Diabetes and Nutrition Flashcards
1
Q
What is the age onset for Type I and Type II diabetes?
A
Type 1: more common in younger people
Type 2: more common in adults, but is becoming more common in children too
2
Q
What is the type of onset for Type I and Type II diabetes?
A
Type 1: signs and symptoms are usually abrupt, disease process may be present for several years
Type 2: Gradual, may go undiagnosed for several years
3
Q
Is Type I or Type II diabetes more prevalent?
A
Type 2
4
Q
Status of endogenous insulin in Type I and Type II diabetes?
A
Type 1: Absent
Type 2: Initially increased in response to insulin resistance but secretion decreases over time
5
Q
Status of islet cell antibodies in Type I and Type II diabetes?
A
Type 1: Often present at onset
Type 2: Absent
6
Q
What are the symptoms of Type I diabetes?
A
Type 1: polydipsia, polyuria, polyphagia, fatigue, weight loss without trying
7
Q
What are the symptoms of Type II diabetes
A
Type 2: (sometimes there is none) fatigue, recurrent infections, may also have polydipsia, polyphagia, and polyuria
8
Q
Ketosis presence for Type I and Type II diabetes?
A
Type 1: Present at onset or during insulin deficiency
Type 2: Not present except for infection and stress
9
Q
What is the typical nutritional status for Type I and Type II diabetes?
A
Type 1: can be thin, normal, or obese
Type 2: often overweight or obese but can be normal
10
Q
What happens to beta cells in type I diabetes?
A
Autoimmune destruction
11
Q
What happens to beta cells in type 2 diabetes?
A
There is defective secretion of insulin, eventually is leads to exhaustion of the beta cells
12
Q
Does type 1 or type 2 diabetes increase glucagon secretion?
A
Type 2
13
Q
Where are beta cells found in the body? (related to diabetes)
A
Pancreas
14
Q
What are examples of rapid acting insulin?
A
Humalog (lispro)
Novolog (aspart)
Apidra (glulisine)
15
Q
What is the onset, peak, and duration of rapid acting insulin?
A
Onset: 15 minutes
Peak: 1 hours
Duration: 2-4 hours
16
Q
What are examples of short acting insulin?
A
Regular (Humulin R, Novolin R)
17
Q
What is the onset, peak, and duration of short acting insulin?
A
Onset: 30 minutes - 1 hour
Peak: 2 - 6 hours
Duration 3-8 hours
18
Q
What are examples of intermediate acting insulin?
A
NPH (Humulin N, Novolin N)
19
Q
What is the onset, peak, and duration of intermediate insulin?
A
Onset: 2 - 4 hours
Peak 4- 10 hours
Duration: 10-20 hours
20
Q
What are examples of long acting insulin?
A
Glargine (lantus), detemir (levemir), degludec (tresiba)
21
Q
What is the onset, peak, and duration of long acting insulin?
A
Onset: 70 minutes
Peak: less defined / no specific peak
Duration: 24 hours
22
Q
Which insulins when you look at them in their vial are not clear?
A
NPH, lispro protamine, and aspart protamine.
23
Q
When is the most ideal time for a diabetic patient to work out?
A
After meals when blood glucose is rising.
24
Q
Diabetics should monitor their blood glucose levels ______, _______, and ________ working out.
A
Before, during, and after
25
Before exercise, if blood glucose levels are <100 what does the patient need to do?
Eat a 15 g carbohydrate snack, wait 15-30 minutes and retest
26
Before exercise, if blood glucose is >250 for a type 1 diabetic and ketones are present what does the patient need to do?
Delay exercise until ketones are gone
27
When should screening begin for diabetes?
If patients are overweight (BMI > 25) and have additional risk factors. If there are no risk factors/overweight - screening begins at 45.
28
What are some risk factors for diabetes? (7)
Family hx, physical inactivity, specific ethnic backgrounds (hispanic, native American, black, asian, pacific islander), women who delivered heavy babies or had gestational diabetes, have hypertension (or are on an antihypertensive therapy), HDL <35, TG >250
29
How might hyperglycemia manifest?
