diabetes Flashcards
what are the 3 types of pancreatic cells and what do they produce? what percentage of the pancreas do they make up?
beta: insulin, 60%
alpha: glucagon, 30%
delta: somatostatin, 10%
what 3 hormones raise glucose levels?
glucagon
stress hormones (cortisol)
epinephrine
what 3 hormones lower glucose?
inslulin
amylin
gut hormones, incretins (GLP-1)
when is GLP-1 secreted and what are its effects?
- secreted upon ingestion of food
- increases beta cell response (enhances glucose-dependent insulin secretion)
- promotes satiety and reduces appetite
- on alpha cells: decreases postprandial glucagon secretion
- on liver: decreased glucagon reduces hepatic glucose output
- on stomach: helps regulate gastric emptying
what are some signs/symptoms of diabetes?
polyuria, polydipsia, polyphagia, weight loss, fatigue, infections, blurry vision, glycosuria, dehydration, osmotic changes
what is a normal FBG, random BG, and A1c for a normal person?
FBG <100
random <140
A1c <5.7%
what FBG, random BG, and A1c levels indicate a prediabetic person? what percent of their pancreas is functioning at this point?
FBG 100-125
random 140-199
A1c 5.7-6.4%
50% functioning pancreas
what FBG, random BG, and A1c indicate diabetes? what percent of the pancreas will be working?
FBG 126+
random 200+
A1c 6.5+
20% functioning pancreas
what does the A1c test measure? about how much glucose does 1% equal?
measures glycation of RBCs over 2-3 months which measures the average glucose in fasting and postprandial states
what causes type 1 diabetes?
autoimmune pancreatic beta cell destruction or viral triggers such as congenital rubella, cytamegalovirus, adenovirus, and mumps
will t1 diabetes pts need insulin therapy?
yes! always.
in what state do t1dm pts usually present in?
dka
at what age is t1dm most commonly diagnosed?
10-14
what antibodies are associated with t1dm?
GAD65
ICA
IAA
t1dm is associated with what other autoimmune conditions?
celiac disease, thyroid disease, addison’s disease, rheumatoid arthritis
what are some risk factors for type 2 diabetes?
first degree family member has it, habitual physical inactivity, prediabetes, hx of heart disease, htn, HDL <35, polycystic ovary syndrome, obesity
what is acanthrosis nigricans (AN)?
- patches of darkened skin over parts of body that bend or rub together (neck, knuckles, eblows)
- signal high insulin levels in bloodstream
- no cure, will go away w tx of insulin resistance
what is the “ominous octet” of t2dm?
- decreased satiation
- decreased b cell secretion
- increased glucagon secretion
- increased glucose production
- increased renal glucose reabsorption
- decreased gut hormones
- increased lipolysis
- decreased glucose uptake
compare the type of onset for t1dm and t2dm
t1: s/sx abrupt
t2: insidious, may go undiagnosed for years
compare the prevalence of t1dm and t2dm
t1: 5-10% of dm cases
t2: 90-95% of dm cases
compare the primary defect for t1dm and t2dm
t1: absent or minimal insulin production
t2: insulin resistance, decreased insulin production over time
what type of diabetes is most likely to cause dka?
type 1
what are some other diseases that diabetes is associated with?
fatty liver disease, sleep apnea, pancreatic/liver/breast cancer, alzheimer’s, depression
what is the prevalence of gestational diabetes?
seen in approx 7% of all pregnancies
what are some autonomic symptoms of hypoglycemia?
anxiety, palpitations, sweating, tingling, trembling, hypoglycemic unawareness
what are some neurological symptoms of hypoglycemia?
irritability, drowsiness, dizziness, blurred vision, difficulty with speech, confusion, feeling faint
if BG is less than 70, how should you treat? what about less than 40?
give 10-15g of carbs to raise BG 35-40 mg/dL, then retest in 15 min. if <40, allow for more recovery time.
what are some precipitating factors of DKA?
- illness and infection
- inadequate insulin dosage
- emotional stress
- often initial manifestation of t1
DKA is found in combination with what?
extreme hyperglycemia
excess stress hormones like glucagon, epinephrine, and cortisol do what?
render insulin less effective
DKA can cause…
osmotic diuresis, dehydration, electrolyte imbalances, acidosis
DKA signs and symptoms
- hyperglycemia
- GI: N/V, abd pain
- Kussmaul breathing
- hypothermia, acetone breath
- tachypnea
- changes in mentation
- dehydration
- orthostatic hypotension
what is hyperosmolar hyperglycemic state (HHS)?
massive fluid loss from osmotic diuresis
what is HHS often precipitated by? what causes it? does it cause acidosis? what population does it often occur in?
- often precipitated by illness or stress
- caused by extreme hyperglycemia (600+)
- does not cause acidosis
- occurs in elderly pts w t2dm that aren’t monitored closely
what are the most important interventions for DKA and HHS?
