Diabetes Flashcards
s/s of type 1 Diabetes
abrupt s/s. polyphagia, polydipsia, polyuria, wt loss & fatigue. children: severe diaper rash
What does a person need to have in order to be placed on insulin therapy
BS over 250, HA1c over 9%, ketoacidosis
Pediatric dietary changes
15% Protein, 30% fat, 55% Carbs
Pediatric BS should be no higher than ___ before meals and ___ at night
120; 100-140
During Ketoacidosis, what will your BS be? your ph, bicarbonate level, & K+, Na+ and Cl- levels? and what will have to the extracellular fluid?
BS=250 or higher, ph=7.35, bicarb ll have serum and urine ketones, Extracellular fluid will be depleted (K+ will come out of cell and be lost in urine).
Ketoacidosis s/s
slow onset, increased thirst and urination, high BS, weak, vomiting, abdominal pain, Kussmal breathing, fruity breath
Ketoacidosis treatment
Initally you give NS IV then once their fluid balance comes back, they will give 1/2 NS then they will be put on an insulin drip until glues=250 then they are put on dextrose & sliding scale
critically ill patients should keep BS around?
110
Non critally ill patients should keep BS around
<126
Things that can lower bs
exercise, stimulants, salicylates, alcohol
hypoglycemia BS range
<45-60
15g of rapid acting sugar that you can give to someone who is hypoglycemic
1/2 fruit juice, 3 glucose tabs, 3 tsp sugar/honey, 6 crackers, 8 oz skim milk
<50 BS means that the person is
severe hypoglycemic
Dawn phenomenon
Rise in BS between 4am-8am in both type 1&2
Somogyi effect
occurs with long acting insulin. No bedtime snack, normal or elevated BS at bedtime then low BS at 2-3am then high BS in am
Hyperosmolar Hyperlycemic Nonketotic syndrome means?
a severe dehydrated state with an increase in glucose level and normal pH (they aren’t spilling ketones)
Hyperosmolar Hyperlycemic Nonketotic syndrome s/s
BS >600, extreme thirst, dry mouth, decreased BP, increased P, fever over 101, blurred vision, NO kussmal breathing, NO ketones in urine, No fruity breath. There is NO metabolic acidosis.
Hyperosmolar Hyperlycemic Nonketotic syndrome treatment
Establish/maintain ventilation, correct/maintain electrolytes, K+ replacement, insulin until BS is at 250
Insulin is used to treat what other than diabetes?
hyperkalemia, its given IV
Rapid Acting Insulin examples
Lispro(Humalog), Aspart (Novolog), Apidra (Glulisine)
Lispro(Humalog), Aspart (Novolog), Apidra (Glulisine) are what kind of insulin?
Rapid acting
Rapid acting works in how many minutes? when does it peak? How long does it last?
works in 5-15 mins, peaks in 40-50 mins and lasts 3-5 hours
Regular or short acting insulin examples?
Regular (Humalin R)
Regular or short acting insulin works in how many minutes? when does it peak? How long does it last?
works in 30 minutes, peaks in 2-3 hours and lasts 4-6 hours
Intermediate insulin examples
NPH (Humalin N)
Intermediate insulin works in how many hours? when does it peak? How long does it last?
works in 2-4 hours, peaks in 6-8 hours and lasts 12-16 hours.
Long acting insulin examples
Levemir (Detemir) & Lantus (Glargine)
Levemir (Detemir) & Lantus (Glargine) are what kind of insulin?
long acting
Long acting insulin works in how many hours? when does it peak? How long does it last?
works in 2 hours, peak continuous and lasts 24+ hours.
Combination insulin works in how many minutes? when does it peak? How long does it last?
works in 30 minutes, peaks in 4-8 hours and lasts 24 hours
Patients with Continuous subcutaneous insulin infusion (CSII) use what kind of insulin?
Rapid acting
Can long acting Lantus be mixed?
no
How long are prefilled syringes good for in stored in fridge?
30 days
CHO=__cal/gram Protein=__cal/gram Fat= __cal/gram
CHO=4cal/gram, Protein= 4 cal/gram, Fat=9 cal/gram
1st generation Sulfonlureas can increase the chance of what disease?
cardiovascular disease
2nd generation Sulfonlureas are excreted where?
in the urine and bile
Do 2nd generation Sulfonlureas have a long or short duration of action?
long
Sulfonlureas action
stimulate insulin release & improve binding to insulin receptors
Sulfonlureas adverse effects
Hypoglycemia, wt gain and sun sensitivity
Glimepiride (Amaryl), Glyberide (DiaBeta/Micronase), Glipizide (Glucotrol XL) & Glyburide (Glynase PresTab) are examples of?
second generation Sulfonylurea drugs
Biguanides action
decrease amount of glucose formed in liver, makes muscle tissue more sensitive to insulin
Biguanides are taken when?
taken two times a day
A Biguanides medication
Metformin (Glucophage)
What medication needs to be held if a cat scan is needed?
Metformin (Glucophage)
Risk factors for Gestational Diabetes/
Family history, Older maternal age, decreased physical activity, obesity, high blood pressure, high cholesterol,
If you are at high risk for GD when is oral glucose tolerance test done? If you are not at high risk, when is test done?
High risk = first prenatal visit, Not high risk = 24-28 weeks
1st trimester, does mom need extra insulin? what are the risks for mom and baby during this time?
No, hypoglycemia is the biggest risk for mom and hyperglycemia is the biggest risk for baby
what happens during 2nd & 3rd trimester with insulin needs and baby?
mom needs extra insulin, baby will produce its own insulin. Baby will get more glucose than needed from mom and it will be stored as fat. After birth, baby is at risk for hypoglycemia because it will be producing insulin but it will not be getting the same amount of glucose from mom
Risks to baby during 1st trimester?
congenital anomalies if mom is having extreme highs and lows
Risks to baby during 2nd & 3rd trimester?
increased amniotic fluid, increased subcutaneous fat deposits & cephalopelvic disproportion (head is too big to fit out of pelvis)
Babies are at risk for what after birth?
hypoglycemia, Respiratory distress syndrome (hyperglycemia delays lung maturity), hypocalcemia, hyperbilirubinemia, may have depressed ABGAR score after 5mins
During labor and delivery glucose should be between?
70-110
mothers glucose level should return to normal after L&D after how many hours? what if they have type 1 or type II?
24; if they have type 1 or type II it will take a few days or a month to return to pre-pregnant levels
does breast feeding increase or decrease the need for insulin?
decreases
s/s of hypocalcemia in baby
jittery, irritable and may have seizures
What do you want your A1C score to be? what will your score be if you are a pre-diabetic or you have diabetes?
Normal =less than 6%, Pre-diabetic = 5.7%-6.4%, Diabetic=6.5% or higher
Glucose tolerance test
NPO for 10 hours, hold meds that alter BS. you drink oral glucose and blood and urine is collected at 30 mins, 1 hr, 2 hr and maybe at 5 hrs. no smoking/caffeine/alcohol/food, can drink water.
Factors that effect a blood sugar test
not enough blood on test strip, acetaminophen, ascorbic acid, ibuprofen, aspirin, tetracycline, increased triglycerides
Adult dietary changes
25-35% but less than 7% saturated fats, 12-20% Protein, 45-60% carbs (whole grains etc)
Caloric requirements are based on what?
age, sex, height, activity level
Maternal Fasting glucose should be between what after 2 hrs after eating?
95-100