High blood glucose level, increase in urination and appetite (followed by a lack of appetite), weakness, blurred vision, headache, glycosuria, N/V, abdominal cramps, mood swings
30
How might hypoglycemia manifest?
Blood glucose <70, cold/clammy, numbness of fingers/toes, tachycardia, emotional changes, headache, nervousness, tremors, faintness, dizziness, hunger, changes in vision, seizures
31
If a glucose level is < 70, what is the rule of 15s?
Take 15 g of simple carbohydrates, recheck in 15 minutes. If still less than 70, repeat. If no change after 2-3 tries, contact HCP.
32
The 2015-2020 dietary guidelines for Americans recommends what in relation to sugar / sweeteners?
Limit added sugar / sweeteners so that it is less than 10% of calories.
33
The 2015-2020 dietary guidelines for Americans recommends what in relation to fats?
Limit saturated and trans fats, consume less than 10% of calories per day from saturated fats.
34
In respect to cultures that believe in hot, cold, wet, and dry foods having different properties, what do cold and hot foods represent?
Hot: warmth, strength, reassurance
Cold: menacing, weak
35
What are the 3 types of causes of dysphagia?
Myogenic, neurogenic, and obstructive
36
When tube feeding a patient should you dilute with water? Why?
No, it has an increased risk of bacterial contamination
37
A complication from tube feeding can be diarrhea, what are some potential causes for this?
Cause: hyperosmolar formulas or medications, antibiotic therapies, bacterial contamination, or malabsorption
38
Define insulin resistance:
Condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both
39
What is polydipsia?
Excessive thirst
40
What is polyuria?
Frequent urination
41
What is polyphagia?
Excessive hunger
42
What is non-proliferative retinopathy?
Partial occlusion of the small blood vessels in the retina that causes micro-aneurysms to develop in the capillary walls -> can eventually cause retinal edema and/or intraretinal hemorrhaging
43
What is proliferative retinopathy?
When retinal capillaries become occluded, the body compensates by forming new blood vessels to supply the retina with blood -> these vessels hemorrhage easily -> if there is a tear, retinal detachment will occur
44
What are 4 non-modifiable risk factors for type 2 diabetes?
Family hx of diabetes
Age over 45 years
Race/ethnicity
History of gestational diabetes
45
What are 4 modifiable risk factors for type 2 diabetes?
Physical inactivity
High body fat or body weight
High blood pressure
High cholesterol
46
What is a normal fasting blood glucose level?
< 126
47
What is a normal casual blood glucose level?
< 200
48
What level of urine ketones considered an emergency?
>300
49
What is the oral glucose tolerance test used for?
Testing for gestational diabetes
50
During the oral glucose tolerance test what should the blood glucose be at fasting, at hour 1, and at hour 3?
Fasting: ~110
1 hour: ~180
3 hours: ~140
51
What is a normal glycosylated hemoglobin?
About 5%
52
What A1C is considered pre-diabetic?
5.7 - 6.4 %
53
What A1C is considered diabetic?
6.5% +
54
What fasting glucose level indicates diabetes?
126 +
55
What is the criteria to be considered diabetic?
At least one of:
A1c > 6.5%
Fasting glucose levels > 126
OGTT 12 hour test = 200
Classic symptoms of hyperglycemia - 3 P's or unexplained weight loss
56
How do you test for type 1 diabetes?
Islet cell autoantibody testing
57
What 2 dietary modifications can someone who has pre-diabetes follow to help?
Avoiding sugary foods and monitor carbohydrate intake
58
How do IV or oral steroids impact blood sugar?
Makes blood sugar rise dramatically
59
If a diabetic patient is sick - what is the concern?
Sickness causes the body stress, which causes the body to release more glucose - so may have to check blood glucose more often.
Prone to go into ketoacidosis when sick
60
When should a diabetic patient call the HCP?
