Diabetes Care Plan

Question 1

In hospital blood glucose target range

Answer 1

5-10 mmol/L

Question 2

If clinicians fail to recognize adn treat hyperglycemia appropriately patients with diabetes are at risk for

Answer 2

-delayed wound healing
-surgical site infections
-hospital acquired infections
-mortality

Question 3

1 in 5 patients in hospital have diabetes, what is the percentage of type 1 vs type 2

Answer 3

Type 2 - 90%

Type 1 - 10%

Question 4

Hyperglycemia is defined as

Answer 4

Blood glucose levels above 10 mmol/L

Question 5

What is BBIT

Answer 5

B- basal insulin
B- bonus insulin
I- insulin correction
T- titrate

Question 6

Basal insulin

Answer 6

Covers the glucose, the liver makes around the clock

Question 7

Bonus insulin

Answer 7

Covers the meal time carbohydrates

Question 8

Insulin correction

Answer 8

Corrects the patients BG back into target range if it is high

Question 9

Titrate

Answer 9

Every patient is different, the BG needs to be checked regularly and insulin doses adjusted every 1-3 days

Question 10

Pancreas in normal physiology

Answer 10

Produces enzymes that digests fats, proteins, and carbohydrates in the food that is consumed

Question 11

Pancreas endocrine function

Answer 11

Produces hormone: insulin (beta cells) and glucagon (alpha cells)

Question 12

Beta cells

Answer 12

Sense glucose levels in the blood when BG rises
-secret insulin and inhibit glucagon

Question 13

Alpha cells

Answer 13

Detect when BG is low
-insulin is inhibited, glucagon is secreted

Question 14

Insulin

Answer 14

Helps cells in our body to take up glucose to be used for energy, or store excess glucose in form of glycogen

Question 15

Glucagon

Answer 15

Increases amount of glucose in bloodstream
-stimulates liver to produce glucose
-breakdown of glycogen into glucose

Question 16

Type 1 diabetes mellitus is caused by

Answer 16

Caused by destruction of insulin producing beta cells, from autoimmune process

Question 17

Type 1 DM pancreas

Answer 17

Produces very little or no insulin since beta cells are destroyed
-so blood glucose rises

Question 18

What happens in type 1 DM when body cannot break down glucose as an energy source?

Answer 18

The body breaks down fat, and produces ketones which are very acidic

Question 19

High levels of ketones can lead to

Answer 19

Diabetic ketoacidosis

Question 20

What do people with T1DM need to survive

Answer 20

-basal bonus insulin regimen

Question 21

People with T1DM tend to be less

Answer 21

Insulin resistant

Question 22

People with T1DM have a higher risk of

Answer 22

Developing severe hypoglycaemia

-where beta cells no longer work in conjunction with alpha cells that produce glucagon

Question 23

Symptoms of hyperglycemia in T1DM

Answer 23

-fatigue
-frequent urination
-dehydration
-thirst
-weight loss despite hunger

Question 24

T2DM is a

Answer 24

Progressive chronic disease

Question 25

T2DM pancreas

Answer 25

The pancreas produces some insulin, but cells in the body fail tor respond to the insulin properly -insulin resistance

Question 26

T2DM insulin resistance

Answer 26

Pancreas often cannot produce enough insulin to overcome this resistance without treatment

Question 27

T2DM have a lower risk of

Answer 27

Severe hypoglycaemia -since the pancreas is still able to make glucagon

Question 28

What is different from T1DM hyperglycemia and T2DM hyperglycemia

Answer 28

Many people may be asymptomatic

Question 29

Initially when diagnosed with T2DM what is an important part of treatment?

Answer 29

Diet and exercise

Question 30

Basal insulin

Answer 30

Serves to suppress glucose and ketone production in periods of fasting -relatively constant

Question 31

Basal insulin is produced by

Answer 31

Liver and to a lesser extent the kidneys

Question 32

Bolus insulin

Answer 32

After meals, insulin levels rise above the basal level in response to the increase in blood glucose from ingested and absorbed carbohydrate

Question 33

What is the 50/50 rule

Answer 33

Basal insulin accounts for about 50% of the total daily insulin secretion and remaining 50% is secreted as bolus insulin

Question 34

How often is basal insulin ordered to cover needs, and how long does the insulin act

Answer 34

Once or twice daily, and is a long/intermediate acting insulin

Question 35

Patients with __

Answer 35

May require basal insulin

Question 36

Bolus meal insulin length of action and when is it given

Answer 36

-short acting insulin -given prior to meals

Question 37

Correction insulin length, and when is it given

Answer 37

-rapid, short acting insulin -given to correct unanticipated hyperglycemia

Question 38

Correction insulin ensures

Answer 38

High glucose values are not left untreated

Question 39

Goal of basal

Answer 39

Replace the background insulin the body naturally makes with basal long acting insulin

Question 40

Goal of bolus

Answer 40

To replace natural mealtime insulin with bolus short acting insulin to cover carb intake

Question 41

Rapid acting insulin analogues (2)

Answer 41

Aspart and lisp r o

Question 42

Onset of aspart/lispro

Answer 42

Aspart - 10 to 15min Lispro - 10 to 15min

Question 43

Peak of aspart and lispro

Answer 43

Aspart - 1 to 1.5h Lispro - 1 to 2h

Question 44

Duration of aspart and lispro

Answer 44

Aspart - 3 to 5h Lispro - 3.5 to 4.75h

Question 45

Short acting bolus insulin (1)

Answer 45

Regular

Question 46

Onset of regular

Answer 46

30min

Question 47

Peak of regular

Answer 47

2 to 3h

Question 48

Duration of regular

Answer 48

6.5h

Question 49

Basal intermediate acting insulin (1)

Answer 49

NPH

Question 50

Onset of NPH

Answer 50

1 to 3h

Question 51

Peak of NPH

Answer 51

5 to 8h

Question 52

Duration of NPH

Answer 52

Up to 18h

Question 53

Long lasting basal insulin (2)

Answer 53

Detemir and glargine

Question 54

Onset of detemir and glargine

Answer 54

Detemir - 90min Glargine - 90min

Question 55

Peak of detemir and glargine

Answer 55

Detemir - not applicable Glargine - not applicable

Question 56

Duration of detemir and glargine

Answer 56

Detemir - 16 to 24h Glargine - 24h

Question 57

What color are long acting basal insulin

Answer 57

Clear

Question 58

What color is Intermediate acting insulin

Answer 58

Cloudy

Question 59

What color is bolus rapid acting insulin

Answer 59

Clear

Question 60

What color is Bolus short acting insulin

Answer 60

Clear

Question 61

Bolus can be

Answer 61

Rapid acting or short acting

Question 62

Basal can be

Answer 62

Intermediate acting or long acting