes
14
Q
Modifiable risk factors for T2DM
A
- physical inactivity
- high body fat or wt
- high BP
- high cholesterol
15
Q
Labs involved in diabetes
A
- fasting blood glucose
- casual blood glucose
- urine ketones
- lipid profile
- oral glucose tolerance test (OGTT)
- HbA1C
16
Q
Fasting blood glucose
A
- no food or drink for 8 hours
- normal < 126
17
Q
Casual blood glucose (random blood glucose)
A
normal < 200
> 300 is considered a medical emergency
18
Q
Urine ketones
A
- high ketones associated with hyperglycemia
19
Q
Lipid Profile
A
HDL (might be lower), LDL, triglycerides (may be elevated in pts with DM)
20
Q
Oral glucose tolerance test (OGTT)
A
- used commonly to dx gestational diabetes (not T1 or T2)
- fasting glucose drawn prior, client consumes oral glucose, then glucose levels obtained every 30 minutes until 2 hours post-consumption
- fasting should be < 110
- at 1 hr, < 180
- at 2 hr, < 140
21
Q
Glycosylated Hemoglobin (HbA1C)
A
- indicator for average glucose level over the past 120 days (3 months)
- used commonly for diagnosis and to evaluate effectiveness of interventions (meds/lifestyle mods)
- normal is 4-6%
- > 6.5% is considered diabetic
** acceptable range for those diagnosed with DM is 6-8%, with a target of 7%
22
Q
Diagnostic Criteria
A
AT LEAST 1 of the following
1. A1C of 6.5% or higher
2. Fasting level > 126
3. OGTT 12-hr level of 200
4. Classic symptoms of hyperglycemia (3ps or unexplained wt loss), random glucose > 200, or hyperglycemic crisis
23
Q
1-3 criteria
A
would do a repeat lab test before official diagnosis
24
Q
T1DM Diagnosis
A
would need islet cell autoantibody testing
25
Pre-diabetic pt
impaired glucose tolerance, impaired, fasting glucose or BOTH
- Pts with pre-diabetes are at HIGH RISK of developing T2DM
- typically no symptoms, but long-term damage can already be occuring
26
Diagnostic criteria for pre-diabetic pt
- An A1C of 5.7-6.4%
- Fasting blood sugar of 100-125
- An OGTT 2 hr blood sugar of 140-199
27
Care of the pre-diabetic pt
- TEACH
- Lifestyle modifications
- Encourage close monitoring of blood glucose and HbA1C
- Monitor for s/s = fatigue, slow wound healing, always getting sick
- Diet modification
28
Pharmacological nursing management
- oral medications are started at low dose and increased gradually based on A1C levels and fasting glucose levels (usually in AM) (used more frequently in T2DM)
29
T2DM patients in hospital
often in hospitalized patients, oral medications are stopped and pt is put on insulin while acutely ill
30
Important concepts from NUR 325
- holding metformin before procedure
- understanding what classes are used to treat diabetes
31
What do we do with pt with DM that is sick?
- Steroids (oral/IV) make your blood sugar RISE
- may need to alter insulin regimen at home, adjust basal dosage, increased schedule doses, etc.
