Diabetes Flashcards
Causes of type one
Auto-immune, idiopathic
What is usually the first sign of type one?
DKA
When you breakdown fats, you get what?
Ketones
Polyuria, think what?
Shock
How is type two discovered?
By accident when the client comes in for a wound that won’t heal or repeated vaginal infections. Not as abrupt as type one
Metabolic syndrome/Syndrome X
Insulin resistance Abdominal obesity (>40 in for male, >35 for female) Increased BP and triglycerides Decreased HDL CAD
Who should you evaluate for metabolic syndrome?
Type two
Tx for type two
First-diet and exercise
Second-oral meds
Third-insulin
Gestational diabetes
Resembles type two
Needs 2-3x more insulin than normal
Screen moms at 24-28 weeks
Screen at first visit if risk factors
Complications to the baby of gestational diabetes
Increased birth weight and hypoglycemia
Majority of calories should come from what?
Complex carbs, then fats, then protein
Daily protein for diabetics
10-20%
Diabetics tend to have what?
Renal dz
Why are diabetics prone to CAD?
Sugar destroys vessels just like fat
Fiber for diabetics
High fiber diet, keeps BS steady, they might have to decrease insulin
High fiber slows down glucose absorption in the intestines, eliminating the sharp rise/fall in BS
When do you exercise?
When BS normalizes, eat first, exercise when BS is at the highest and at the same time/amount daily
How do oral hypoglycemic agents work?
Stimulate the pancreas to make insulin or work to decrease the amount of circulating glucose
Oral diabetic meds
Glipizide, Metformin, Pioglitazone, Sitagliptin
What is the average dose of adult insulin?
0.4-1.0 units/kg/day
When is the insulin dose adjusted until?
BS is normal, no more glucose and ketones in urine
Regular insulin
Clear, standard insulin given IV, onset 30 min
NPH insulin
Cloudy, intermediate acting onset 1.5 hours, peak 4-12, duration 16-24
-novulin N, humulin N
Lantus
Clear insulin, long acting, can’t mix, given once a day, no peak, popular since there is no fluctuation of BS
Onset 2-4 hours, duration 24
Most common method of daily dosing insulin
Vasobolus
Rapid acting insulin
Never give without food, given throughout the day before meals, covers the food eaten at meals
-Novalog
Are snack required with basal.bolus insulin dosing?
No, but clients still must eat when dosing with rapid acting, so have food available
When should clients eat with insulin?
When it’s at its peak
When insulin is at its peak, the BS is what?
The lowest
Will you see metabolic acidosis/DKA with type two?
No, they make enough insulin to keep from breaking down fats for energy
HbA1c
Gives an average of BS over past 3 months
What should diabetics’ HbA1c be?
4-6% or less
Diagnostic HbA1c level for diabetes
6.5-7%
What does BS do when you’re sick or stressed?
Increase, normal action to help you fight the illness, normal pancreas can handle these fluctuations
Illness, think what?
DKA
Insulin infusion pumps
Alternative to daily injections, only rapid acting, better control of BS by getting a basal (continuous) level of insulin and boluses as needed with meals or if they have an increase in BS
What is the only insulin that can be given in IV fluids as an IV infusion?
Regular
What is the only insulin given as a subq infusion pump?
Rapid acting
S/S of hypoglycemia
Cold/clammy HA Shaky Nervous Nausea Increased HR Confused
What should the hypoglycemic pt do?
Drink or eat a simple sugar, once BS is up, eat a meal
Glucose absorption is delayed in what foods?
Fats
How to treat a passed out client with hypoglycemia
D50W (hard to push, use large bore IV)
Injectable glucagon-used when there is not IV access, it’s IM
Put sugar under their tongue
Food choices for hypoglycemia
4-6 oz of orange juice, apply juice, coke, milk, raisins, NOT chocolate or cookies
S/S of DKA
Polyuria, polydipsia, polyphagia
Fat breakdown leads to acidosis
Kussmaul’s respirations to blow off CO2 to compensate for metabolic acidosis
As the pt becomes more acidotic, the LOC goes down
Treatment of DKA
Hourly BS and K
IV insulin
ECG
Hourly outputs (polyuria causes shock)
ABGs
IVFs-start with NS, then when BS is about 300 switch to D5W to prevent throwing them into hypoglycemia
Doc will want to add K to their solution at some point
Hyperosmolar Hyperglycemic Nonketosis (HHNK)
Happens only to type two
Looks like DKA, but no acidosis
Making just enough insulin to not break down body fat so no ketones or acidosis, no kussmaul’s
IV insulin causes what?
Hypoglycemia and hypokalemia
Problems with neuropathy
Sexual problems: impotence/decreased sensation
Foot/leg pain/paresthesia/numbness
Neurogenic bladder: doesn’t empty properly, empties spontaneously, retention
Gastroparesis: stomach emptying is delayed, aspiration
Risk for infection
Nephropathy-end up on dialysis
Retinopathy-eyes are very vascular
How should the diabetic cut their toenails?
Straight across
