Diabetes Flashcards
How much insulin does the pancreas secrete daily?
40-50 units
What is the first major organ that insulin reaches?
The liver
What secretes insulin?
The beta cells of the Islets of Langerhan of the Pancreas gland
What does insulin promote in muscles?
Protein and glycogen synthesis
Converting fats to acids
Ketogenesis
What is insulin made of?
Alpha and Beta chains
What is the secretion of low levels of insulin during fasting called?
Basal insulin secretion
Promotes the production and storage of glycogen
Glycogenisis
What are the characteristics of diabetes mellitus?
Hyperglycemia, Glycosuria, and Ketonuria
How does insulin inhibit tissue breakdown?
Inhibits liver glycogenolysis, ketogenesis, and gluconeogenisis
Conversion of proteins to glucose
Gluconeogenisis
Precursors of insulin
Preproinsulin and Proinsulin
Which insulin precursor must be made smaller before becoming active?
Preproinsulin
Which electrolyte does insulin allow to pass from the ECF to the ICF?
Potassium
Inhibits glycogen breakdown into glucose
Glycogenolysis
What is increased when a patient is stressed?
Glycogenisis
What is the increased level of insulin after eating called?
Prandial Secretion
An endocrine disorder in which there is insufficient amount or lack of insulin secretion to metabolize carbohydrates
Diabetes Mellitus
What does insulin promote in fat cells?
Triglyceride storage
What molecules does insulin increase the synthesis of?
Proteins and lipids
What is proinsulin made of?
Alpha, beta, and c-peptide chains
What is the main fuel for the CNS?
Glucose
What is insulin’s purpose?
Takes sugar into the cells
How long after eating is insulin released?
10 minutes
Which of the precursors of insulin is inactive?
Preproinsulin
What historical questions should a patient be asked during an assessment for diabetes?
How long they have been feeling off and if they’ve lost any weight
What types of carbohydrates should diabetics eat?
Complex carbs
What is the most accurate blood test for diabetes?
A1c
Finger-stick test used to monitor blood sugar
FSBS
What happens in the absence of insulin?
Hyperglycemia, polyuria, polydipsia, polyphagia, hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion, hypoxia, acidosis, Kussmaul respirations, hypokalemia, or hyperkalemia
What are the clinical manifestations of hypoglycemia?
Sudden onset of weakness, diaphoretic, sweat, pallor, tremors, nervousness, hunger, diplopia, confusion, aphasia, vertigo, and convulsions
What level does a patient’s fasting blood glucose have to be at in order to be diagnosed with diabetes?
Greater than 110 mg/dL
How much glucose does the body need to support the brain?
70-100 mg/dL
Why do diabetics develop extensive skin wounds?
The excess glucose in the blood stream damages their nerves and skin integrity
What are the clinical manifestations of hyperglycemia?
Gradual onset of polyuria, polyphagia, polydispsia, dehydration, hypotension, mental changes, glycosuria, fever, hypokalemia, hyponatremia, seizures, and coma
Follows the life of a hemoglobin cell and its average glucose level
A1c
What chemical stops the production of insulin when glucose levels are decreased?
Glucagon
What are the respirations that diabetics demonstrate in the absence of insulin?
Kusmaul
What types of infection generally increases in patients with diabetes?
Vaginal infections
Why does the brain need a continuous supply of glucose?
Because it does not make or store it
At what level does an A1c indicate diabetes?
> 6.9%
What does the urine test of a diabetic test for?
Keytones, renal function, and glucose
How is glucose made?
Glycogenolysis
What is the best thing to eat to quickly raise blood sugar?
Milk, ice cream, cheese, and crackers
What is the treatment for hypoglycemia?
Sugar followed by a protein or IV glucose
When glucose is not available, what does the brain use for fuel?
Fatty acids (trigylcerides)
What is the priority nursing diagnosis for diabetics?
Risk for injury
What are the nursing interventions to prevent injuries of diabetic patients?
Dietary interventions, blood glucose monitoring, and giving proper medications
What is broken down if liver glucose is not available?
Fat or amino acids
What does glucagon do?
Causes the release of glucose from the liver
How long can insulins be kept?
Four weeks
Surge of glucose released at dawn
Dawn’s phenomenon
Why are intensified insulin therapy regimens the best?
Because they act more like regular body function
What should the diet of a diabetic patient look like?
High protein, high fat, and no simple carbs
How should two insulins be drawn into one syringe?
Clear before cloudy
What are the complications of insulin therapy?
Hypoglycemia, lipoatrophy, Dawn phenomenon, and Somagyi’s phenomenon
What is more dangerous, hypo or hyperglycemia?
Short term hypo, long term hyper
What preventative actions should be taught to diabetics?
Proper skin and foot care, proper eye exams, proper diet and fluids, diabetic neuropathy, diabetic retinopathy, diabetic nephropathy, and diabetic gastroparesis
When should diabetics not exercise?
If their blood sugar is over 250 or they have glycosuria
What is the hallmark of diabetic ketoacidosis?
Presence of ketone bodies in the urine and blood
What common complications can occur in patients with diabetes?
Hyperglycemia, hypoglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic nonkeytonic syndrome
Blood sugar drops rapidly over night
Somagyi’s phenomenon
What are the nursing interventions for diabetic ketoacidosis?
Monitoring for manifestations, assessment of airway, LOC, hydration status, and blood glucose levels, and management of fluid and electrolytes
What teaching should take place for patients on oral hypoglycemics?
