Diabetes Flashcards
1
Q
What is diabetes usually caused from?
A
Obesity- bad diet and no exercise
2
Q
What is diabetes characterized by?
A
Hyperglycemia
3
Q
What defects is diabetes caused by?
A
Defects in:
Insulin secretion, insulin action or both
4
Q
What portion of diabetes cases are undiagnosed?
A
one third
5
Q
In terms of diabetes:
Minority populations and older adults are…
A
Disproportionately affected
6
Q
In patients with diabetes:
What needs to happen to the patients insulin and glucagon levels?
A
Insulin levels need to be increased and glucagon levels need to be decreased.
7
Q
What does insulin (beta) mainly do?
A
Moves glucose from blood into cells
8
Q
What does insulin inhibit?
A
It inhibits the breakdown of stored glucose, protein and fat
9
Q
What does insulin accelerate?
A
It accelerates transport of amino acids into cells
10
Q
What does insulin enhance?
A
It enhances storage of dietary fat in adipose tissue
11
Q
What does insulin stimulate?
A
It stimulates storage of glucose in the liver and muscle as glycogen
12
Q
What does insulin transport and metabolize?
A
It transports and metabolizes glucose for energy
13
Q
When is glucagon (alpha) released?
A
When serum glucose decreases
14
Q
Glucagon stimulates what?
A
It stimulates glycogenolysis in the liver
15
Q
Glucagon increases what?
A
Increases formation by liver of glucose from noncarbohydrate sources
16
Q
Gluconeogenesis is described as?
A
The formation of glucose from noncarbohydrate sources
17
Q
Type 2 diabetes affects what percentage of patients diagnosed with diabetes?
A
90 to 95%
18
Q
Type 1 diabetes affects what percentage of patients diagnosed with diabetes?
A
5-10%
19
Q
Gestational Diabetes affects what percentage of pregnancies?
A
2-5%
20
Q
What happens to a patient’s risk of diabetes if they come down with gestational diabetes?
A
it increases
21
Q
What are the two things that occurs in a patient if they are diagnosed with type 2 diabetes?
A
A decreased sensitivity to insulin and impaired secretion of insulin
22
Q
What secondary diagnosis does a patient frequently have if they have type 2 diabetes?
A
Hypertension
23
Q
What is type 2 diabetes initially treated with?
A
Diet and exercise
24
Q
What type of medication is a patient with type two diabetes initially put on?
A
A pill form of hypoglycemic agents.
25
If the pill form of hypoglycemic agents doesn't work then a patient with type two diabetes will likely be put on?
Insulin
26
What age group is type two diabetes increasing in?
Children
27
Impaired insulin secretion from the pancreas and increased basal hepatic glucose production leads to what?
Hyperglycemia
28
Gastrointestinal absorption of glucose and decreased insulin-stimulated glucose uptake in the muscle leads to what?
Hyperglycemia
29
Patients who are thirty years of age or older are at a higher risk for what?
Type 2 diabetes
30
What BMI are patients of the Asian American decent at a higher risk for type 2 diabetes?
greater than 23
31
What races have an increased risk of type two diabetes?
African Americans, Hispanics, Native Americans, and Alaskan Natives
32
Metabolic syndrome is a risk factor for what?
Type 2 diabetes
33
Hypertension, elevated triglyceride, and decreased HDL are risk factors for what?
Type 2 diabetes
34
What disease is a patient at risk for if they have polycystic ovary syndrome?
Type 2 diabetes
35
What are the two things a patient typically goes to the doctor for and end up being diagnosed with type 2 diabetes?
An eye issue or a wound that won't heal
36
What does polydipsia mean?
Increased thirst
37
What does polyphagia mean?
Increased hunger
38
Does type 2 diabetes have a slow or fast onset of clinical manifestations?
Slow
39
Skin infections, blurred vision, fatigue, paresthesias, polydipsia and polyuria are all clinical manifestations of what?
Type 2 diabetes
40
History of Hypertension and obesity could potentially lead to what?
Type 2 diabetes
41
What do you need to include when taking vital signs in a patient suspected of having type two diabetes?
Orthostatic blood pressure
42
In a patient who has type two diabetes what happens when taking orthostatic blood pressure?
It takes 10-15 minutes for brain to regulate so their BP will be different each time.
43
During a physical exam:
| What would be happening to the skin that would suggest the patient has type 2 diabetes?
The back of their neck turns dark and looks dirty. Due to a fungal infection.
44
When doing an eye exam on a patient suspected to have type 2 diabetes what must you make sure you use?
A fundoscope
45
When doing a physical exam on a patient who is suspected to have type 2 diabetes: what should you make sure you do when checking out their feet?
