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Basic Med-Surg > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What things are diabetes the leading cause of?

A

Non-traumatic amputations, blindness, end stage kidney disease

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2
Q

What does diabetes have a high rate of?

A

Cardiovascular disease, stroke, peripheral vascular disease

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3
Q

Deficiency of insulin production or usage. Results in hyperglycemia. Requires a lot of self-care management.

A

Diabetes mellitus

Area of a lot of research. Endocrinologist.

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4
Q

What is the pancreas made up of?

A

Pancreatic acini cells and islets of langerhans. Each islet consists of beta and alpha cells

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5
Q

Regulates glucose metabolism and stimulates glucose uptake. Promotes the conversion of glucose to carbohydrate glycogen.

A

Beta cells

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6
Q

Opposes the action of insulin. Stimulates the liver to break down glycogen and amino acids.

A

Glucagon produced by alpha cells

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7
Q

What two things can insulin deficiency be?

A

Can be absolute or relative

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8
Q

Explain the pathophysiology of diabetes?

A

Insulin deficiency. Glucose builds up in the blood case it cannot get into cells to be used. Leads to increased glucose levels and impaired fat metabolism. Cells end up metabolizing their own glycogen supply and breaking down protein to produce the needed engird. This alters triglycerides, fatty acid, and glycerol metabolism. Ketone bodies are formed, leading to metabolic acidosis.

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9
Q

What re the risk factors for type 1 diabetes?

A

Autoimmune disorders, genetics, environmental

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10
Q

What percent of diabetics tend to be type 1? type 2?

A

5-10% of diabetics

90-95% of diabetics

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11
Q

Usually develops before the age of thirty but may develop any time. Rapid clinical presentation. Little or no insulin available. Lean or normal body build. Weak family history.

A

Type 1 diabetes. Not so much a genetic disorder but a genetic predisposition. Insulin dependent. Positive for human leukocyte antigens (HLA).

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12
Q

What are the risk factors for type 2 diabetes?

A

Abdominal obesity. Hyperglycemia. HTN. Hyperlipidemia.

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13
Q

Usually occurs after age 30 and obese patients. Slow clinical presentation. Often seen in overweight people and those with a family history of obesity. Lack of physical exercise

A

Type 2 diabetes. History of gestational diabetes mellitus. The problem is insulin resistance or impaired insulin secretion.

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14
Q

What are the similarities between the two types?

A

Both greatly increase a person’s risk for a variety of complications. Although monitoring and management can prevent or delay complications, diabetes remains the leading cause of blindness and kidney failure.

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15
Q

Reflects the average blood glucose level over the previous 3 months. Provides objective measure of control.

A

HgbA1c (Glycosylated hemoglobin). Blood glucose readily attaches to hemoglobin.
Normal non-diabetic: 4-6%
Diabetic: goal below 7%
ADA recommends quarterly checks

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16
Q

HgbA1c blood sugar equivalents?

A
  1. 0 = 126
  2. 0 = 154
  3. 0 = 183
  4. 0 = 212
  5. 0 = 240
  6. 0 = 269
  7. 0 = 298
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17
Q

What are some common findings when diagnosing diabetes?

A

HgbA1c may be elevated. Serum lipids may be elevated. Electrolytes, especially K, will be out of balance.

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18
Q

When diagnosing in adults, what should be found for random (casual) plasma glucose?

A

> 200 plus presence of polydipsia, polyuria, polyphagia , and weight loss.

19
Q

What should fasting blood sugar be when trying to diagnose diabetes?

A

> 126 mg/dL

20
Q

What should the 2 hour post-prandial plasma glucose be when diagnosing?

A

Equal to or greater the n200 mg/dL during oral glucose tolerance test

21
Q

What added symptom is looked for when diagnosing children? In addition to what is seen in adults

A

Ketouria

22
Q

What are clinical manifestations of hyperglycemia?

A

Weight loss (type 1). Fatigue, weakness, vision changes, tingling and numbness of feet, wounds that are slow to heal.

23
Q

What clinical manifestations of hyperglycemia are seem with diabetic ketoacidosis?

A

Nausea, vomiting, ab pain. Rapid, deep respirations (Kussmaul). Acetone (fruity) breath. Dehydration (also seen with HHS).

24
Q

Blood glucose less than 70 mg/dL?

A

Hypoglycemia. Potential complication of insulin or oral meds. Occurs more often in diabetics who are on insulin.

