Diabetes- EXAM 2 Flashcards
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
Risk factors to Type 1 DM
Genetic
Occurs to younger population
Thin and unnourished
Manifistations of Type 1 DM
Polyuria, polydipsia, Polyphagia= frequent thirst, urination, hunger
Fatigue
Sudden vision changes
Tingling or numbness of feet
Recurrent infection
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
Type 1 DM managment
Insulin
Type 2 managment
Oral Hypoglycemic agents
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
Type 2 DM risks
Obesity, Diet, Genetic components, pre diabetic diagnosis
Type 2 DM manifestations
reoccurring infection
Reoccurring heat infection
Prolonged wound healing
Vision changes
Fatigue
Prediabetic lab levels
A1C and FBG
5.7% or higher
FBG: 100 to 125 mg/dL or higher
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
Short acting Insulin and duration
Regular, Clear
5-8 hour duration, onset in 30-60 min
Before meals
Intermediate Acting Insulin and duration
NPH, cloudy
20-24 hours, onset in 1-2 hours
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
Gestational DM
Develops during pregnancy from stress, pre-existing DM, altered metabolism due to hormones
Increases risk for C-section
Hydramnios
Increased amniotic fluid may be result of increased fluid urination due to fetal hyperglycemia
Preclampsia
eclampsia occurs especially when vascular changes are present
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
High risk factors for gestational DM
Previous history of GDM
Previously elevated BG
Over 40 years old
Previous macrosomia
Taking antiphycosis and corticosteroid use
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