Check their pedal pulses and reflexes.
Check for sensation in their feet to rule out neuropathy.
Check for any wounds that aren't healing.
46
When checking the patients hemoglobin A1C- what levels would diagnose them with diabetes?
Greater than or equal to 6.5%
47
What is a bench mark diagnostic test for a patient with diabetes?
Hemoglobin A1C
48
During an oral glucose tolerance test: what would diagnose a patient with diabetes?
If their two hour plasma glucose was anything over 200
49
If a patient has a fasting glucose of this they are a diabetic.
126 or greater
50
What does FPG stand for?
Fasting Plasma Glucose
51
What is a normal FPG?
Less than 100
52
What is an impaired FPG?
Greater than 100 but less than 126
53
If a patient has an impaired FPG what would they be classified as?
Prediabetic
54
What is a microalbuminuria?
A urine test for albumin
55
If a patient has a positive microalnuminuria what does that mean and what will the doctor ask for?
It means they are dumping albumin in their urine and a doctor will likely ask for a 24 hour urine test.
56
The first treatment for type 2 diabetes is what?
Life style modifications of their diet, exercise, and weight control.
57
If a patient cannot control their type 2 diabetes through life style modifications what is the next step?
Pharmaceuticals
58
If a patient is able to lose just this percentage of their original weight it will have a BIG effect on their diabetes.
10%
59
One of the dietary management goals for type 2 diabetes is to pace food intake throughout the day. What does that mean?
Small meals to maintain blood sugar. Typically 3 meals with 3 small snacks.
60
Why is it so important for a patient with type two diabetes to maintain their blood pressure in a normal range?
Anything abnormal going on in the body increases stress which will increase the body's blood sugar.
61
What is the best way for a patient to assess their diet history and make sure they meet caloric requirements throughout the day?
By keeping a diet journal.
62
How many grams of fiber should a patient with diabetes have per day?
25 g
63
What percentage of fat can a patient with diabetes have?
20-30%
64
A patient with diabetes should have less than what percentage of saturated fat per day??
Less than 10%
65
What percentage of protein should a patient with diabetes have per day?
10-20%
66
How many milligrams of cholesterol a day should a patient with diabetes have?
Less than 300 mg
67
A patient with diabetes should have what percentage of carbohydrates a day?
50-60%
68
What type of carbohydrates should a patient focus on consuming throughout the day?
Whole grains
69
What food groups should you combine to slow absorption and glycemic response?
Starchy foods with protein and fats
70
What types of foods tend to lower glycemic index?
raw or whole foods
71
Why should you eat whole fruits rather than juices if you have diabetes?
Whole fruits decrease glycemic response because of their fiber-slowing absorption.
72
Consuming ETOH on an empty stomach causes what?
Hyperglycemia
73
If a patient sticks to a ROUTINE exercise regimen what can happen with their blood sugar?
It can help maintain it.
74
Where is the best spot to administer insulin when giving it to a patient in the hospital?
The back of the arm due to the patient not being able to reach it.
75
If you have diabetes what are you four more times likely to die from?
Cardiovascular complications.
76
What do hypoglycemic agents do?
- Stimulate or increase insulin secretion
- Prevent breakdown of glycogen to glucose
- Make cells less resistant to insulin
77
What are the two acute complications with diabetes?
- Hypoglycemia
| - Hyperglycemic hyperosmolar syndrome (HHS)
78
If a diabetes patient experiences nausea, vomiting, or diarrhea what could happen to their blood sugar?
They could become hypoglycemic.
79
Hypoglycemia is characterized by?
Abnormally low blood glucose levels
| -below 50-60.
80
What are the adrenergic symptoms of hypoglycemia?
- Sweating
- Tremors
- Tachycardia
- Palpitations
- Nervousness
- Hunger
81
What are the central nervous system symptoms of hypoglycemia?
- Inability to concentrate
- Headache
- Confusion
- Memory Lapses
- Slurred speech
- Drowsiness
82
Severe hypoglycemia has symptoms of:
- Disorientation
- Seizures
- Loss of consciousness
- Death
83
If a patient can swallow:
| What would you give them if they are having a hypoglycemic episode?
15 g of rapid acting sugar
| -half of a cup of juice, 8 oz of skim milk, 3 glucose tabs
84
If a patient cannot swallow:
| What two things would you give them if they are having a hypoglycemic episode?
50 ml of 50% D50 solution.
-10 ml per minute IVP
Glucagon
85
How long should a patient be monitored after having a hypoglycemic episode?
24 hours
86
What is the 15/15 rule?
