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nurse 251 > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

what is diabetes mellitus?

A

Diabetes is a multisystem disease related to abnormal insulin production, impaired insulin utilization or both.

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2
Q

what is insulin?

A

a hormone produced by the B cells int he islets of Langerhans of the pancreas

  • in continuously released in the bloodstream in small pulsatile increments with increased release when food is ingested
  • normal glucose range is 4-gmmol/L
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3
Q

what is type 1 diabetes?

A

results from progressive destruction of pancreatic B cells

  • manifestations develop when the persons pancreas can no longer produce insulin
  • Cardinal symptoms include weight loss, polydipsia (excessive thirst), polyuria (frequent urination) and polyphagia (excessive hunger)
  • these ppl will always need insulin
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4
Q

what type of ppl get diabetes type 1?

A
  • most often occur in ppl who are younger than 30

- typically seen in ppl with a lean body type

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5
Q

what Is prediabetes?

A
  • Prediabetes is when your blood glucose levels are too high, but not high enough to be called diabetes.
  • is noted when a fasting or 2hr plasma glucose level is higher than normal (7.1-11mmol/L)
  • ppl with prediabetes usually dont have symptoms
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6
Q

what might already be occurring in the body with a person who has prediabetes?

A

long term damage to the body, especially the heart and blood vessels, may already be occurring in patients with prediabetes

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7
Q

what can reduce the risk of developing actual diabetes with a person who has prediabetes?

A
  • maintain a healthy weight
  • exercising regularly- biggest thing to maintain blood sugar
  • eating a healthy diet
  • using medication when requires
  • reduces chance of developing DM by 58%
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8
Q

what is type 2 diabetes?

A
  • the pancreas usually continues to produce some insulin, but the insulin produced in insufficient for the needs of the body or is poorly utilized by the tissues or both
  • muscle is unable to use glucose due to insulin resistance = increase blood glucose
  • person may go for many years with undetected hyperglycemia
  • disease onset is usually gradual
  • usually diagnosed on routine labs
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9
Q

what charactericts present with a diagnosis of type 2 diabetes?

A
  • occurs in ppl older than 35
  • 80-90% are overweight at the time of diagnosis
  • 3X higher in ppl with schizophrenia, this is presumably due to high sugars in the antipsychotics
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10
Q

What is gestational diabetes?

A
  • develops during pregnancy
  • detected between 24 and 28 weeks gestation
  • nutritional counseling is considered to be the first line therapy
  • if nutritional counselling alone does not achieve target fasting, or after-eating blood glucose levels or both, insulin therapy is usually indicated.
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11
Q

what test is used in determining glycemic control over time?

A

Hemoglobin A1C test

  • works by showing the amount of blood glucose that has been attached to hemoglobin molecules, which are attached to the red blood cells for the life of the cell (120 days)
  • A1C test indicated the overall glucose control for the previous 90-120 days
  • normal range in 6% or less
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12
Q

what are the goals of Diabetes managment?

A
  • promote well being
  • reduce symptoms
  • prevent acute complications of hyperglycemia and hypoglycemia
  • delay the onset and progression of long-term complications
  • nutritional therapy
  • excersise
  • self monitoring of blood glucose
  • drug therapy
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13
Q

what are oral antihyperglycemic agents?

A
  • are not insulin, but the work to improve the mechanism by which insulin and glucose are produced and used by the body
  • primary action is to reduce glucose production by the liver
  • does not promote weight gain
  • for type 2, NOT type 1 (only use insulin)
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14
Q

what is the first line medication for most ppl with type 2? (that is a oral antihyperglycemic agent)

A

Metformin (Glucophage)

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15
Q

what is exogenous (injected) insulin always required for the managment of?

A

type 1 diabeties

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16
Q

what might insulin requirement increase during periods of?

A

severe stress, such as illness or surgery

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17
Q

what to insulins differ in regard to?

A

onset, peak action and duration

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18
Q

how many injections of insulin per day?

A

1-4 injections

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19
Q

what does exogenous (injected) insulin regime most closely mimics endogenous (body made) insulin?

A

basal-bolus regime, which uses rapid or short acting (bolus) insulin before meals and intermediate- or long acting (basal) background insulin once or twice a day

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20
Q

what is Lantus?

A

a 24 hours insulin with no peaks

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21
Q

what is the difference between basal and bolus insulin?

A

Basal insulin, also referred to as background insulin, regulates your glucose levels in between meals, and bolus insulin is extra insulin needed to manage your glucose levels after a meal.

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22
Q

what is mealtime insulin (bolus)

A
  • synthetic rapid acting insulin
  • onset is 10-15 min
  • rapid-acting insulin is considered to be the type that best mimics natural insulin secretion in response to a meal
  • should be administered 15 min BEFORE MEAL
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23
Q

benifits of bolus insulin?

A
  • decreased post-meal hyperglycemia
  • decreased hypoglycemic episodes
  • increased flexibility compared to regular insulin
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24
Q

what is long acting insulin?