32
Sick + DM
- sickness causes the body stress, may cause body to release more glucose, so may have to check BG more often
- pts are more prone to go into DKA, HHNS when sick
33
stomach virus + DM
- may not be eating or drinking, may need to check BG more often
- still need to take oral medications if possible
34
Nursing teaching points for illness + DM
- Notify your provider when sick
- monitor BG more
- continue to take medications
- prevent dehydration
- rest
- meet carb needs -> either through oral food intake or liquid (gatorade)
35
If sick, call provider when
- urine ketones
- BG > 250
- fever > 101.5, not responding to meds
- feeling confused/disoriented/rapid breathing
- persistent n/v/d
- inability to tolerate liquids
- illness longer than 2 days
36
Self monitoring of BG
- requires small drop of blood from tip of finger
- some newer technology allows for CGM (more common in type 1)
37
Frequency of BG check depends on
- glycemic goals
- type of diabetes
- medication regimen
- access to supplies and equipment
- pt willingness
38
Nursing management of insulin
- we do our best to MIMIC the bodies normal insulin production
- combine "basal" insulin with "mealtime" insulin
- called "basal-bolus" regimen
- uses rapid and short-acting (bolus) insulin before meals
- use a background insulin once a day
39
Commonly prescribed as 4 injections a day
- lantus or levemir at bedtime (basal) dose
- novolog or regular before each meal (bolus)
40
Insulin types
- rapid
- regular/short
- intermediate
- long
41
Rapid acting
insulin lispro (humalog), aspart (novolog), glulisine (apidra)
onset = 15 min
peak = 1 hr
duration = 2-4 hr
GIVE WITH THE FOOD
MUST BE USED WITH EITHER AN INTERMEDIATE OR LONG ACTING
42
Short acting/regular
human regular (Novolin R/Humulin R)
onset = 30-60 minutes
peak = 2-6 hr
duration = 3-8 hr
given before meals, but can also be given for longer acting glycemic control (tube feeding pt)
43
Intermediate acting
NPH (Humulin N/Novolin N)
onset = 2-4 hr
peak = 4-10 hr
duration = 10-20 hr
CLOUDY (agitate before using)
CLEAR BEFORE CLOUDY (if given with rapid or short acting)
INJECTED TWICE DAILY
44
Long acting
insulin glargine (Lantus), detemir (levemir), degludec (Tresiba)
onset = 70 minutes
peak = NONE
duration = 24 hr
ONCE-A-DAY DOSING
NEVER MIX WITH OTHER INSULINS
often given at night, then check BG with meals and give rapid to fix
45
Sliding scale regimen
regular insulin doses given throughout the day with meals according to blood glucose levels
- can also include a basal dose of long-acting insulin
46
Lipodystrophies, lipoatrophy
depression of skin at injection sites, feels hard and changes color
47
Insulin HIGH ALERT MED
1. always check current glucose level, know normal range, know pt's trends
2. check diet order and pt's oral intake tolerance
48
Somogyi effect
overdose of insulin causes hypoglycemia and counter-regulatory mechanisms cause hyperglycemia and ketosis
49
Dawn phenomenon
hyperglycemia in the morning due to natural hormonal release
50
Insulin things to know before admin
- onset of action of insulin
- when does insulin peak
- what is duration of action
- how will I know if my pt develops hypoglycemia
- is my pt NPO
- what do I do when insulin is scheduled and they can't eat
- what nursing interventions for hypoglycemia
51
Teaching points
- TEACH, they know their bodies better than we do for insulin
- observe newly diagnosed client perform self-administration
- TIMING is crucial
- monitor for side effects = hypoglycemia
52
Hypoglycemia
Blood sugar < 70
- can have symptoms even if blood sugar is greater than 70, especially if uncontrolled diabetic
53
Hypoglycemia treatment
1. FSBG
2. The rule of 15 (if conscious and able to swallow)
3. FSBG in 15 minutes, then eat regular meal
4. If still < 70 repeat, when glucose stable give additional food
54
The rule of 15
15g simple CHO (ie 4 oz. juice, regular soda, 3 glucose tabs)
- avoid sugars w/ fat (like candy bar) = delays absorption
- 15 grams of CHO increases BS 50 mg/dL
55
If pt is unconscious/unable to swallow
IM glucagon
IV D50 (25-50ml) (dextrose)
56
S/S of hypoglycemia
- sweating
- blurry vision
- irritability
- dizziness
- anxiety
- hunger
- shakiness
- fast HR
- HA
- weakness/fatigue
57
Hyperglycemia causes
illness
infection
self-management issues
stress
58
Hyperglycemia manifestations
weakness
fatigue
blurry vision
HA
n/v/d
59
Hyperglycemia treatment
- check for ketones in urine
- insulin
- drink fluids, prevent dehydration
- education on prevention
60
Hyperglycemia crisis situations
- Diabetic ketoacidosis (DKA)
- Hyperglycemic Hyperosmolar Syndrome (HHS)
- life threatening conditions related to uncontrolled hyperglycemia
61