If a patient is having a hypoglycemic episode:
| Give 15 g of rapid-acting sugar then check blood sugar after 15 minutes. If still low repeat the process.
87
If giving a patient orange juice due to a hypoglycemic episode what should you be careful of?
Heart or renal problems.
88
Why would a patient become dehydrated if they are experiencing osmotic diuresis?
Because they are getting rid of urine but no sodium becoming severely dehydrated.
89
How is hyperosmolar hyperglycemic syndrome described?
Blood glucose levels greater than 600 mg/dL from lack of sufficient insulin.
90
What are the precipitating factors of hyperosmolar hyperglycemic syndrome?
Infection or illness
91
What results from hyperosmolar hyperglycemic syndrome?
Severe dehydration with increase in serum sodium.
92
True or false:
| It is no big deal if a patient has hyperosmolar hyperglycemic syndrome?
False:
| It is serious and life-threatening.
93
What are the symptoms of hyperosmolar hyperglycemic syndrome?
- Altered level of consciousness
- Neuro deficits
- Coma from cerebral dehydration
- Hypotension
- Tachycardia
- Dry skin and mucous membranes
- Extreme thirst
94
What is the treatment for hyperosmolar hyperglycemic syndrome?
- Correct fluid and electrolyte imbalances
| - Lower blood sugar levels with insulin
95
Chronic complications from diabetes alter what system in the body?
Cardiovascular
96
What types of macrovascular complications can result from diabetes?
- Earlier onset of atherosclerosis
- CAD
- Carotids
- PAD
97
What types of microvascular complications can result from diabetes?
- Retinopathy
| - Nephropathy
98
What is a common comorbidity associated with chronic complications from diabetes?
Hypertension
99
If a patient has diabetic retinopathy what are they at an increased risk for?
Cataracts
100
How is diabetic retinopathy described?
Retinal ischemia and breakdown in blood-retinal barrier that can lead to blindness.
101
How is diabetic nephropathy described?
Thickening of basement membrane of glomeruli, impairing renal function.
102
What does diabetic nephropathy allow to happen?
It allows protein to be lost in the urine resulting in microalbuminuria
103
What does hypertension do to nephropathy?
It accelerates it
104
What class of drugs is used to control hypertension in relation to nephropathy?
ACEIs
105
What is the number one education topic for a patient with type 2 diabetes?
Proper foot care!
106
When should a patient with diabetes wear closed toed shoes?
ALL the time even around the house.
107
When a patient with diabetes is taking care of their feet what should they do?
- Get up and look at them once per day
- Wash feet daily
- Wear closed toed shoes at all times
- Check shoes everyday before putting them on.
108
True or false:
| There is only alterations in the peripheral nervous system in a patient with diabetes?
False:
| A patient can experience alterations in both the peripheral and autonomic nervous systems.
109
Where do peripheral neuropathies due to diabetes normally start at?
In the feet
110
What symptoms do patients have when experiencing distal paresthesias due to peripheral neuropathies?
- Pain
- Cold feet
- Tingling
- Numbness
- Impaired sensations of pain, temperature, light touch, and vibration.
111
What symptoms do patients have who are experiencing autonomic neuropathies?
- Sweating
- Abnormal pupillary function
- Cardiac dysfunction
- GI motility dysfunction
- GU dysfunction
- Hypoglycemic unawareness
- Sexual dysfunction
112
Why are patients with diabetes more likely to have a UTI?
Due to urinary retention
113
If a patient with diabetes needs to have what once per year to make sure they don't have retinopathy or to make sure that it has not progressed.
A blood dilated eye exam
114
Why do patients with diabetes have an increased risk for dementia?
Due to autonomic neuropathies
115
Why would a patient with diabetes have to go to a dentist more often?
Because periodontal disease progresses more rapidly in these patients.
116
What types of alterations in mood could patients with diabetes experience?
- Strains of living with complex self-care
- Risk of depression and anxiety
- Increased risk of dementia
117
Patients with diabetes have an increased susceptibility to infection. What types of complications could arise from this?
- Vascular, neurological impairments
- Nephrosclerosis
- Urinary retention
- Bacterial and fungal skin infections
118
What is the most common complication a patient with diabetes will experience?
Complications involving feet
119
What are the most common traumas in the feet that a patient with diabetes can experience?
- Cracks of fissures from dry skin
- Blisters or pressure ulcers
- Ingrown toenails
120
When a patient with diabetes develops an ulcer- what typically happens?
It begins as superficial and extends deeper.
121
What are the nursing diagnoses associated with diabetes?
- Knowledge deficit
- Risk for infection
- Risk for injury
- Risk for impaired skin integrity
- Ineffective coping
