Diabetes Flashcards
This disease is defined as a lack or inadequate secretion of insulin, or insulin resistance resulting in hyperglycemia
Diabetes mellitus
2 major classifications of diabetes include:
Type 1-insulin dependent diabetes mellitus and Type-2- non-insulin-dependent diabetes mellitus
In diabetes, what organ fails to secrete an adequate amount of insulin (hormone responsible for glucose metabolism)
Pancreas, specifically beta cells of islets of Langerhans
Type 1- IDDM
Results from destruction of pancreatic beta cells, which leads to insulin dependence (little to no insulin is produced from beta cells of pancreas), 20-30% hereditary, and ketoacidosis very likely, insulin must be received exogenously
Type II - NIDDM
Results from a decrease in beta cell weight and number or insulin resistance (some, but not enough insulin produced), 90% hereditary (e.g. diet patterns from parents), may be managed with diet and exercise and/or antodiabetic agents,
Difference between type I and type II
Same symptoms but type II has a more gradual onset, can be undetected for years, no ketones are usually present, and experiences weight gain, not weight loss found in type I
Causes of Type 1 Diabetes
occurs as a result of genetic, environmental, or immunological factors that damage the pancreatic beta cells (the insulin-secreting cells)
Causes of Type 2 Diabetes
idiopathic, but obesity is the single most important risk factor
Gestational diabetes
pt. likely to be overweight, risk for developing type 2 diabetes
Other types of diabetes include:
stress diabetes (critically ill patients) and steroid diabetes
Diabetes mellitus affects the metabolism of ___, ____, and ___
protein, carbs, and fats
Dyslipidemia, hypertension and hyperglycemia cluster together to form _____
Syndrome X- insulin resistance syndrome and metabolic syndrome
What is metabolic syndrome?
Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes.
What type of obesity is most strongly associated with the metabolic syndrome?
Abdominal obesity (apple shaped)- Excess adipose tissue releases several products: fatty acids (NEFA), cytokines, PAI-1, and adiponectin.
Beside central obesity, what is the second most important risk factor?
Insulin resistance. The body uses insulin less effectively than normal Insulin is needed to help control the amount of sugar in the body As a result, blood sugar and fat levels rise.
As a nurse caring for a patient with metabolic syndrome, what can you educate the patient about to reduce risk for heart disease and diabetes?
lose weight, get 30 min of moderate intensity exercise, quit smoking, decrease insulin resistance [(using metformin and insulin sensitizers- thiazolidinediones (TZDs)], decrease hyperlipidemia (use Statins), treat HTN, aspirin
What are the 7 labs you expect ordered for a diabetic patient?
Serum fasting glucose (>126 mg/dL), serum glycosylated hemoglobin levels ( > 7%), UA (+ for glucose, ketones, protein), Serum K+ (hypokalemia), 2h plasma glucose (after meal > 200 mg/dL), and cholesterol and triglyceride levels (elevated)
As a diabetic nurse, describe the AACE treatment goals you want your patient to fall within:
A1C less than or equal to 6.5%, pre-prandial plasma glucose less than or equal to 110mg/dl, postprandial plasma glucose less than equal to 140 mg/dl, and blood pressure < 130/85mmHg.
The most recent diagnostic parameter for diabetes is a fasting (4 hours) glucose level, either serum or capillary, of greater than ____ mg/dl
126 mg/dl- test must be preformed twice to be definitive
What is the parameters for the oral glucose tolerance test?
blood glucose >200 mg/dL at 120 mins
How much glucose is needed to support the brain?
68-105 mg/dL. Brain cannot make or store Glucose so a continuous supply is needed.
Describe the renal threshold for glucose
180-200 mg/dL, glucose spills into urine once it exceeds renal threshold
You are ordered to obtain a urine Sample for Bob, a patient suspected for Type II diabetes. What are you looking for?
ketones, renal function, glucose
What are the 3 Ps of type I diabetes?
polyuria, polydipsia, and polyphagia
Why does a diabetic develop polyuria?
Because glucose is highly osmotic, fluids “follow” glucose and are excreted from body in large amounts, causing an excess loss of fluids and electrolytes (Polyuria)
Loss of fluids leads to _____
polydipsia (excessive thirst)
Why does DKA, weight loss, and polyphagia occur?
because of lack of insulin, body is unable to utilize carbs (source of energy), the body must use proteins and fats for energy, leading to unexplained weight loss. The use of fat results in Ketones > Acidosis> DKA. Breakdown of nutritional stores leads to excessive hunger (polyphagia).
Early manifestations of Type I Diabetes
polyuria, polydipsia, polyphagia, glucosuria, fatigue, weight loss, N/V, abdominal pain
Early manifestations of Type II Diabetes
polyuria, polydipsia, blurred vision, and weight gain
What can happen in the absence of insulin?
hyperglycemia, polyuria, polydipsia, polyphagia, hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion hypoxia, acidosis, kussmaul respiration, hypo/hyperkalemia or normal K levels
As the nurse caring for Sarah, a patient with diabetes, what do you assess?
symptom analysis (e.g. 3Ps, blurred vision), fluid status, I & O, nutritional status, weight, energy level, GI symptoms, neurological assessment, history of recent infections with difficulty healing
Nursing priorities for a diabetic pt. include:
Medications, monitor I & O, serum glucose, electrolytes and provide client education
Type 1 diabetes medications
short acting insulin, intermediate-acting insulin, long-acting insulin or combination insulin
Short acting insulin
regular
Intermediate-acting insulin
NPH
Long acting insulin
Lantus
Combination insulin
Novalin
Signs of hypoglycemia *hint think TIRED
tachycardia, irritability, restless, excessive hunger, diaphoresis and depression
Hot & Dry =
Sugar High
Cold & Clammy =
Need some candy
Long term complications macrovascular
coronary artery disease, cerbrovascular disease and peripheral vascular disease
Long term complications microvascular
retinopathy, nephropathy, and neuropathy
What should you teach your patient about?