Care of the pt with insulin pump
continuous release of subcutaneous insulin infusion -> use rapid acting insulin
- pts receive continuous basal infusion, can be increased or decreased based on FSBG
62
Insulin pump BG checks
- required to check BG at least 4 times a day, can use CGM in conjunction with the insulin pump
- usually deactivated in hospital and switched to sliding scale regimen
63
Problems with insulin pump
- infections at insertion site
- increased risk for DKA if pump malfunctions
- cost
64
Chronic complications of diabetes and how nurses can help
related to end-organ disease from chronic damage to blood vessels (angiopathy) from long-term hyperglycemia
65
Macrovascular
damage to large vessels
- coronary arteries (heart)
- peripheral vascular (extremities)
- cerebral vascular (brain)
66
Microvascular
damage to capillaries
- retinopathies (eyes)
- nephropathies (kidneys)
- neuropathies (sensation specifically in the extremities)
67
Macrovascular disease
- women with diabetes have 4-6x more risk of CVD than those without
- men have 2-3x more risk
- EDUCATE pt
- stop smoking, control BP, modify high fat diet
68
Retinopathy
damage to the retina related to chronic hyperglycemia
- regular eye exams
69
Nephropathy
damage to small blood vessels in the kidneys
- leading cause of end-stage renal disease
70
Neuropathy
nerve damage due to metabolic imbalance associated with hyperglycemia
71
Nursing considerations r/t neuropathy
highest risks -> lower extremities & feet
- foot ulcerations and lower extremity amputations common complications
- loss of protective sensation (LOPS) = prevents pts from being aware that injury has occurred
72
Diabetic foot care 1-6
1. wash feet daily with mild soap and warm water after testing water temp with hand
2. pat feet dry gently, esp between toes
3. inspect feet daily for cuts, swelling, blisters, red areas
4. use lanolin to prevent dry skin and cracking but do not put between toes
5. mild foot powder on sweaty feet
6. do not use commercial remedies to remove calluses or corns
73
Diabetic foot care 7-13
7. clean cuts with mild soap and water, don't use alcohol, iodine or adhesives
8. report skin infections or non-healing wounds
9. trim nails after shower or bath and cut evenly with rounded contours
10. separate overlapping toes with cotton
11. do not go barefoot, wear open-toe, open-heel or plastic shoes, shake out shoes before wearing
12. clean, absorbent socks
13. no hot water bottles
74
Nutritional considerations for DM
balanced, high fiber, low fat, low cholesterol diet is best
75
Carbohydrates + DM
encourage clients to consume grains, fruits, legumes, and milk
- limit simple carbs -> pasta, bread
- should be 45-65% of total daily caloric intake
76
Fats + DM
diets low in saturated and trans fat
- polyunsaturated fatty acids best -> fish
77
Fiber + DM
promote fiber intake (beans, vegetables, oats, whole grains)
- can improve carb metabolism and lower cholesterol
78
Protein + DM
promote intake from meats, eggs, fish, nuts, and beans
- should be 15-20% of total caloric intake
79
Alcohol + DM
limit alcohol intake
- 1 drink for women, 2 for men
80
Exercise + DM
- encourage pts
- properly fitting footwear
- exercise can LOWER BG
- do not exercise if BG < 80 or > 250
- best to exercise after meals
- if more than 1 hr has passed since eating and high intensity exercise planned, eat a carbohydrate snack prior
- medical alert bracelet
81
Nursing considerations for hospitalized DM pt
- stress/surgery can increase BG levels
- common for those with controlled BS at home to become uncontrolled in the hospital
- wound healing is IMPAIRED in pts with diabetes
- HIGH risk for infection
82
Diabetic dermopathy
reddish, brownish spots, usually on shins
83
Acanthosis nigricans
brown/black thickening of skin often seen in skin folds
84
Necrobiosis lipoidica diabeticorum
red patches around blood vessels
85
Pancreas exocrine
pancreatic cells secrete directly into ducts (NOT bloodstream)
86
Pancreas endocrine
cells secrete INSULIN directly into blood stream
87
Insulin does what?
LOWERS blood glucose levels by stimulating uptake and use of glucose
- secreted by beta cells
- stimulates liver to store glucose as glycogen
88
Hyperglycemia is rapid...
build up of glucose in the blood
89
Ketone bodies
substance that are composed of these acid breakdown products (extra free fatty acids in blood)
90
Ketosis
increased serum ketones -> can cause severe metabolic acidosis which leads to coma
91
Insulin deficiency & Protein metabolism
increased protein breakdown -> muscle wasting
92
Insulin deficit and electrolytes
increased urination
- intracellular dehydration from fluid shifting into bloodstream
- sugar in urine