Urine is positive for ketones
BG > 250
Fever > 101.5 not responding to Tylenol
Feeling confused, rapid breathing, disoriented
Persistent nausea, vomiting, diarrhea
Inability to tolerate liquids
Illness lasting longer than 2 days
61
Before you give any insulin - EVER - what do you check?
You have to check the blood glucose level.
62
What blood glucose level is hypoglycemic?
Less than 70
63
What are signs and symptoms of hypoglycemia? (10)
Sweating, blurry vision, dizziness, anxiety, hunger, irritability, shakiness, tachycardia, headache, weakness/fatigue
64
What are 3 specific examples of a 15 g simple carb "snack" for low blood sugar?
4-6 oz of orange juice, a regular soda, or 3 glucose tablets.
65
What are 4 potential causes of hyperglycemia?
Illness, infection, self-management issues (with controlling sugar), and stress
66
How does hyperglycemia manifest?
Weakness, fatigue, blurry vision, headache, N/V/D
67
What are 4 potential treatments / interventions for hyperglycemia?
Check for ketones, use insulin correctly, drink fluids to prevent dehydration, and educate on prevention
68
How often do patients with an insulin pump need to check their blood glucose levels?
At least 4 times a day
69
What are 3 problems specifically of insulin pumps?
Infection at insertion site, increased risk of DKA is pump malfunctions, and cost
70
Women who have diabetes have a ________ times risk of CVD.
4-6
71
Men who have diabetes have a ________ times risk of CVD.
2-3
72
What are two complications from long term hyperglycemia?
Macrovascular complications (damage to large vessels)
Microvascular (damage to capillaries like retina, kidneys, and nerves)
73
What are the major concerns with diabetic patients who have neuropathy?
They have a loss of protective sensation so they may not feel injuries to their feed and those can become injected or non-healing.
74
How often should diabetic patients inspect their feet?
Daily.
75
What are the nutrition considerations for diabetic patients?
Balanced, high fiber, low fat, and low cholesterol
76
Are diabetic dermopathy and acanthosis nigricans life threatening?
No,, but the patient should be educated about it.
77
What are the 3 functions of the GI system?
Transportation, digestion, and absorption
78
Why is good nutrition important to health? (3)
Helps reach and maintain a healthy weight
Reduces the risk of chronic diseases
Promotes overall health
79
What types of things are patients who are malnourished at an increased risk for developing?
Dysrhythmias, skin break down, sepsis, hemorrhage, increased length of hospital stay, delayed healing
80
What are some environmental factors that influence nutrition (5)
Income, education levels, physical function level, transportation, availability of foods
81
What are some factors influencing nutrition? (7)
Appetite, negative experiences, medications, disease/illness, environmental factors, developmental needs, and alternative food patterns (cultural, religion)
82
How different is the vitamin/mineral need for older adults compared to younger adults?
Not different, it is the same.
83
What are 3 examples of standardized tools that help assess nutritional status?
Subjective global assessment, mini-nutritional assessment, and malnutrition screening tool
84
What is anthropometry? What does it include?
The study of measurements and proportions of the human body. Includes things like height, weight, BMI, skin fold measure, fat %
85
What is the normal range for total protein?
6.4-8.3 g/dL
86
What is the normal range for albumin?
3.5-5 g/dL
87
What is the normal range for prealbumin?
15-36 mg mg/dL
88
What is the normal range for hemoglobin for males and females?
Male: 14-18 g/dL
Female: 12-16 g/dL
89
Is prealbumin or albumin better at indicating chronic illness?
Albumin
90
is prealbumin or albumin better at indicating acute illness?
Prealbumin
91
Does albumin or prealbumin have a longer half life - what is it?
Albumin has longer half life - 21 days. Compared to prealbumin's half-life of 2 days.
92
What is hemoglobin responsible for?