A
  • glargine (lantus) is an extended long-acting basal insulin that are released steadily and continuously over 24 hours
  • may be used in type 1 and type 2
  • because the lack a peak action time, the risk for hyperglycemia is greatly
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25
Q

when might a diabetic patient be hypoglycemic?

A

pt will be hypoglycemia at peak of insulin if the dont eat

-always go back and check on pts after insulin administration and check their food tray for how much they ate

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26
Q

onset of rapid acting?

A

15 min

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27
Q

onset of short acting?

A

30min-1hr

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28
Q

onset of intermediate acting?

A

1-2 hour

29
Q

onset of long acting?

A

1-4 hours
or
2-4 hours

30
Q

why cant insulin be taken orally?

A

because it is inactivated by gastric juices

31
Q

where is insulin absorbed the fastest?

A

1st: abdomen
2nd: Arm
3rd: thigh /buttock

32
Q

should you rotate injection sites for insulin?

A

no, instead rotate injection sites within one particular site, such as the abdomen

33
Q

what is an insulin pump?

A

a continuous subcutaneous insulin infusion of rapid acting insulin 24 hours a day, known as basal rate

  • evert 2-3 days the injection site is changed
  • at mealtime, the user programs the pump to deliver a bolus infusion of insulin appropriate to the amount of carbs digested
  • major advantage is reduction of hypoglycemic episodes
  • these are common especially in type 1
34
Q

nutritional therapy for diabetes?

A
  • eating three times a day at regular times and eating at intervals no more than 6 hours apart
  • limiting sugars and sweets such as sugar, regular pop, deserts, candies, jam and honey
  • limiting high-fat foods such as fried foods, chips, and pastries
  • eating MORE high-fibre foods (whole grain bread, cereals, lentils, died beans and peas, brown rice, fruits and veggies)
  • drink water if thirsty
  • adding physical activity to lifestyle
  • low carb diets are not recommended for DM managment
35
Q

what is glycemic index?

A
  • is the term used to describe the rise in blood glucose levels after a person has consumed carbohydrates containing food
  • food with high GI (potatoes, white bread) will cause a sharp rise in blood glucose, whereas those with low GI (eg, brown rice) steadily increase blood glucose over a longer period.
  • tell them to eat carbs with a low GI
  • dont eat anything white
36
Q

what can cause severe hypoglycemia?

A
  • alcohol - high in calories
  • the inhibitory effect of alcohol on glucose production by the liver can cause severe hypoglycemia in pts taking insulin or OHA that increases insulin secretion
  • should limit to 1-2 drinks per day
  • a pt can reduce risk for alcohol induced hyperglycemia or hypoglycemia by taking alcohol with food, using sugar free mixes, and drinking light wines
37
Q

what is a essential part to DM and prediabetes managment?

A

exercise

38
Q

how much exercise should a person with DM get?

A

at least 150 min of moderate-intense aerobic activity- such as brisk walking, cycling, or dancing each weak, spread over at least 3 days
-strenuous activity can be perceived the body as stress and results in a temporary elevation of blood glucose

39
Q

what is important to check when u have diabeties?

A

blood glucose - provides “real time” blood glucose reading

40
Q

is there an invasive blood glucose monitor?

A

yes, called the Medtronic MiniMed, uses a sensor under the skin, it displays glucose values continuously with updated values occurring every 5 min

  • the patient is altered during episodes of hypoglycemia and hyperglycemia, allowing corrective action to be taken quickly
  • if pt says blood sugar is 200 (American value), divide by 18
41
Q

what can emotion and physical stress, illness, injury, and surgery cause?

A

hyperglycemia

42
Q

what should a nurse do with a pt with DM who is ill in a hosptial?

A

continue taking OHA’s and insulin as prescribed but check blood sugar q4hr around the clock

43
Q

what should the pt do if they are unable to keep anything down, or if vomiting occurs twice in 12 hrs?

A

pt should go to emergency department

44
Q

what should be administered immediately before major surgery (type 1 and type 2)

A

Iv fluids with dextrose and insulin are immediately administered before and after surgery

45
Q

what happens to a person with DM when they are sick?

A

more insulin is being produced, and have increased metabolic demands

46
Q

what should pts undergoing surgery or radiological procedure involving contract medium be instructed to do?

A

-hold thier Glucophage at the time or before the procedure, they will also be instructed to no resume Glucophage until 48 hours after surgery or until after creatinine has been checked.
(contrast and Glucophage (metformin) is very hard on kidneys, risk of kidney injury)

47
Q

what are some personal hygiene complications that can result?

A

the potential for microvascular complications and infections necessitates thorough skin and dental hygiene practices on the part of the patient
-routine care should include an emphasis on foot care, including daily assessments of the feet (bottoms of feet and in-between toes)

48
Q

what is diabetic ketoacidosis?

A

DKA- an acute complication of DM occurring when dats are metabolized in the absence of insulin

  • caused by profound deficiency of insulin
  • characterised by hyperglycemia, ketosis, metabolic acidosis and dehydration
  • most often seen in ppl with type 1
49
Q

what occurs in the body when pt has DKA?