- fluids
- insulin
- e-lyte replacement
- determine/treat precipitating cause
- education to prevent in future
give some examples of rapid acting insulins. what is their onset, peak, and duration?
- ex: lispro (Humalog), aspart (Novolog), glulisine (Apidra)
- onset: 5-20 min
- peak: 30 min - 3 hr
- duration: 3-5 hr
give some examples of short acting insulins. what is their onset, peak, and duration?
- ex: regular, (Humulin R, Novolin R)
- onset: 30 min - 1hr
- peak: 2-3hr
- duration: 5-8 hr
give some examples of intermediate acting insulins. what is their onset, peak, and duration? what is their appearance?
- ex: NPH (Humulin N, Novolin N)
- onset: 2-4 hr
- peak: 4-10 hr
- duration: 10-16 hr
- a cloudy appearance is normal
give some examples of long acting insulins. what is their onset, peak, and duration? can they be mixed with others?
- ex: glargine (Lantus), detemir (Levemir), degludec (Tresiba)
- onset: 2-4 hr
- peak: no peak!
- duration: 24 hr ish
- Lantus and Levemir can’t be mixed
what two insulins are often mixed as combination therapy?
NPH and regular. always go clear to cloudy. often premixed.
give some examples of biguanide oral diabetes meds. what do they do? what are some side effects and considerations?
- ex: metformin (Glucophage), Riomet (liquid metformin)
- decrease hepatic glucose output
- first line med at dx of t2
- side effects: nausea, bloating, diarrhea, B12 deficiency
- to minimize GI side effects, use XR
- obtain GFR before starting
give some examples of sulfonylureas oral diabetes meds. what do they do? what are some side effects?
- ex: glyburide (Diabeta), glipizide (Glucotrol)
- stimulates sustained insulin release
- side effects: hypoglycemia, weight gain
give some examples of SGLT inhibitor oral diabetes meds. what do they do? what are some side effects and considerations?
aka “glucoretic”
- ex: canagliflozin (Invokana)
- decreases glucose reabsorption in the kidneys
- side effects: hypotension, UTIs, increased urination, genital infections, ketoacidosis
give some examples of DPP-4 inhibitor oral diabetes meds. what do they do? what are some side effects and considerations?
aka “incretin enhancers”
- ex: sitagliptin (Januvia)
- prolongs action of gut hormones
- increases insulin secretion
- delays gastic emptying
- side effects: headache, flu like symptoms
- can cause severe joint pain
the nurse teaches a patient recently diagnosed with t1dm about insulin admin. Which statement by the patient REQUIRES AN INTERVENTION by the nurse?
a) “i will discard any insulin bottle that is cloudy in appearance”
b) “the best injection site for insulin is the abdomen”
c) “i can wash the site with soap and water before insulin admin”
d) “i may keep my insulin at room temp for up to 1 mo”
a) “i will discard any insulin bottle that is cloudy”
intermediate insulin is normally cloudy.
Soap and water are adequate.
Insulin can be left at room temp for 1 mo.
Rotating sites is no longer recommended, just rotate areas within one site.
a pt with t2dm has a uti, is difficult to arouse, and has a bg of 642. when the nurse assesses the urine, there are no ketones. what nursing action is appropriate?
a) routine insulin therapy and exercise
b) admin a different abx
c) cardiac monitoring for K changes
d) admin IV fluids rapidly to correct dehydration
c) cardiac monitoring will be needed bc K changes r/t fluid and insulin therapy and osmotic diuresis
Will have to admin fluid but need to do it slowly bc this is an older pt.
which pt with t1dm would be at the highest risk for developing hypoglycemic unawareness?
a) a 58 yo pt w diabetic retinopathy
b) a 73 yo pt who takes propranolol
c) a 19 yo pt who is on the track team
d) a 24 yo pt w A1c of 8.9%
b) a 73 yo pt on propranolol
hypoglycemic unawareness is r/t autonomic neuropathy. Older pts and pts on B blockers are at risk.
the nurse is assigned to the care of a pt diagnosed with t2dm. in formulating a teaching plan that encourages the pt to actively participate in the management of diabetes, what should be the nurse’s initial intervention?
a) assess pts perception of what it means to have diabetes
b) ask the pt to write down current knowledge about diabetes
c) set goals for the pt to actively participate in managing his diabetes
d) assume responsibility for all pts care
a) assess pts perception of what it means to have diabetes.
this is the first step for effective teaching
the nurse has been teaching a pt with diabetes how to perform self monitoring of blood glucose. during evaluation of the pts technique, the nurse identifies a need for ADDITIONAL teaching when the pt does what?
a) chooses a puncture site in the center of the finger pad
b) washes hands with soap and water to cleanse the site to be used
c) warms the finger before puncturing
d) tells the nurse that the result of 110 indicates good control of diabetes
a) chooses a puncture site in the center of the finger pad
the pt should choose a site not on the center bc this area contains many nerve endings
