Diabetes Flashcards
What is Diabetes?
An endocrine disorder in which there is an insufficient amount or lack of insulin secretion to metabolize carbohydrates.
It is characterized by hyperglycemia, glycosuria and ketonuria
What is the main fuel for the CNS?
Glucose is the main fuel for the CNS
Brain cannot make or store insulin, therefore needs a continuous supply
True or False
Fatty acids can be used when glucose is not available
True
Pathophysiology of type 1 diabetes
The underlying pathophysiologic defect in type 1 diabetes is an autoimmune destruction of pancreatic beta cells. Following this destruction, the individual has an absolute insulin deficiency and no longer produces insulin. Autoimmune beta cell destruction is thought to be triggered by an environmental event, such as a viral infection. Genetically determined susceptibility factors increase the risk of such autoimmune phenomena.
The onset of type 1 diabetes is usually abrupt. It generally occurs before the age of 30 years, but may be diagnosed at any age. Most type 1 diabetic individuals are of normal weight or are thin in stature. Since the pancreas no longer produces insulin, a type 1 diabetes patient is absolutely dependent on exogenously administered insulin for survival. People with type 1 diabetes are highly susceptible to diabetic ketoacidosis. Because the pancreas produces no insulin, glucose cannot enter cells and remains in the bloodstream. To meet cellular energy needs, fat is broken down through lipolysis, releasing glycerol and free fatty acids. Glycerol is converted to glucose for cellular use. Fatty acids are converted to ketones, resulting in increased ketone levels in body fluids and decreased hydrogen ion concentration (pH). Ketones are excreted in the urine, accompanied by large amounts of water. The accumulation of ketones in body fluids, decreased pH, electrolyte loss and dehydration from excessive urination, and alterations in the bicarbonate buffer system result in diabetic ketoacidosis (DKA). Untreated DKA can result in coma or death.
Patho of diabetes
The underlying pathophysiologic defect in type 1 diabetes is an autoimmune destruction of pancreatic beta cells. Following this destruction, the individual has an absolute insulin deficiency and no longer produces insulin. Autoimmune beta cell destruction is thought to be triggered by an environmental event, such as a viral infection. Genetically determined susceptibility factors increase the risk of such autoimmune phenomena.
The onset of type 1 diabetes is usually abrupt. It generally occurs before the age of 30 years, but may be diagnosed at any age. Most type 1 diabetic individuals are of normal weight or are thin in stature. Since the pancreas no longer produces insulin, a type 1 diabetes patient is absolutely dependent on exogenously administered insulin for survival. People with type 1 diabetes are highly susceptible to diabetic ketoacidosis. Because the pancreas produces no insulin, glucose cannot enter cells and remains in the bloodstream. To meet cellular energy needs, fat is broken down through lipolysis, releasing glycerol and free fatty acids. Glycerol is converted to glucose for cellular use. Fatty acids are converted to ketones, resulting in increased ketone levels in body fluids and decreased hydrogen ion concentration (pH). Ketones are excreted in the urine, accompanied by large amounts of water. The accumulation of ketones in body fluids, decreased pH, electrolyte loss and dehydration from excessive urination, and alterations in the bicarbonate buffer system result in diabetic ketoacidosis (DKA). Untreated DKA can result in coma or death.
Is type 1 diabetes a progressive disease?
Type 1 diabetes is usually a progressive autoimmune disease, in which the beta cells that produce insulin are slowly destroyed by the body’s own immune system.
- Genetic
- Viral exposure
- Low vitamin D levels
What are major symptoms of diabetes?
- Polydipsia
- Polyuria
- Polyphagia
- Weight loss
- Fatigue
- Ketoacidosis
- Blurred vision
Normal vs. fasting glucose
Normal <100 mg/dL
Fasting plasma glucose (FPG) at or above 126 mg/dL diagnostic of diabetes
Fasting is defined as no caloric intake for at least 8 h
Criteria for Impaired Fasting Glucose (IFG) is 100-125 mg/dL
Oral glucose tolerance: pregnancy
Normal <100 mg/dL
Fasting plasma glucose (FPG) at or above 126 mg/dL diagnostic of diabetes
Fasting is defined as no caloric intake for at least 8 h
Criteria for Impaired Fasting Glucose (IFG) is 100-125 mg/dL
Diabetes lab assesment
Normal A1C 4-6% A1C of 6.5% or higher (Glycosylated hemoglobin, Hemoglobin A1C, HgbA1C) Levels > 8% = poor diabetic control
What is the honey moon peroid?
In Type I - after diagnosis, need very little insulin to control glucose. Even as insulin islet cell antibodies destroy B-cells, B-cells continue to produce insulin.
Period may last up to a year.
What are some complications of type 1 diabetes
- Diabetic ketoacidosis
- Hypoglycemia from
too much insulin or
too little glucose
What is diabetic ketoacidosis?
Extreme hyperglycemia >300 mg/dL due to insulin deficit
Glucose is osmotic diuretic so 3 p’s occur
Can occur in a few hours if ill or under stress
Body breaks down fat for energy ketones
What are symptoms of DKA?
Flu-like symptoms LOC changes N & V Abdominal pain Dehydration with orthostatic changes Kussmaul breathing with fruity breath Metabolic acidosis
When should you test for keytones?