Transporting oxygen
93
With malnutrition, a person's general appearance will be:
Fatigued, apathetic affect, sagging shoulders, sunken chest, and/or a humped back
94
With malnutrition, a person's weight status may be:
Obese, overweight, or underweight
95
With malnutrition, a person's neuro status may be:
Inattentive, irritable, confused, and/or have decreased reflexes
96
With malnutrition, a person's cardio status may:
Still show stable vital signs
97
With malnutrition, a person's GI system may show:
Anorexia, indigestion, constipation, diarrhea, n/v
98
With malnutrition, a person's musculoskeletal system may be:
Weak, have poor tone, have a wasted appearance, be bowlegged, and/or have visible ribs
99
With malnutrition, a person's nails may be:
Spoon shaped, brittle
100
With malnutrition, a person's hair may be:
Stringy, dull, brittle, dry
101
With malnutrition, a person's face and neck may be:
Swollen, have dark circles under eyes
102
With malnutrition, a person's eyes may show:
Pale conjunctiva or be dry
103
With malnutrition, a person's lips may be:
Red, swollen, dry
104
What does it mean for someone to tolerate a diet?
No nausea, vomiting, and bowel sounds present
105
What is a typical diet progression starting from clear liquids?
Clear liquid -> full liquid -> low residue -> regular
106
What is a regular diet?
No restrictions, regular consistency
107
What is included in the modified texture diets?
Mechanical soft, pureed (soft like pudding), minced (finely chopped), ground, chopped (bigger chunks but still chopped)
108
When would a patient be on a clear liquid diet?
If they are going for a procedure or if they are having digestion problems
109
What are some examples of clear liquids?
Juices (apple, grapefruit), broth, sports drinks, jello, black coffee
110
What is included with full liquid diets?
Everything from clear liquid + more juices, soup, and milk
111
When would a patient be placed on a fluid restriction diet?
When they are retaining too much fluid (HF)
112
What are the levels of modified consistency liquids?
Thin -> nectar -> spoon -> honey thickened
113
When would someone need a modified consistency liquid?
If they have dysphagia
114
What is a consistent carb diet? What is this also called?
Balances carbs, fats, and proteins. Diabetic diet
115
What is a cardiac diet?
Low salt, low cholesterol, low saturated fats
116
Who would use a low residue diet?
Those with ulcerative colitis or Chron's disease
117
What is a low residue diet?
Low roughage and limiting dairy
118
A high fiber diet can improve what?
Cholesterol
119
A gluten free diet benefits who? Why?
Those with celiac disease or a gluten intolerance. Gluten is the protein found in wheat, barely, and rye
120
Why would someone be on a bland diet?
To avoid irritation / decrease peristalsis in the GI tract
121
Being NPO for more than _________ days increases the possibility of a nutritional risk.
5-7
122
What is anorexia?
Lack or loss of appetite
123
What are some potential causes for anorexia?
Pain, fatigue, medication, SOA
124
What are potential ways to help a patient experiencing anorexia?
Treating the cause
Trying to stimulate appetite
Creating a conductive environment
Smaller, more frequent meals
allow food preferences
Seasoning
Oral care
Comfort
125
What are some of the warning signs of dysphagia?
Drooling, problems with regurgitation
126
What are potential causes for dysphagia?
Some muscle related or neuro related problem
127
What is silent aspiration and why is it a problem?
Food/water getting into lungs and not being coughed out (or no cough reflex present at all) - we don't know that the patient has aspirated. This is a problem because it could lead to PNA
128
What are complications of dysphagia?
Aspiration related PNA, dehydration, malnutrition, weight loss
129
What can we do as nurses to help dysphagic patients?
Sit in high fowlers, allow for time in between bites, check for oral pocketing, providing oral care, have suction ready, tucking chin, minimize distractions
130
What is considered in intake and output (what counts)?
Input - oral intake, IV fluids, blood products, feeding tubes feedings, flushes
Output - urine, bowel movement, emesis, drainage
131
What are the indiciations of enteral nutrition?
Prolonged anorexia, severe protein-energy malnutrition, coma, impaired swallowing, critical illness
132
What are the benefits of enteral nutrition?
Reduce sepsis, decrease hospital mortality, maintains intestinal structure function