Monitor serum glucose levels daily, teach the patients the signs and symptoms of hyper/hypoglycemia, altered liver or renal function will affect the medication’s action, avoid OTC drugs without MD’s approval, know appropriate times to administer the medications
How often should diabetics exercise?
Three times a week
What do patients with ketoacidosis need?
Hydration, insulin, and electrolyte replacement
How long does ketoacidosis take to develop?
4-10 hours
What are the blood sugar levels in patients with diabetic ketoacidosis?
Around 600
Why does HHNC not occur in patients with type 1 diabetes?
Because they have absolutely no insulin
What should the diet of a diabetic patient look like?
60% Carbs, 30% fats, and 12-20% protein
What is the goal of drug therapy for patients with diabetic ketoacidosis?
Lower serum glucose by 75 to 150 mg/dL/hr
What happens in patients with HHNC?
Fluid moves from indie to outside the cell causing diuresis and loss of sodium and potassium
What does diabetic ketoacidosis occasionally occur with?
Infection
What is the purpose of exercise for diabetics?
To control and lower blood glucose and reduce the amount of insulin needed
What are the nursing interventions for patients with diabetic ketoacidosis?
Keep airway patent, suction, cardiac monitoring, vital signs monitoring, monitor central venous pressure, ABG, BS, chemistry panel, administration of sodium bicarb, foley to monitor fluid output, strict I/Os, and frequent repositioning
What are the nursing interventions for diabetic patients with ineffective tissue perfusion?
Control of blood glucose levels, yearly evaluation of kidney function, control of blood pressure levels, prompt treatment of UTIs, avoidance of nephrotoxic drugs, diet therapy, fluid and electrolyte management
Which types of patients are candidates for whole-pancreas transplantation?
Type 1 diabetics only
What are the key nursing diagnoses for patients with diabetes?
Anxiety and fear, altered nutrition, pain, and fluid volume deficit
What causes HHNC?
Lack of a thirst center, causing profound dehydration without thirst and severe hyper glycemia
What interventions should be done for diabetics with chronic pain?
Maintenance of normal blood glucose levels, anticonvulsants, antidepressants, and capsaicin cream
What is the drug therapy for diabetic patients with hypoglycemia?
Glucagon, 50% dextrose, diazoxide, and octreotide
What are the nursing interventions for patients with diabetes?
Prevent complication, monitor blood sugars, administer meds and diet, teach diet and meds, and constantly assess
What are the chronic complications of diabetes?
Cardiovascular disease, cerebrovascular disease, retinopathy problems, diabetic neuropathy, diabetic nephropathy, and male erectile dysfunction
What should diabetics do to take care of their feet?
Cleanse and inspect feet daily, wear properly fitting shoes, avoid walking barefoot, trim toenails properly, report non healing breaks in the skin, and wear flat shoes
What would a patient who in HHNC have blood sugars of?
1000s
How soon should a patient in HHNC have their blood sugars restored to normal?
36-72 hours
What interventions should be done for diabetic patients with disturbed sensory perception?
Blood glucose control, and environmental management
What wound care should be performed for diabetic patients?
Wound environment, debridement, elimination of pressure on infected area, and growth factors applied to wounds
What are the Sulfonylureas?
Glipizade and glucotrol XL
What are the signs and symptoms of HHNC?
Hypotension, mental changes, dehydration, hypokalemia, and hyponatremia
What are the meglitinide analogs?
Prandin and starlix
How fast should a diabetic patient in HHNC be given insulin?
10 units/hour
What are the biguanides?
Metformin and glucophage XL
What is the onset of the meglitinide analogs?
Short acting
What is the treatment for HHNC?
Give insulin and correct the fluid and electrolyte imbalances
What should be monitored when taking thiazolidinediones?
Monitor liver function
What needs to be monitored when taking alpha-glucosidase inhibitors?
Kidney function
What are the thiazolidinediones?
Actos and avandia
What are the alpha-glucosidase inhibitors?
Precose and Glyset
Which type of oral hypoglycemics should be held 48 hours before tests with contrast dyes
Biguanides
What is the onset and peak of Apidra?
Onset 20 minutes and peak 30-90 minutes
What are the classifications of insulins?
Rapid-acting, short-acting, intermediate-acting and long-acting
What are the types of short-acting insulin?
Novolin R and Humulin R
What are the types of rapid acting insulins?
Novalog, Apidra, and Humalog
What are the onset and peak of Humulin R?
Onset 30 minutes and peak 2-4 hours
What are the classifications of oral hypoglycemics?
Sulfonylura, meglitinide analogs, biguanides, thiazolidinediones, and alpha-glycosidease inhibitors
What are the onset and peak of Humulin R Concentrated?
Onset 90 minutes and peak 4-12 hours
What is the onset and peak of Humalog?
Onset 15 minutes and peak 1-3 hours
What is the onset and peak of Novolin R?
Onset 30 minutes and peak 2.5-5 hours
What is the onset and peak of novolog?
Onset 15 min and peak 1-3 hours
Which insulin should never be mixed with anything else?
Lantus
What is the long-acting insulin?
Lantus
What is the intermediate-acting insulin?
NPH, Humulin N, Novolin N, and ReliOn N
What is the onset and peak of Lantus?
Onset 2-4 hours and no peak
What is the onset and peak of NPH?
Onset 90 minutes and peak 4-12 hours