Test for ketones if:
Blood sugar is higher than 240 mg/dl on a glucose meter
Sick with the flu or food poisoning and vomiting, Test for ketones every four to six hours, since ketoacidosis is more likely to develop
Do not exercise if ketones present
When should you call MD, related to DKA
Blood glucose > 240 Moderate or large ketones BG elevation after 2 doses of insulin Fever over 101.5 or fever longer than 24 hrs Ketonuria lasting more than 24 hours Client cannot take food or liquids Illness lasts more than 1 to 2 days Persistent nausea and vomiting
Blood sugar mnemoics
Shaky, sweaty - take sugar
Hot & Dry = Sugar High
Cold and Clammy = Need some
candy
Causes of hypoglycemia
Takes too much insulin (or an oral diabetes medication that causes your body to secrete insulin)
Does not eat enough food
Exercises vigorously without eating a snack or decreasing the dose of insulin beforehand
Waits too long between meals
Drinks excessive alcohol, although even moderate alcohol use can increase the risk of hypoglycemia in people with type 1 diabetes
True or false
DO NOT MIX GLARGINE WITH ANY OTHER INSULIN
True
What is Lipohypertrophy?
Lipohypertrophy: Repeated needle injections into the same site can create hardened tissue or fatty deposits called lipohypertrophy
What is Lipoatrophy?
Lipoatrophy: a breakdown of subcutaneous fat at the site of an insulin injection. It usually occurs after several injections at the same site
A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse.
What does the nurse suspect is happening with this patient?
What serum glucose level would the nurse expect to see with this patient?
The manifestations point to diabetic ketoacidosis.
The patient’s glucose level is most likely >300 mg/dL.
The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response?
“His serum pH is high and this is a compensatory mechanism.”
“His serum pH is low and this is a compensatory mechanism.”
“His serum potassium is high and this is a compensatory mechanism.”
“His serum potassium is low and this is a compensatory mechanism.”
ANS: B
As ketone levels rise, the buffering capacity of the body is exceeded and the pH of the body decreases, leading to metabolic acidosis. Kussmaul respirations (very deep and rapid) cause respiratory alkalosis in an attempt to correct the acidosis by exhaling carbon dioxide.
In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA).
What is the nurse’s first priority for managing this condition?
Airway assessment
Fluid and electrolyte correction
Administration of insulin
Administration of IV potassium
ANS: A
The first priority is airway management, rapidly followed by the administration of insulin, fluids, and correction of any electrolyte imbalances.
Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent finger sticks to check his glucose level. His potassium level is 2.5 and IV potassium supplements have been ordered.
What assessment must be made before giving the IV potassium?
Production of at least 30 mL/hr of urine
Level of consciousness and orientation
Finger stick glucose of less than 200 mg/dL
Respiratory rate of less than 24/min
ANS: A
Hypokalemia is a common cause of death in the treatment of DKA. Before giving IV potassium, make sure the patient produces at least 30 mL/hr of urine.
Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from happening again.
What should the nurse teach the patient and his wife? (Select all that apply.)
Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.
Check urine ketones when blood glucose is greater than 300 mg/dL.
Decrease fluid intake when nausea and vomiting occur.
Watch for and report any illness lasting more than 1 to 2 days.
Monitor glucose whenever the patient is ill.
ANS: A, B, D, E
It is important to teach the patient to reduce the risk of dehydration by maintaining fluid and food intake. Small amounts of fluid may be tolerated even when vomiting is present. The patient should drink at least 3 L of fluid daily and increase this amount when infection is present.
What is MetS?
Metabolic syndrome, also called MetS, is classified as the simultaneous presence of metabolic factors known to increase the risk for developing Type 2 diabetes and cardiovascular disease.
What are some sulfonylurea agents?
Sulfonylurea agents – Increase insulin secretion Glipizide (Glucotrol) Glyburide(Diabeta/Micronase) Glimepiride (Amaryl) Chlorpropamide (Diabenese) Tolazamide (Tolinase)
Side effects –
Hypoglycemia
What are Biguanides?
Biguanides –Reduce hepatic production and tissue sensitivity . They stop the liver from making extra sugar when its not needed.
Metformin (Glucophage)
Side effects –
GI side effects (diarrhea, N &V, abdominal pain)
Use caution with renal, liver or cardiac disease
HyperosmolR HYPERGLYCEMIC STATE
Lack of insulin or insulin resistance leads to profound hyperglycemia Osmotic diuresis – dehydration Polyuria Hypotension Tachycardia Altered sensorium Seizures and/or hemiparesis
How do your treat HHS?
Identify and correct cause (infection, stress)
Correct dehydration
Insulin administration
Restore electrolyte balance
Continuous monitoring of VS, u/o, blood glucose, lung sounds and mental status
What are some macrovascular complications of diabetes
Complications affecting larger diameter vessels, such as those of the heart, brain and periphery. MI Stroke Atherosclerosis CAD PVD
True or false
Retinopathy is a microvascular complication of diabetes
True,
Retinopathy
Microaneurysms leak or ooze fluid and blood into the retina
Smaller vessels may close and the larger retinal veins may begin to dilate and become irregular in diameter
Nerve fibers in the retina may begin to swell
Central part of the retina (macula) begins to swell causing macular edema.
True or false
Nephropathy is a microvascular complication of diabetes
True,
Nephropathy
Persistent albuminuria confirmed on at least 2 occasions 3-6 months apart
Progressive decline in the glomerular filtration rate (GFR) nl > 60 ml/min
Elevated arterial blood pressure – use of ACE Inhibitors and Angiotensin Receptor Blockers delay
progression of nephropathy