s/s of hypoglycemia/hyperglycemia and tx, self-admin of insulin or antidiabetic agents, onset & peak of insulin, self-monitoring of glucose, dietary mgmt. , diabetic foot care, teach sick day insulin rules, and encourage proper exercise to aid in mgmt. of diabetes
s/s of hypoglycemia and tx
irritability, fatigue, weakness, tremors, headache, possible coma. Carb replacement
S/s of hyperglycemia and tx
frequent urination, increased thirst, high blood sugar. Exercise if BS under 240 mg/dL and no ketones in urine. Pt. should also cut down on food the patient eats, work with dietitian to make changes, and consult w/ MD.
Onset and peak of rapid acting insulin (regular and regular humulin)
O= 0.5- 1 h, P = 2-3 h
Onset and peak of intermediate-acting insulin (NPH and Lente)
O = 1-2 and P = 6-8
This form of insulin has onset in 2 hours and peaks 16-20 hours
Long acting (e.g. Ultralente)
Combination insulin onset and peak
O= .05h, P=4-8h
What things will a patient need to know about dietary mgmt. of diabetes?
balanced meal plan, food groups, food exchanges, and need to correlate diet with serum glucose levels
While going over foot care education with your patient, what things do you cover?
proper shoe fit, cleanse and inspect feet daily, avoid walking barefoot, trim toenails properly, and report nonhealing breaks in skin
While discussing sick day rules, what might you educate your patient on?
maintain or increase insulin when a common sickness occurs (virus, colds) and monitor glucose more often (q 2 to 4 h) and maintain fluid intake
Priority nursing dx for diabetes mellitus include:
imbalanced nutrition, risk for self-care deficit, risk for deficient fluid volume, risk for impaired skin integrity, and risk for deficient knowledge
Site for subq injection include
abdomen, thigh, lower back, and upper arm
Why should a patient rotate injection sites?
Infrequent rotation can lead to lipoatrophy
What is the difference between Dawn phenomenon and somogyi effect
Dawn Phenomenon- 3 am glucose levels start to rise. Somogyi effect- nocturnal hypoglycemia (2-3am) with rebound hyperglycemia
If you patient doesn’t want to give himself insulin shots everyday, what are other route of admin?
continuous SUBQ infusion, implanted pump, injection devices, inhaled insulin and transdermal patch
Which do you draw up first, a clear and fast acting or a cloudy and long-acting insulin med
Clear before cloudy
Your patient has a blood glucose of <70, what are actions to bring the BS up?
diet therapy (carb replacement), drug therapy ( glucagon, 50% dextrose, diazoxide, octreotide)
If a patient has visual disturbances, what education about environmental control can you educate he or she about?
incandescent lamp, coding objects, syringes with magnifiers, and use of adaptive devices
Control of blood glucose, yearly evaluation of kidney fxn, control of blood pressure, prompt tx of UTI, avoidance of nephrotoxic drugs, diet therapy and fluid and electrolyte mgmt are all interventions for which nursing dx?
ineffective tissue perfusion: renal
You walk into the patient’s room and notice he is having kussmaul respirations. He complains of being thirsty and having to go pee 3x within the hour. You notice his breath smells like juicy fruit gum. You decide to take a set of vitals/BS check. Vitals & BS are >240 mg/dl, tachycardic, and hypotensive. What does he need STAT?
Suffering from DKA. He needs HI?E Hydration, Insulin, and Electrolyte Replacement
Nurse priorities for patient with DKA
patent airway, suctioning, cardiac monitoring, VS, central venous pressure, LABS (ABGs, BS, chem panel), admin. Of Na Bicarb, foley to monitor UO, I & O, and frequent repositioning
You are working in the ED and Charlie a patient with Type 1 diabetes comes in shaky, sweating, and anxious with palpitations. What is you first action?
Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies such as lifesavers, or 1 TBS of sugar.
Charlie has worsening symptoms and eventually becomes unconscious, as the nurse, what are your actions?
1 mg of glucagon SUBQ or IM, or 50 mL of 50% glucose IV.
Hyperosmolar Nonketotic Syndrome interventions
monitoring, fluid therapy (need to restore normal blood glucose levels w/in 36 to 72 h), IV regular insulin 10u/h
6 things every diabetic needs to know
storage and dose preparation, syringes, blood glucose monitoring, interpretation of results, frequency of testing, and blood glucose therapy goals
6 things every diabetic needs to know about diet therapy
protein, fats, carbs, fiber, sweeteners, and fat replacers; alcohol; food labeling exchange system & carb counting; special consideration for type 1 and type 2 diabetes
You are educating Timmy about what his plate should look like, what percent of carbs, fats, and proteins would you recommend?
60% carbs, 30 % fats, and 12-20% protein
5 things every diabetic should know about exercise
benefits of exercise, risks related to exercise, screening before starting exercise program, guidelines for exercise and exercise promotion
Other health teachings that you should cover include:
assessing learning needs, assessing physical, cognitive, and emotional limitations, explaining survival skills, counseling, psychosocial preparation, home care mgmt. and heath care resources.
What is the action of Biguanides and give an example
lower blood glucose by reducing the amount of glucose produced by the liver. Metformin
What do Sulfonylureas and Meglitinides do?
stimulate the beta cells of the pancreas to produce more insulin
What do alpha-glucosidase inhibitors do?
block the breakdown of starches and some sugars, which help to reduce blood glucose levels