25
Q

What may hypoglycemia in the elderly be due to?

A

Failure to recognize the symptoms. Decreasing kidney function (longer to eliminate meds). Skipping meals (decreased appetite, decreased money). Decreased visual acuity (incorrect dosing of insulin).

26
Q

How do signs and symptoms of hypoglycemia vary?

A

With the individual. With how quickly the blood glucose level falls. With other meds the patient is receiving.

27
Q

What are adrenergic clinical manifestations of hypoglycemia?

A

Pallor, diaphoresis, tachycardia, piloerection (cold, clammy), palpitations, hunger, irritability, trembling, nervousness

28
Q

What are CNS clinical manifestations of hypoglycemia?

A

Headache, confusion, circumoral paresthesia, fatigue, diplopia, blurred vision, incoherent speech, seizures, coma

29
Q

After verifying low blood glucose (<60) with a finger stick if possible, what is the treatment for hypoglycemia? If no finger stick then treat anyway.

A

If conscious, give 15g of a quick acting carbohydrate. Recheck blood sugar in 15 mins. Repeat if still <60. If unconscious do not attempt anything PO. May give 50% glucose IV.

30
Q

What are micro and macro vascular chronic complications?

A

Micro: reintopathy, nephropathy, neuropathy
Macro: Coronary artery disease, cerebrovascular disease, peripheral vascular disease

31
Q

What are complications of retinopathy?

A

Damage to the small blood vessels in the eyes. Vessels rupture. Asymptomatic. Blurred vision (spider web). Floating spots. Blindness. No smoking

32
Q

What are complications of nephropathy?

A

Affects small blood vessels in the kidneys. Kidneys cannot filter out wastes. Decreased production in urine. Number one reason dialysis. Symptoms are late to appear. Kidney function cannot be replaced.

33
Q

What are clinical manifestations of nephropathy?

A

Microalbuminuria. Elevated BUN and creatinine. Decreased urinary output. Electrolyte imbalances. Weight gain. Hypertension. Same as other patients with kidney dysfunction.

34
Q

What helps control neophropathy?

A

Good BG control. BP control (ACE inhibitor). Prevention and treatment of UTIs. Avoiding contrast dyes and nephrotoxic drugs. Low Na/protein diet. Dialysis: either hemo or peritoneal. Kidney transplant.

35
Q

What are complications of neuropathy in relation to the peripheral nervous system?

A

All extremities but esp legs. Usually bilateral and symmetric. Pain. Parasthesias. Complete or partial loss of sensitivity to touch and temp. Foot injuries and ulcerations can occur without pain. Skin sensitivity.

36
Q

Complications of neuropathy in relation to the ANS?

A

Postural hypotension. Resting tachycardia. Silent MI. Neurogenic bladder. Impotence. Nocturia. Gastroporesis (delayed gastric emptying). Anorexia. Nausea/vomiting. Persistent feeling of fullness. Can trigger hypoglycemia why delaying food absorption.

37
Q

What are the six exchange lists of the ADA diet exchange system?

A 
based on caloric level (1800 ADA). 
Starch/bread
Meat/meat subs
Veggies
Fruit
Milk
Fat
38
Q

How often should the patients monitor themselves?

A

Type 1 before meals and at bedtime, often 2-4 times a fay.
Type 2 frequency depends on the patient. Usually 2-3 times a day.
Both groups should keep a log book.

39
Q

When should ketones be tested for?

A

Blood sugar readings >300. Look in the urine, often with test strips.

40
Q

When should exercise not be performed?

A

When the blood sugar is >250 or if there are ketones in the urine.

41
Q

What should be taught to the patient along with diet and meds?

A

Check BS before, during, and after exercise. Carry easily absorbed carbs. May need to lower insulin dose. Coordinate with food intake. Check feet daily. Wear correct and well-fitting shoes. Avoid wrinkles or bunched up socks.

42
Q

What should be done on sick days?

A

BS usually goes up. Must continue to take meds. Try to continue to eat food in the normal meal plan. If cannot eat, call doctor. Stay hydrated. Check BS often. Tell a friend or family member.

43
Q

How can problems with surgery be minimized?

A

Good control prior to surgery. Schedule early in the AM. regular schedule on intake until the night before surgery. Start IV with dextrose before surgery. Give 0.5 dose of intermediate acting insulin before surgery. Should check BS during long procedures. Continue IV after surgery.

Basic Med-Surg (11 decks)

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