Diabetes

Question 1

How many Americans have diabetes ?

Answer 1

29.1 million

1 out of 4 do not know that they have diabetes

Question 2

How many Americans have prediabetes

Answer 2

86 million americans 20 years or older - more than 1 out of 3 adults have prediabetes

9 out of 10 do not know that they have prediabetes

Question 3

Without weight loss and moderate physical activity ,

Answer 3

15-30% of people will develop type 2 diabetes within 5 years

Question 4

How much higher is the risk of death for those with diabetes than those without diabetes ?

Answer 4

50% higher

Question 5

What does type 1 diabetes do physiologically ?

Answer 5

There is the destruction of beta cells of pancreas

and there is absolute insulin deficiency

Question 6

What does type 2 diabetes do ?

Answer 6

Progressive loss of beta cells of pancreas

Preceded or Accompanied by insulin resistance

Question 7

Gestational diabetes

Answer 7

develops during the 2nd or 3rd trimester of pregnancy
disease is not present prior to gestation

Risk factors

Strong family hx of type 2 DM
Obesity
Glycosuria (glucose in urine),
Prior hx of GDM or previous large-for-gestation infant

Question 8

What are the three P’s of diabetes mellitus?

Answer 8

Polydipsia
Polyuria
Polyphagia

Question 9

What is polydipsia ?

Answer 9

Excessive thirst - as glucose levels are raised in the blood, water is pulled out of the cells and this results in dehydration and thirst stimulation

Question 10

What is polyuria ?

Answer 10

Excessive urination
Glucose filtered by glomeruli exceed water reabsorption in renal tubules
Results in glycosuria and large water loss in the urine

Question 11

What is polyphagia ?

Answer 11

Excessive hunger

Depletion of cellular storage of carbs, fats, and proteins
Results in cell starvation with corresponding increased hunger

Question 12

What are signs and symptoms of diabetes Type 1 ?

Answer 12

Rapid onset 
 3 “Ps” - polydipsia, polyuria, polyphagia 
 Weight Loss
 Fatigue
 Blurred Vision
 Nocturnal Enuresis (children) (wetting the bed)
 Ketosis
Hyperglycemia

Question 13

Type 2 diabetes signs and symptoms

Answer 13

Gradual onset
 3 ”Ps” not as pronounced
 Symptoms of neuropathy
 Fatigue
Blurred Vision 
 Poor wound healing
 Prone to infections

Question 14

What is neuropathy ?

Answer 14

Weakness, numbness, and pain from nerve damage, usually in the hands and feet.

Question 15

A patient with type 2 diabetes asks the nurse what “type 2” means. The nurse explains which pathophysiologic features?

Answer 15

The liver is producing glucose abnormally during times of fasting
Over time the pancreas loses its ability to produce insulin.
There is decreased muscle and fat cell sensitivity to insulin.

Question 16

Who are the pancreatic cells involved in diabetes ?

Answer 16

Alpha cells, beta cells and delta cells

Question 17

Alpha cells

Answer 17

produce glucagon, which increases blood sugar levels

Question 18

What is glycogenolysis ? What pancreatic cell stimulates this ?

Answer 18

The transformation of glycogen to glucose.

Done by the alpha cells

Question 19

What is gluconeogenesis??

Answer 19

The transport of amino acids into the liver. This is done by the alpha cells

Question 20

Beta cells

Answer 20

Produce insulin and amylin

Question 21

What does amylin do ?

Answer 21

It increases satiety and suppresses glucagon release

Question 22

What does insulin do ?

Answer 22

Lowers serum glucose
Stimulates cellular metabolism
Promotes glucose transport
Stimulates storage of glycogen in liver and muscle
Enhances fat deposition
Inhibits protein degradation
Accelerates amino acid transport into cells and protein synthesis

Question 23

What do delta cells do ?

Answer 23

Produce gastrin and somatostatin

Question 24

What does gastrin do ?

Answer 24

Stimulates secretion of gastric juice

Response to the presence of food

Question 25

What does somatostatin do ?

Answer 25

Secreted in response to food intake, high levels of blood glucose and amino acids
Inhibits the secretion of insulin and glucagon

Question 26

What is a priority nursing action when a patient’s blood glucose level is 50?

Answer 26

Administer 15 gm of carbohydrates (orange juice, soda, milk)
IV dextrose
IM glucagon

Question 27

Long term complications of Diabetes

Answer 27

Macrovascular Damage - cardiovascular disease, hypertension and stroke

Microvascular damage - directly related to the degree and duration of hyperglycemia- retinopathy, nephropathy, sensory and motor neuropathy, autonomic neuropathy such as gastroparesis, amputations second to infections,

Question 28

What are the different types of insulin categories?

Answer 28

Short Duration: Rapid Action
Short Duration Slower Acting
Intermediate Duration
Long Duration

Question 29

What kind of insulin is Lispro(Humalog)

What is its onset, peak and duration of effect ?

Answer 29

short duration; rapid acting

Onset is 15-30 minutes
Peak is 0.5-2 hours
Duration is 3-6 hours

Question 30

What kind of insulin is regular insulin ?

Answer 30

Short Duration; slower acting 
This is unmodified human insulin
Onset is 30-60 minutes 
Peak is 1-5 hours 
Duration is 6-10 hours

Question 31

What kind of insulin is NPH insulin?

Answer 31

Intermittent duration
NPH = Neutral Protamine Hagedorn

Onset is 60 -120 minutes
Peak is 6-14 hours
Duration is 16-24 hours

Question 32

What kind of insulin is Insulin Glargine (Lantus)

Answer 32

Long Duration Insulin

Onset is 70 minutes
No Discernible Peak
Duration is up to 24 hours