Diabetes- EXAM 2 Flashcards by El S

Type 1 DM

Characterized by hyperglycemia
Lack of insulin into the cells, body doesn’t produce it; genetic—-> NEED INSULIN
Usually onsets in childhood and adolescents
Genetic predisposition and viral exposure

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Risk factors to Type 1 DM

Genetic
Occurs to younger population
Thin and unnourished

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Manifistations of Type 1 DM

Polyuria, polydipsia, Polyphagia= frequent thirst, urination, hunger
Fatigue
Sudden vision changes
Tingling or numbness of feet
Recurrent infection

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Diagnostic tests to determine Type 1 DM

Fasting plasma glucose test: Over 100 is preDM
Over 126 is DM
Hemoglobin A1C, above 5.7 is DM
Urinalysis for ketones and glycosuria
Urine for protein dipstick

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Type 1 DM managment

Insulin

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Type 2 managment

Oral Hypoglycemic agents

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Type 2 DM

90-95%—-> You are the problem
Pancrease produces insulin but the body doesn’t take it, insulin resistence. Too much insulin.
Glucose hangs out in the body

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Type 2 DM risks

Obesity, Diet, Genetic components, pre diabetic diagnosis

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Type 2 DM manifestations

reoccurring infection
Reoccurring heat infection
Prolonged wound healing
Vision changes
Fatigue

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Prediabetic lab levels
A1C and FBG

5.7% or higher
FBG: 100 to 125 mg/dL or higher

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Rapid acting insulin and duration

Lispro, Aspart and Glulisine
3-5 hour duration, Onset is 15 min
Same time as you eat
Think move your Ass, Let’s go, Glue dries fast

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Short acting Insulin and duration

Regular, Clear
5-8 hour duration, onset in 30-60 min
Before meals

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Intermediate Acting Insulin and duration

NPH, cloudy
20-24 hours, onset in 1-2 hours

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Type 2 DM managment meds

Metformin is the initial drug of choice but Glipizide swell
M:causes N,V,D, CNS symptoms too, Palpitations and chest discomfort
G: taken 30 min before breakfast, causes: nervousness, anxiety, depression, dizziness and insomnia

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Gestational DM

Develops during pregnancy from stress, pre-existing DM, altered metabolism due to hormones
Increases risk for C-section

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Hydramnios

Increased amniotic fluid may be result of increased fluid urination due to fetal hyperglycemia

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Preclampsia

eclampsia occurs especially when vascular changes are present

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Hyperglycemia & SS

HOT AND DRY, SUGAR IS HIGH
Sugar above 100
Increased stress=increased glucose
Skipping or not using enough insulin
Increased hunger/thirst/ urination

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High risk factors for gestational DM

Previous history of GDM
Previously elevated BG
Over 40 years old
Previous macrosomia
Taking antiphycosis and corticosteroid use

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Tests done to fetal status of GDM

AFP protein done at 16-20 weeks
Monitor fetal activity at 28 weeks
Ultrasound is done at 18 weeks to determine anomalies

Diabetic ketoacidosis
DKA

Associated with Type 1DM
Life threatening, Body produces too many ketones
Insulin deficit, depletion of potassium
Can be triggered by infection, inadequate insulin and CVD
Required immediate medical attention and fluid replacement due to polyuria and vomiting

DKA laboratory findings
Symptoms and considerations

BG of 250 or higher ( up to 800)
blood pH less then 7.30
Serum bicarbonate lower then 16

Dehydration, Lethargy, Polyuria, Blurred vision, Gastro symptoms, Acetone breath aka fruity, Hyperventilation

Hydrate first! D5W
Then slowly lower sugar, Monitor glucose levels

HHS & symptoms

Life threatening
Occurs in type 2 diabetics, When blood sugar levels are too high for long period of time; UNMANAGED DIABETES!!!! Sugar is above 600
Like DKA but without the ketones, there’s enough insulin circulating in the body to prevent DKA
Glucose gets into bloodstream and overflows the kidneys causing electrolyte depletion and extreme dehydration
Develops slower then DKA

Nursing managment of DKA and HHS

Monitor BG levels and ketones
Maintain fluid and electrolyte balance!!!
Increase patient knowledge about diabetes managment
Decrease anxiety
Monitor for fluid overload, hypokalemia and cerebral edema

Hypoglycemia & its causes

Cool & Clammy, give me some candy Overuse of glucose, BG less than 70mg/dL Too much insulin, too little food, delaying time of eating after insulin received or too much exercise

Hypoglycemia manifestations

Shakiness, Palpitations, Nervousness, Sweating, Diaphoresis, Anxiety, Hunger and Pallor Altered mental functioning, difficulty speaking, confusion and coma

Hypoglycemia treatment

Less then 70mg, begin treatment Rule of 15, consume 15g of simple carb Fruit juice, 4oz Recheck glucose level in 15 min Avoid food with fat, and overtreatment

Chronic complications to hypoglycemia

Microvascular and Macrovasculat problems Alterations in mood Increased susebtability to infections Complications involving feet

Microvascular

Damage to eyes, kidneys, nerves (retinopathy,nephropathy,neuropathy)

Macrovascular

Twice the risk for heart attack and stroke, peripheral vascular disease

Diabetic Retinopathy

Occlusion of small blood vessels in retina that causes micro aneurysms Can cause retinal displacement

Peripheral Neuropathy

Occurs when trauma or disease interrupts intervention of peripheral nerves Decreased blood flow on constricted areas Symptoms include numbness and muscle weakness

What neuropathy has no known causes

Idiopathic neruopathy

Peripheral neuropathy manifestations

Depends on the nerves involved and the amount of damage Patients will report aching, burning, feeling and report cold feet or hands

Guillain-Barre Syndrome

Patients report feeling as though they are wearing a glove or stocking and pain in the hands, feet and legs Will have weakness in arms and legs, clumsiness, difficulty walking and maintaining balance

Diagnostic tests for PN

CBC, Thyroid function tests, Serum levels for B12, Urine screening, Nerve biopsy

Diabetic complications involving the feet

Sense of touch and perception of pain are absent Most common trauma include: cracks, fissures from dry skin blisters, pressure, ingrown toenails Foot lesions begin as superficial skin ulcer and can go deeper to muscle,bone

Type 1 diabetes results from lack of? Oxytocin Cortisol insulin Endorphins

Insulin

Condition when the body has a problem using insulin it produces a) Insulin return b) Insulin remedv Insuln retired d) Insulin resistance

Insulan resistance

Which tasting glucose range is classitied as pre-diabetes! a) 60-100 mg/dl b) 50-95 mg/dl c) 100-125 mg/dI d) 50-80 mg/dl

100-125

Type1 diabetes IS characterized by

Hyperglycemia

Insulln Is released into the bloodstream In small amounts and larger amounts after food consumption ?

Yes

Hemoglobin A1c Is a measure or glucose levels tor the past 6 months 1 month 17 months 3 months

3 months

This insulin covers needs tor meals eaten within 30-60 minutes. NPH Regular LISpro Aspart

Regular

Diabetic ketoacidosis results in: severe dehydration Requires fluid replacement due to vomiting Depletion of serum potassium all of the above

All

Hypoglycemia can result from

delaying meals too much hypovolemic agent too much insulin

Ideopathy neuropathy cause

No known cause

Peripheral neuropathy can be due to Carpal tunnel alcohol abuse Untreated lyme disease All of the above

All