A
  • decrease insulin or no insulin
  • cells use fatty acids instead of sugar because in order for sugar to get into cells they need insulin
  • sugar remains outside of cell in blood stream
  • using fatty acids lead to production of ketones which are acidic
  • pt now has metabolic acidosis (low bicarb and pH)
  • hyperkalemia occurs because of acidosis
  • as blood sugar rises it leads to osmotic diuresis
  • cells get dehydrate
  • polyuria- peeing out ECF
  • increased creatinine
  • renal failure
50
Q

what is most affected in DKA?

A

potassium

  • because it is pushed out of cells so serum K+ is high initially
  • once it is pissed out, depleted quickly
  • potassium moves out because Hydrogen moves into cell due to acidosis (to dilute blood stream)
  • renal failure will eventually occur from hypovolemic shock
51
Q

clinical manifestations of DKA?

A
  • polyuria and polydipsia leading to dehydration
  • tachycardia and hypotension
  • poor skin turgor, dry mucous membranes, tachycardia and orthostatic hypotension
  • nausea and vomiting are common
  • kussmauls respirations (rapid, deep breathing) -body attempt to revere metabolic acidosis
  • breath is sweet, fruity odour
  • ketones in blood and urine
52
Q

interventions for DKA?

A
  • IV fluid and electroyle replacement
  • Early potassium replacement is key since hypokalemia can result in death
  • Insulin needs to be held until potassium in around 3.3mmol/L because insulin allows water and potassium to enter the cell along with glucose and can lead to a depletion of glucose, vascular volume and hypokalemia
53
Q

what is the least concerning in DKA?

A

blood sugar

54
Q

what can fast administration of IV fluids cause?

A

cerebral edema which can lead to hypoxia

55
Q

nursing managment for DKA?

A
  • responsible for monitoring blood glucose every hour and urine output and ketones as well as lab data
  • monitoring administration of IV fluids to correct dehydration
  • insulin therapy to reduce blood glucose and serum ketones
  • electrolytes to correct electroyle imbalance
  • assessment of renal status
  • monitoring levels of conciousness
  • if u have a DKA pt, advocate for urself, they are a lot of work
56
Q

normal urine output?

A

30-60ml per hour

57
Q

what is hypoglycemia?

A
  • low blood glucose
  • occurs when there is too much insulin in proportion to available glucose in blood
  • blood glucose is less than 4mmol/L
  • Diaphoresis, tremors, hunger, nervousness, anxiety, palpitations, irritability, visual disturbances, difficulty speaking, confusion, and coma
58
Q

what is hypoglycemia caused by?

A

-caused by administration of too much insulin, insufficient carbs, delay the tine of eating, and performing unusual amount of exercise

59
Q

treatment of hypoglycemia?

A
  • ingesting 15 to 20g of simple (fast acting) carbs, such as a 175ml fruit juice or regular soft drink
  • tx with sweet foods containing fat should be avoided because fat will slow down absorption of sugar and delay tx response
  • avoid overtreatment to prevent hyperglycemia
  • recheck blood glucose in 15 after tx
  • repeat tx if blood glucose is less than 4mmol/L
  • once the blood glucose is greater than 4mmol/L, pt should eat a snack
60
Q

what is diabetic retinopathy?

A
  • process of microvascular damage to blood vessels in the retina as a result of chronic hyperglycemia, presense of nephropathy and hypertension in pts with DM
  • most common cause of new cases of blindness in pp of working age
  • pt with diabetes must have regular dilatated eye exam by an ophthalmologist for early detection and tx
61
Q

what is diabetic NEPHROpathy?

A
62
Q

what is achieved when near-normal blood glucose control is achieved and maintained?

A

kidney disease can be significantly reduced

63
Q

what are prescribed to pts with DM to help protect the kidneys?

A

-ACE inhibitors are often prescribed to patients with DM even when they are not hypertensive because they have protective effects on the kidneys that prevents the progression of diabetic nephropathy independent of hypertension control

64
Q

what is diabetic neuroPATHY

A
  • is nerve damage that occurs because of the metabolic derangements associated with DM
  • can lead to loss of protective sensation in the lower extremities and increases the risk for complications that can result in lower limb amputation
  • includes abnormal sensations, pain, loss of sensation, tingling, burning and itching
65
Q

what is the tx of diabetic neuropathy?

A
  • control of blood glucose

- tricyclic antidepressants are also moderately effective in tx of symptoms

66
Q

what is the most common cause of hospitalization in ppl with DM?

A

complications of feet and lower extremity

67
Q

what does neuropathy prevent?

A

prevents the pt from becoming aware that a foot injury has occurred
-improper footwear and injury stepping of objects while barefoot are common causes of undetected foot injury

68
Q

how can a pt avoid foot injury?

A
  • practice skin and nail care

- inspect the foot thoroughly each day, and treat small problems promptly

nurse 251 (14 decks)

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